Endometrial Cancer

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What is endometrial cancer?

The lining of the uterus is called the endometrium. Cancer of the endometrium, the most common cancer of the female reproductive organs, is a disease in which malignant (cancerous) cells are found in the endometrium. Endometrioid cancer is a specific type of endometrial cancer.

Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus. About 80 percent of all endometrial cancers are adenocarcinomas. Endometrial cancer is highly curable when found early. According to the American Cancer Society (ACS), about 42,160 cases of cancer of the uterine body will be diagnosed in the US during 2009.

What are risk factors for endometrial cancer?

The following have been suggested as risk factors for endometrial cancer:

• Early menarche - starting monthly periods early - before the age of 12

• Late menopause

• Infertility (inability to become pregnant)

• Never having children

• Obesity

• Being treated with tamoxifen for breast cancer

• Estrogen replacement therapy (ERT) for treatment of effects of menopause

• Diet high in animal fat

• Diabetes

• Increases as women get older

• Caucasian women

• Family history of endometrial cancer or colon cancer (hereditary nonpolyposis colon cancer (HNPCC)

• Personal history of breast cancer

• Personal history of ovarian cancer

• Prior radiation therapy for pelvic cancer

• Personal history of polycystic ovary syndrome (PCOS) or atypical endometrial hyperplasia

What are the symptoms of endometrial cancer?

Consult a physician if you experience any/all of the following symptoms:

• Bleeding or discharge not related to your periods (menstruation)

• Post-menopausal bleeding

• Difficult or painful urination

• Pain during intercourse

• Pain and/or mass in the pelvic area

• Weight loss

How can endometrial cancer be prevented?

The exact cause of endometrial cancer is not known, and there is no medical cure for it at this time. However, physicians believe that avoiding the known risk factors, when possible, using oral contraceptives, controlling obesity, and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

How is endometrial cancer diagnosed?

Diagnosis includes a medical history and physical exam, including a pelvic exam to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic exam. Several additional tests may be used to diagnose endometrial cancer, including:

• Internal pelvic examination - to feel for any lumps or changes in the shape of the uterus

• Pap test (Also called Pap smear.) - a test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation. However, because cancer of the endometrium begins inside the uterus, problems may not be detected using a Pap test. Therefore, in some cases, an endometrial biopsy will be performed.

• Endometrial biopsy - a procedure in which an endometrial tissue sample is obtained by using a small flexible tube that is inserted into the uterus. The tissue sample is examined under a microscope to determine if cancer or other abnormal cells are present. An endometrial biopsy procedure is often performed in a physician’s office.

• Dilation and curettage (Also called D & C.) - a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.

• Transvaginal ultrasound (Also called ultrasonography.) - an ultrasound test using a small instrument, called a transducer, that is placed in the vagina. The physician may perform a biopsy if the endometrium looks too thick.

Treatment for endometrial cancer:

Specific treatment for endometrial cancer will be determined by your physician(s) based on:

• Your overall health and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The choice of treatment depends on the stage of cancer - whether it is just in the endometrium, or has spread to other parts of the uterus or other parts of the body. Generally, treatment for patients with cancer of the endometrium includes one or more of the following:

• Surgery, including:

  • Hysterectomy - surgical removal of the uterus

  • Salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries

  • Pelvic lymph node dissection - removal of some lymph nodes from the pelvis

  • Laparoscopic lymph node sampling - lymph nodes are removed through a viewing tube called a laparoscope, which is inserted through a small incision in the abdomen

• Radiation therapy

• Chemotherapy

• Hormone therapy