An Overview of Endometrial Cancer

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Endometrial cancer, the main type of uterine cancer, starts in the cells that make up the endometrium—the lining of the uterus that is built up and then shed each month in a menstruating woman if pregnancy doesn't occur. The disease is more common in women who have gone through menopause and while it's typically curable, factors such as the stage and effect of hormones on cancer can determine each individual's prognosis.

Symptoms

The most common symptom of endometrial cancer is unusual vaginal bleeding, either in between periods or a year or more after you've been through menopause. An abnormal discharge that's watery or bloody and pain during sexual intercourse are also symptoms. In later stages of the disease, you may experience pelvic pain, weight loss, and an ability to feel a mass in your pelvis.

If you have abnormal bleeding that's not related to your period or unusual discharge, it's important to have it evaluated by your doctor. Like any type of cancer, the earlier it's detected, the better your outcome will likely be. Many cases of endometrial cancer are diagnosed at early stages because the abnormal bleeding leads women to see their doctors.

Causes

No one knows exactly what causes endometrial cancer, but it occurs when normal cells mutate and multiply. As they accumulate, a tumor begins to form. The abnormal cells can then spread to other parts of the body. There are a number of different types of endometrial cancer, such as adenocarcinoma (the most common), squamous cell carcinoma, carcinosarcoma, small cell carcinoma, undifferentiated carcinoma, clear-cell carcinoma, and transitional carcinoma.

Risk factors for developing endometrial cancer include:

  • Obesity
  • Being past menopause
  • Menstruation that began before age 12
  • Never having been pregnant
  • High estrogen levels; changes in the balance of your hormones
  • Use of hormone replacement therapy with estrogen
  • Polycystic ovarian syndrome (PCOS)
  • Diabetes
  • A personal or family history of breast or ovarian cancer
  • Hereditary cancer syndromes such as Lynch syndrome (hereditary nonpolyposis colorectal cancer or HNPCC)

Diagnosis

Your doctor can find abnormalities in your uterus and cervix during a pelvic exam, as well as with a pelvic or transvaginal ultrasound. You may also have a hysteroscopy, in which a flexible, lighted tube is inserted into your uterus so your doctor can look around.

There are two procedures to diagnose endometrial cancer. The first is an endometrial biopsy. Your doctor will remove a few cells of the endometrium, usually in the office, to study them under a microscope and look for abnormalities of cell shape, structure, or growth. The second is a surgical procedure called a dilation and curettage (D&C). Under anesthesia, your cervix is dilated, and endometrial cells are extracted and evaluated in the same way.

If a cancer diagnosis is made, your doctor will probably order more tests to determine if cancer has spread outside of your uterus. These tests can include a computerized tomography (CT) scan, chest X-ray, positron emission tomography (PET) scan, and blood tests. The results of these tests will determine the staging of your cancer:

  • Stage 0: Cancer cells are found on the endometrium's surface layer and have not grown into other cell layers.
  • Stage I: The cancer is only in your uterus.
  • Stage II: The cancer is in your uterus and cervix.
  • Stage III: The cancer has spread beyond the uterus and may be in your pelvic lymph nodes and reaching to fallopian tubes and ovarian ligaments, but it hasn't gotten outside of your pelvic area.
  • Stage IV: The cancer has spread outside your pelvic area, possibly to your bladder, rectum, or other areas.

Treatment

If you're diagnosed with endometrial cancer, it's imperative to speak with a specialist as soon as possible. A number of treatments are available, and your doctor can help determine your best option. Treatments include:

  • Surgery: Your doctor may elect to remove your uterus, a procedure known as a hysterectomy. If the cancer has spread, he or she may need to remove other organs such as your fallopian tubes, ovaries, part of the vagina, or lymph nodes, depending on where the cancer is. Even if surgery is performed, your doctor may feel that chemotherapy or radiation treatment is necessary as well to prevent cancer from spreading.
  • Radiation: This type of therapy involves exposing cancer cells to high-energy radiation, either from a machine that sends external radiation toward the cancer tissue or with seeds, needles, or catheters that are placed internally and in direct contact with the cancerous tissue.
  • Chemotherapy: When this type of treatment is utilized, special chemicals are introduced into the body, either by mouth or intravenously, that directly kill the cancer cells. Sometimes chemotherapy can be placed into a body cavity or a more localized part of the body to better target cancer. Again, it's up to your doctor to determine which method will work best for you depending on the type of cancer you have.
  • Hormone therapy: If your cancer responds to hormonal stimulation, there are medications that can help prevent further growth of cancer. These may include medications to increase the amount of progesterone in your body or medications to decrease the amount of estrogen.

Prevention

You can't prevent endometrial cancer, but you can lower your risk of developing it by staying active, maintaining a healthy weight, eating a balanced diet, talking to your doctor about hormonal therapy, and making sure you get treated for any endometrial issues you're having.

It usually takes years for endometrial cancer to develop, and it often comes after lesser endometrial problems have started. If you have abnormal bleeding, be sure to see your doctor.

Taking birth control pills for at least a year has been shown to lower the risk of endometrial cancer. Using an intrauterine device (IUD) that doesn't contain hormones also seems to lower your risk, though this hasn't been researched on IUDs that release hormones. Talk to your doctor about the risks and benefits of using either of these types of contraception.

A Word From Verywell

Because the most common symptom of endometrial cancer is abnormal bleeding, a fairly obvious issue, many cases are caught in the early stages and the overall prognosis for this type of cancer is good. If you've been diagnosed, it's important to become your own advocate when it comes to your care. Ask your doctor lots of questions. Consider getting a second opinion. Take time to relax and unwind. Enlist the help of your family and friends, if needed. Educate yourself and your loved ones about what to expect. Most importantly, take one day at a time.

The #1 Symptom of Endometrial Cancer
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