Endometrial cancer

Symptoms

Unusual vaginal bleeding is the first sign of endometrial cancer. Extra attention should be given to the bleeding that is not associated with the menstrual period. Following are the key signs and symptoms of endometrial cancer that women need to look for:

Vaginal bleeding after menopause

Bleeding between periods

An abnormal, watery or blood-tinged discharge from your vagina

Pelvic pain

Pain during intercourse and urination

Causes

Several risk factors increase the risk of endometrial cancer. Obesity is considered the biggest risk factor. Below are the key risk factors that might increase a woman’s risk of developing endometrial cancer.

Obesity: Fatty tissue in women who are overweight produces additional oestrogen, a sex hormone that can increase the risk of uterine cancer.

Age: The risk of developing endometrial cancer increases with age. Uterine cancer most often occurs in women over 50. The average age at diagnosis is 60.

Genetics: Those with a family history of endometrial cancer are at a higher risk of developing the disease.

Diabetes: Women may have an increased risk of endometrial cancer if they have diabetes, which is often associated with obesity.

Other cancers: Women who have had breast cancer, colon cancer, or ovarian cancer may have an increased risk of endometrial cancer.

Radiation therapy in the past: Women who have undergone radiation therapy for another cancer in the pelvic area have an increased risk of endometrial cancer.

Diet/nutrition: Women who eat foods high in animal fat may have an increased risk of uterine cancer.

Hormone-related risks: Extended exposure to oestrogen and/or an imbalance of oestrogen increases the risk of endometrial cancer:

Women who started having their periods before age 12 and/or go through menopause later in life

Women who take hormone replacement therapy (HRT) after menopause, especially if they are taking oestrogen alone

Women who have never been pregnant

Diagnosis

Diagnostic tests used to detect and confirm endometrial cancers:

Pelvic examination: The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done for cervical cancer screening, is performed to check if there are any abnormal glandular cells, which are caused by endometrial cancer.

Endometrial biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. Endometrial biopsy is often a very accurate way to diagnose uterine cancer.

Dilation and curettage (D&C): A D&C is a procedure to remove tissue samples from the uterus. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure.

Imaging tests: Transvaginal ultrasound, CT scan and MRI scan are some of the imaging tests used to capture detailed images of the insides of the uterus. These images help in treatment planning, studying the treatment response and to check if cancer has recurred.

Treatment

Treatment for endometrial cancer is usually with surgery to remove the uterus, fallopian tubes and ovaries. Another option is radiation therapy with powerful energy. Drug treatments for endometrial cancer include chemotherapy with powerful drugs and hormone therapy to block hormones that cancer cells rely on. Other options might be targeted therapy with drugs that attack specific weaknesses in the cancer cells and immunotherapy to help your immune system fight cancer.

Surgery

Treatment for endometrial cancer usually involves an operation to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy makes it impossible for you to become pregnant in the future. Also, once your ovaries are removed, you’ll experience menopause, if you haven’t already. During surgery, your surgeon will also inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps determine your cancer’s stage.

Radiation therapy

Radiation therapy uses powerful energy beams, such as X-rays and protons, to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove.

If you aren’t healthy enough to undergo surgery, you may opt for radiation therapy only. Radiation therapy can involve:

• Radiation from a machine outside your body. During external beam radiation, you lie on a table while a machine directs radiation to specific points on your body.
• Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells. Chemotherapy is sometimes recommended after surgery if there’s an increased risk that the cancer might return. It can also be used before surgery to shrink the cancer so that it’s more likely to be removed completely during surgery. Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer that has spread beyond the uterus.

Hormone therapy

Hormone therapy involves taking medications to lower the hormone levels in the body. In response, cancer cells that rely on hormones to help them grow might die. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus.

Targeted drug therapy

Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy for treating advanced endometrial cancer.

Immunotherapy

Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body’s disease-fighting immune system might not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For endometrial cancer, immunotherapy might be considered if the cancer is advanced and other treatments haven’t helped.