Endometrial Cancer: Causes, Symptoms, Diagnosis, Treatment, Risks, Prevention

Mohd Sufyan   by Mohd Sufyan, BSME, MBA    Last updated on April 22, 2019,

endometrial cancer

 

 

Overview and definition of endometrial cancer: What is endometrial cancer?

Endometrial cancer is a type of cancer that develops in the cells of the inner lining of the uterus (called endometrium).  The cells in endometrium begin to grow in an uncontrolled manner. Endometrial cancer is sometimes called uterine cancer also. Other types of cancer can also develop in the uterus such as uterine sarcoma. But, these cancers are not as common as endometrial cancer.

Facts and important information about endometrial cancer

  • Endometrial cancer or endometrial neoplasm (malignant neoplasm of endometrium) is a cancer in which malignant cells develop in the tissues of endometrium in women.
  • Common signs of endometrial cancer are vaginal bleeding or pelvic pain.
  • Diagnosis of the endometrium aims to detect the cells in the lining of the uterus that might be cancerous. Pap tests don't always detect the endometrial cancer, and most women who get it have normal findings.
  • Obesity, having diabetes, and metabolic problems can increase the risk of endometrial cancer.
  • Tamoxifen that is used for breast cancer can increase the risk.
  • Going through menopause later than normal or having your first period at an extra young age can also increase the risk.
  • Use of estrogen hormones alone can also increase the risk of endometrial cancer.
  • One can develop endometrial cancer in any age, but it's most common when you are 45-74 years old.
  • The most important thing you can do to avoid endometrial cancer is to know the early warning signs.

What are uterus and endometrium?

The uterus is a hollow and muscular organ where a fetus grows and develops when a woman is pregnant. It is located in the pelvic region. It is normally about the size and shape of a medium-sized pear. A woman’s uterus has 2 main parts:

  • Cervix: It is the lower end of the uterus that extends into the vagina
  • Corpus: It is the upper part of the uterus and is also called the body of the uterus

Endometrium is the lining of the uterus. Cancer of the endometrium is different from the cancer of the muscle of the uterus (body of the uterus), which is called sarcoma of the uterus.

Types of cancers of the endometrium

Endometrial carcinomas or endometrial cancers can be classified into various types based on how the cells appear under a microscope view. These are such as:

  • Adenocarcinoma: Most cases of endometrial cancers are adenocarcinomas
  • Carcinosarcoma
  • Small cell carcinoma
  • Transitional carcinoma
  • Squamous cell carcinoma
  • Undifferentiated carcinoma

The most common of all adenocarcinoma is endometrioid cancer. There are many sub-types of endometrioid cancers, such as:

  • Adenocarcinoma
  • Ciliated carcinoma
  • Villoglandular adenocarcinoma
  • Adenoacanthoma
  • Adenosquamous
  • Secretory carcinoma

Causes of endometrial cancer: What causes endometrial cancer?

We do not know much about what exactly causes endometrial cancer. A lot of research is in progress to understand more about the disease.

Most cases of endometrial cancer cells contain estrogen and/or progesterone receptors on their surfaces. Therefore, scientists believe that interactions of these receptors with their hormones might be responsible for an uncontrolled growth of the endometrium cells leading to endometrial cancer.

The most common cause of endometrial cancer is too much of the hormone estrogen compared to the hormone progesterone in the body. This causes an imbalance in the hormones, which eventually causes the lining of the uterus to get thicker. If this continues, the cancer cells can grow out of control.

Women who have this hormone imbalance over time are more likely to develop endometrial cancer in later ages such as after they are 50 years.

Risk factors for endometrial cancer


It is important to know that having a risk factor for a disease does not mean that you will get it. If you are at an increased risk for endometrial cancer, it does not mean you will necessarily get it. Similarly, not having risk factors doesn't always mean that you will not get cancer. You must talk to your doctor if you think you may be at risk for endometrial cancer.

Some women with endometrial cancer do not have any known risk factors. Even if a woman has one or more risk factors, it is not possible to know exactly which of these factors might be responsible for the cancer.

Although the exact cause of endometrial cancers is unknown, there are certain risk factors that may increase the women to develop in. These may include such as women with endometrial overgrowth (hyperplasia), women who have never had children, obesity, menstruation at an early age, delay in menopause, estrogen therapy, using tamoxifen alone, radiation therapy for the pelvis, family history, Lynch syndrome (which is an inherited form of colorectal cancer).

Common and important risk factors are described herein:

Hormone factors

As mentioned above, hormone imbalances may disturb the normal growth of cells and might play a part in the development of endometrial cancers. In fact, most endometrial cancers occur due to a disturbance in their hormone balance. Many known risk factors for endometrial cancer cause a change in their estrogen levels.

Before a woman has menopause, ovaries produce two main types of female hormones called estrogen and progesterone. The balance between these two hormones changes during a woman's menstrual cycle each month. This keeps the endometrium of a woman healthy. A change in this balance of estrogen and progesterone (in which a shift occurs toward producing more estrogen) increases the risk of getting endometrial cancer.

After a woman has menopause, her ovaries stop making these hormones. However, her body still produces a small amount of estrogen in fat tissues. Estrogen from fat tissues has a bigger influence after menopause than before menopause.

Estrogen therapy

Menopausal hormone therapy also sometimes called hormone replacement therapy is also responsible to increase the risk of endometrial cancer. Estrogen is primarily used in this therapy, which can also cause an imbalance between the two hormones. Use of estrogen alone (without any progesterone) can cause type I endometrial cancer in women. In order to reduce this risk, progestin progesterone must be given along with estrogen in the therapy. This is called combination hormone therapy.

Women who do not take progesterone along to treat menopausal symptoms do not have an increased risk of endometrial cancer. But, doctors have found that taking this combination also increases a woman's chance of developing other cancers such as breast cancer and also increases the risk of other diseases.

There is enough epidemiologic evidence that postmenopausal estrogen therapy substantially increases the risk for endometrial cancer. According to a research, since 1970, more than 30 epidemiologic studies have documented the strong association between unopposed estrogen use and increased endometrial cancer risk. The risk is increased with an increase in the dosage of estrogen and duration of use. Women who use it for more than 10 years continuously have a 10-times increased risk of developing this cancer.

Menstrual cycles

The risk of endometrial cancer increases with having more menstrual cycles during lifetime. Starting menstrual periods at an early age (before age 12) and/or going through menopause later in life also increases the risk of endometrial cancer.

Birth control pills

Birth control pills such as oral contraceptives can reduce the risk of endometrial cancer. The risk is lowest in women who take the pill for a long time. The risk remains lower even several years after a woman stops taking these pills.

The more periods you've, the more exposure your endometrium has to estrogen.

Pregnancy

Women who have never been pregnant are at higher risk of endometrial cancer than those women who have had at least one pregnancy. This is because the hormonal balance shifts toward more progesterone during pregnancy. Therefore, having several pregnancies protects women against endometrial cancer.

Women who have had no pregnancy, especially if they were infertile (unable to become pregnant) also are even at higher risk of this cancer.

Tamoxifen

Tamoxifen is a drug used to prevent and treat breast cancer. It works as an anti-estrogen in breast tissue, but it acts as an estrogen in the uterus. The drug can cause the uterine lining to grow in some women, which can increase their risk of developing endometrial cancer. However, the risk of developing endometrial cancer from tamoxifen is low.

Your doctor will evaluate whether the harms with taking tamoxifen balances against the benefits of this drug in treating and preventing breast cancer. If you are taking tamoxifen, your doctor may recommend for regular tests and exams to make sure that any sign of endometrial cancer can be reported early on.

Ovarian tumors

Certain types of ovarian tumors make estrogen. Estrogen release by these tumors may not be controlled and can sometimes lead to higher levels of the estrogen. This may result in a hormonal imbalance and lead to endometrial cancer. Vaginal bleeding is a common sign of endometrial cancer in such tumors.

Obesity

Ovaries produce most of the estrogen in a woman’s body, but fat tissue can also convert some other hormones into estrogens. Fat tissue can increase a woman's estrogen levels, which eventually increases the risk of endometrial cancer. Women who are obese are thrice at risk for endometrial cancer as compared to women who maintain a healthy weight.

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) can cause abnormal hormone levels in women. The increase in estrogen compared to progesterone in women due to PCOS can put a woman at higher risk of getting endometrial cancer.

Intrauterine devices

Scientists believe that women who use an intrauterine device (IUD) for birth control are likely to be at lower risk of developing cancer of the endometrium.

Age

The risk of endometrial cancer increases with age.

Diet and exercise

A high-fat diet can increase the risk of cancers, including endometrial cancer. Fatty foods are high-calorie foods, which leads to obesity. Obesity is a commonly understood risk for endometrial cancer. Some researchers believe that fatty foods may have a direct influence on your estrogen levels, which is a major endometrial cancer risk factor.

Inherited colon cancer syndrome

Hereditary nonpolyposis colorectal cancer (HNPCC) increases the risk of colon cancer and other types of cancers, including endometrial cancer. HNPCC is caused by a gene mutation that is passed off from parents to children.

Other risk factors for endometrial cancer

  • Having metabolic syndrome
  • Having type 2 diabetes
  • Exposure of endometrial tissue to estrogen made by the body for various reasons
  • Having certain genetic conditions such as Lynch syndrome
  • Having endometrial hyperplasia
  • Having been diagnosed with breast cancer or ovarian cancer in the past
  • Treatment with radiation therapy to the pelvis

Prevention of endometrial cancer

Cancer prevention is thee action taken to lower the chances of developing cancer. Prevention measures can help reduce the number of new cases of cancer within a population group. This eventually lowers the number of deaths caused by the cancer every year.

Can Endometrial Cancer Be Prevented?

In most cases, the endometrial cancer cannot be prevented. However, there are ways to lower the risk of developing or spreading the cancer.

Scientists try to identify the risk factors to prevent the cancer from developing or spreading. Some risk factors can be avoided, but others cannot. Different risk factors contribute to different types of cancer. Research is being done to identify different ways of preventing endometrial and other types of cancers. Scientists are investigating what factors can increase your risk for this type of cancer.

Although there is no known way till date to completely prevent endometrial cancer, you may be able to reduce the risk by following these guidelines. Talk to your doctor for more information about your individual risk of endometrial cancer.

What are the ways to lower the risks and prevent endometrial cancer?

Get proper treatment for your endometrial problems

It is important to get proper treatment of pre-cancerous disorders of the endometrium. Most cases of endometrial cancers occur gradually over a period of several years. Many of them are easy to detect at an early pre-cancerous stage and usually start from less serious problems of the endometrium. One of the abnormalities that may contribute to the development of endometrial cancer is hyperplasia. Though the disease go away without treatment after some time, but it can sometime require more careful attention and treatment with hormone therapies or surgery such as hysterectomy. This can prevent the disease to become cancerous. Abnormal vaginal bleeding is a common symptom of endometrial pre-cancers and cancers, and it requires prompt evaluation and treatment.

Common symptoms of hyperplasia are heavy menstrual periods, bleeding between the periods, and bleeding after menopause.

Evaluate benefits and dangers of hormone therapy

Hormone therapies of estrogen are generally recommended to treat the symptoms of menopause through different forms such as pills, shots, creams, etc. You must ask your doctor about your risk of developing endometrial cancer as a result of the hormone therapy.

Progestins or drugs similar to it can help reduce the risk of endometrial cancer in women who take estrogen therapy. However, this combination therapy increases the risk of breast cancer, as found in some studies. Particularly, if you had not gone through hysterectomy and still have the uterus and are going through hormone (estrogen alone) therapy, you must evaluate the risks of developing various types of cancers with your doctor.

Exercises

Research shows that exercises and higher levels of physical activity lower your risk of getting endometrial cancer. It is to good engage in regular physical activity (such as exercise) to possibly prevent endometrial cancer.

An active lifestyle can help maintain a healthy weight and avoid problems such as high blood pressure and diabetes, which are some other risk factors for endometrial cancer.

Get proper treatment of hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome)

As discussed above, women who have hereditary nonpolyposis colon cancer (such as HNPCC or Lynch syndrome) are at an increased risk of endometrial cancer.

One of the ways to lower their risk of getting endometrial cancer is to remove the uterus through a process called hysterectomy. However, women who want to have children in future may not want to choose it.

Avoiding other risk factors and adapting to protective factors can help prevent endometrial cancer

Avoiding cancer risk factors discussed above may help prevent it. Increasing protective factors such as quitting smoking and increasing physical activity levels may also help prevent the cancer.

Protective factors that decrease the risk of endometrial cancer and help prevent it

The following protective factors decrease the risk of endometrial cancer:

Pregnancy and breast-feeding

Estrogen levels are lower in pregnancy and when breastfeeding. The risk of endometrial cancer is reduced with children, particularly, at an early age (before 30 years). Breastfeeding at an early age in women for about 2 years also decreases the risk of endometrial cancer.

Breast-feeding decreases ovulation and estrogen activity.

Combination oral contraceptives

Contraceptives that contain both estrogen and progestin decrease the risk of developing endometrial cancer. The more duration for they are consumed, the more are the benefits. In fact, their effects can last for many years even after a woman stops using them.

However, these contraceptives do have certain side effects such as being at higher risk of blood clots, stroke, and heart attack, especially for women who are older than 35 years. Therefore, you should discuss the pros and cons of these oral contraceptives with your doctor before you plan to use them regularly.

Diet

A diet that is low in saturated fats and high in fruits and vegetables may lower the risk of endometrial cancer. The risk may also be lowered when soy -based foods are a regular part of your diet. In some studies, however, fruits and vegetables are found to have no direct influence on the risk of developing endometrial cancer in women.

Cigarette smoking

If you are smoking 20 cigarettes a day, you are at lower risk of endometrial cancer. The risk of endometrial cancer is even lower in women who smoke after menopause. However, there are many other dangers of smoking, which does not justify smoking as a prevention measure for endometrial cancer. These disease could be severe and life-threatening in the long run such as:

Others factors that are not proven yet to influence the risk of endometrial cancer

  • Fruits, vegetables
  • Weight loss
  • Vitamins and multi-vitamins

REMEMBER: You have no risk for endometrial cancer if you have had your uterus removed (through a procedure called hysterectomy).

Clinical trials for cancer prevention are used to study how to prevent endometrial cancer (and other cancer types)

Cancer prevention clinical trials are used to find ways to reduce the risk of developing certain types of cancer such as endometrial cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who are at an increased risk for the cancer. Other prevention trials are done with people who have had cancer and are trying to prevent another cancer of the same type or to lower the risk of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for any type of cancer.

The objective of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

New ways for the prevention of endometrial cancer are being investigated in clinical trials

Clinical trials are taking place in many parts of the world. Information about clinical trials can be found in the Clinical Trials section of the websites of respective countries. You can check out NCI's list of cancer clinical trials for endometrial cancer prevention trials that are now accepting patients in the United States, for example. You can request for enrollment as a participant if you think you are a likely candidate and can benefit from it.

Early detection of endometrial cancer

Early detection of cancer means identifying for the cancer before a person has its symptoms. This can sometimes find the disease early, which can lead to early treatment. This improves the chance that treatment will work and the person’s life can be saved or improved.

Can Endometrial Cancer Be Found Early?

In most cases, identifying the signs and symptoms of endometrial cancer early and reporting them promptly to the doctor allows the cancer to be diagnosed at an early stage. Early detection of endometrial cancer improves the chances that the cancer will be treated early and successfully. However, not all cases of endometrial cancer can be detected early. Some types of endometrial cancers may progress to an advanced stage before any signs and symptoms are noticed by the patient.

If detected early and treated well on time, endometrial cancer provides a good prognosis. About 81 percent of women are likely to live five years after the diagnosis in such cases. Many of them can live much longer than this. But if the cancer returns and spreads after the treatment, it can be more dangerous.

What is endometrial cancer screening?

Screening for endometrial cancer is the method of looking for cancer before a person has any noticeable symptoms. This can help find the cancer at an early stage. When abnormal tissue or cancer is found early during screening tests, it may be easier to treat it better and on time. Otherwise, by the time symptoms appear, it’s already too late and cancer may have spread to other parts of the body.

Early detection allows the use of tests to find a disease such as cancer in people who do not have symptoms of that disease.

Scientists are trying to gather information that can help doctors recommend who should be screened for endometrial cancer and which screening tests, in particular cases, should be used and how often.

It is important to know that you may not necessarily have cancer if your doctor suggests a screening test for it. Screening tests are done when you have no cancer symptoms at all. They are considered a prevention strategy.

If a screening test result is abnormal, you may need to have more tests done to find out if you have the cancer. These are called diagnostic tests.

There is no single screening test for endometrial cancer that can completely detect the cancer. This means women should stay alert for the symptoms and follow the guideline of their doctors if they are at high risk of developing the cancer.

Tests for early detection or screening of endometrial cancer

Screening tests are procedures to prevent the disease. There are no routine tests used to screen for endometrial cancer, but if your doctor thinks you are at higher than average risk of endometrial cancer, he or she can check for it in the following ways:

Transvaginal ultrasound (TVU)

In this test, a probe is inserted into the vagina to generate images of the uterus. The probe sends out sound waves that echo off the walls of the uterus. These waves are translated into images. The inside of the uterus and changes in the thickness of the lining can be seen through this procedure. An ultrasound is generally used in the beginning to see if a biopsy is needed for ruling out other possibilities.

Pelvic ultrasound

A probe is moved over the skin of lower belly to get images of your uterus instead of in the vagina as done in transvaginal ultrasound. A gel is applied on the skin to slide the probe and get clear images. You may be asked for a full bladder before this test.

Endometrial sampling (Biopsy, Hysterescopy, Dilation and Curettage)

A sample of the cells is taken from the lining of the uterus. The procedure can be done in many ways. An endometrial biopsy is one of the methods. It uses a thin flexible tube that’s put through your vagina and cervix into the uterus. Cells are than removed through the tube.

A hysteroscopy is another procedure which allows your doctor see inside the uterus. It’s done with a small telescope kind of tool. The telescope is inserted into the vagina and the cervix. Tissues can be taken too. Polyps or other abnormal tissues can also be removed in this procedure. If the doctor determines to extract more cells, he or she may conduct a dilation and curettage (D&C) procedure.

In a dilation and curettage procedure, drugs may be introduced in the body to help you relax and sleep. A special tool is inserted through an opened (dilated) cervix. Your doctor will remove the lining of the uterus. Sampled of the cells may be taken which are investigated under a microscope for cancer.

Early detection (screening) according to different levels of risks for endometrial cancer

Women at an average risk for endometrial cancer

There are no screening tests or exams to find endometrial cancer early in case you are at an average endometrial cancer risk and experience no symptoms.

According to The American Cancer Society, at menopause, all women should be told about the risks and symptoms of endometrial cancer and strongly encouraged to report any vaginal bleeding, discharge, or spotting to their doctor.

Women should get regular pelvic exams, which can help detect some cancers. But these tests are not very effective in finding early endometrial cancers.

Pap test is a well known test to screen women for cervical cancer. It can occasionally find some early endometrial cancers, but it’s not a very good test for this type of cancer.

Women at increased endometrial cancer risk

According to The American Cancer Society, women who are at an increased risk of endometrial cancer should be informed of the risk and be asked to see their doctor whenever they notice any symptoms such as vaginal bleeding, abnormal discharge etc.

Women’s risk of endometrial cancer may be increased due to increasing age, late menopause, never had child birth, infertility, obesity, diabetes, high blood pressure (hypertension), estrogen therapy, or tamoxifen therapy etc.

Who may need screening for endometrial cancer?

Doctors recommend screening tests for the cancer if you are at more than average risk for cancer. Your healthcare provider may advise screening in these situations:

  • You may have genes with hereditary nonpolyposis colon cancer (HNPCC). Your doctor may ask if HNPCC runs in your family. You may have this gene if other types of cancer such as colon cancer, ovarian cancer, or uterine cancers run in your family.
  • You have known risk factors and are going through menopause stage.
  • You have pre-cancerous changes (such as hyperplasia) in the cells inside your uterus. These cells may turn into cancer.

According to The American Cancer Society, women who have or may have HNPCC must be offered yearly testing for endometrial cancer with endometrial biopsy beginning at age 35. Doctors should discuss this test, its risks, benefits, limitations with them. This is applicable for women who are known to carry HNPCC-linked gene mutations, women who are likely to carry such a mutation (those with a mutation known to be present in the family), and women from families with a tendency to get colon cancer where genetic testing has not been done.

A woman who have (or may have) HNPCC may be asked for a hysterectomy if she is not planning any children in future.

More research funding needed for endometrial cancer

The main treatment for endometrial cancer is a hysterectomy. It involves surgically removing the uterus of a woman. The fallopian tubes, ovaries, and some lymph nodes may also be taken out at the same time depending on the risk of spread of cancerous cells to the nearby areas.

A hysterectomy can be done through minimally invasive routes too. The uterus also can be taken out either robotically or laparoscopically in minimally invasive approaches.

Sometimes, further treatment may be needed such as radiation, hormonal, or chemotherapy etc.

There is a need for more funding of research and clinical trials to help provide better treatment for women whose endometrial cancer has returned.

Endometrial cancer’s mortality is increasing and the funding for it is relatively very low. There is a need for more research on this cancer and more clinical trials to fight this disease.

Signs and Symptoms of Endometrial Cancer

There are a few symptoms that may indicate the chances of endometrial cancer. Some of them are more common when the cancer is at a later stage.

Unusual heavy vaginal bleeding, spotting, or other abnormal discharge from vagina

Most women diagnosed with endometrial cancer experience abnormal vaginal bleeding. These may include changes in their menses or bleeding between periods or after menopause.

Such types of discharge or vaginal bleeding can occur in some non-cancerous conditions also, but it is important to be careful and rule out the possibilities of it being a cancer. You must speak to your doctor and have her look into the bleeding as early as possible.

If you have gone through menopause, it’s more important to report any vaginal bleeding, spotting, or abnormal discharge to your doctor, as this puts you at higher risk.

Other types of discharge without any blood may also be a sign of endometrial cancer. Even if you do not see any blood in the discharge, it does not mean there is no cancer. In some cases, the discharge due to endometrial cancer does not contain any blood. Any abnormal discharge should be reported to the doctor.

Pelvic pain, a mass, and weight loss

Pelvic pain, feeling of the presence of a mass (tumor), and unexpected weight loss can also be symptoms of endometrial cancer. These symptoms are more common in later stages of the cancer. But you must seek help if you suspect cancer before the disease progresses further. This lowers the chances of treatment being successful if the cancer is detected late.

Uncomfortable or Painful Urination and Intercourse

In the early to middle stages of endometrial cancer, you may find it difficult to empty your bladder or to control the muscles for urination. Urinating may be painful. You may also experience pain during sexual intercourse. If you experience any of these symptoms, you must consult your doctor.

Presence of Uterine Polyps

The presence of an abnormal mass in the pelvic cavity or any polyps in the uterine lining can be a sign of endometrial cancer. If your doctor suspects any such abnormalities, she may first conduct an ultrasound and then take samples of the tissue for further confirmation if it is a cancerous tissue or some other problem of the endometrium or uterus etc.

Low Blood Count and CA 125

The loss of blood from the uterine lining can cause anemia, which results in a decreased number of red blood cells. This may sometimes be a sign of endometrial cancer. The presence of CA 125 in the blood can also indicate endometrial or uterine cancer. CA 125 is a chemical that may be found in the blood in some cases of uterine or endometrial cancer. The higher the level of CA 125, the more likely is the chance of it to be a cancer and its spread.

A test called a complete blood count (CBC) can be done to determine if your red blood cells are lower than the normal range.

Other common signs and symptoms of endometrial cancer are

  • An abnormal, watery or bloody discharge from the vagina
  • bleeding between the periods
  • pain in the back, legs, or pelvis
  • loss of appetite
  • tiredness / fatigue
  • nausea or vomiting

When to seek medical advice for endometrial cancer

You should book an appointment with your doctor if you experience any signs or symptoms that worry you, such as vaginal bleeding or heavy or abnormal discharge not related to your periods, pelvic pain, or painful intercourse.

If you have unusual vaginal bleeding or abnormal discharge from vagina, it's important to get the cause of your symptoms find out by a doctor. The bleeding may occur because of other potentially serious health conditions, such as:

  • endometriosis – it is a disease of the lining of the womb
  • non-cancerous polyps in the womb lining
  • Other types of gynaecological cancer can also cause unusual vaginal bleeding, such as cervical cancer or uterus (womb) cancer.

Diagnosis of endometrial cancer

Tests and procedures to diagnose endometrial cancer are:

Physical or Pelvic examination

In a pelvic exam, the doctor observes the outer region of the genitals, and then inserts fingers into the vagina to feel your uterus and ovaries. She may also insert a device into the vagina to perform examination better. The device opens your vagina so that your doctor can view inside the vagina and cervix for any abnormal mass etc.

Endometrial biopsy

Biopsy involves removal of a small amount of tissue from the site for testing through a microscope. While other tests can suggest whether that cancer can be present or not, only biopsy can make a definite diagnosis of the cancer of any type. A pathologist will analyze the sample taken for biopsy.

The doctor will remove a small sample of tissue using a thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed. The process takes about a few minutes.

You may experience cramps and vaginal bleeding after the procedure is done. But this will go away soon. Your doctor may give some medicines to manage them. Endometrial biopsy is generally preferred to diagnose uterine cancer or endometrial cancer.

Dilation and Curettage (D&C)

 A D&C is a procedure that involves removal of tissue samples from the uterus lining. A woman is given anesthesia during the procedure. It is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. In a hysteroscopy, a thin, flexible tube is inserted through the cervix into the vagina and uterus. The sample taken from the site is checked for cancer.

Transvaginal ultrasound

An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina to obtain pictures from the uterus. If the endometrium looks too thick, the doctor may decide to perform a biopsy, as discussed above.

The images can indicate how thick the endometrium is. A thick endometrium can be a sign of cancer in post-menopausal women. Ultrasound also can help show whether cancer has spread into your uterine muscle.

Magnetic resonance imaging (MRI)

An MRI uses magnetic fields to produce detailed images of the body. MRI can also measure the size of a tumor. A dye is given before the scan to create a clear picture. This dye is injected into a patient’s vein. MRI is often used in women with low-grade cancer to see how far the cancer has grown into the wall of the uterus.

After the necessary diagnostic tests and or screening are done, your doctor will evaluate the results to see if the cancer is present. If the diagnosis is cancer, he or she may order some more tests to discover how far the cancer has grown and spread. This helps to categorize and stage the disease and plan the type of treatment that will be needed for the condition.

Hysteroscopy

Hysterscopy is a procedure that allows your doctor to view the inside of the uterus and get an endometrial tissue sample for further evaluation under microscope by a pathologist.

In some cases, a hysteroscopy may be used before dilatation and curettage. D&C is a minor surgical procedure that is done under general anaesthetic, where some tissue from the womb lining is removed. The tissue is then examined in a laboratory for further testing.

Blood test

There are cases when your doctor may order some blood tests. A blood test can sometimes help diagnose endometrial cancer. This is because some cancerous tumours release certain chemicals into your blood, known as tumour markers, which can be detected during a blood test.

However, blood tests are not very reliable. The presence of these chemicals doesn't mean you definitely have the cancer. Some people with endometrial cancer don't have these chemicals in their blood.

Tests to see if the cancer has spread, Tests to determine the stage of endometrial cancer

If you're diagnosed with endometrial cancer, your doctor may want to order more tests to help determine the stage of the cancer. Staging the cancer will allow the doctors to plan how large the cancer is, whether or not and where it has spread, and the treatment options that are suitable for you.

The process followed to find out if and how far the cancer has grown beyond the original site is called staging. The following tests and procedures may be used in the endometrial cancer staging process:

Removal of the uterus (hysterectomy)

Hysterectomy may be done to detect a tumor or determine the extent of the spread of the cancer beyond the endometrium. This method can be used in both diagnosing the cancer and decreasing the chance of its further growth.

In some cases, the cancer can be removed at the time of surgery, along with affected organs, to prevent the cancer spreading in other areas later.

Chest x-ray

X-rays are high energy beams that are passed through the organs and bones inside the chest to generate a picture.

MRI (magnetic resonance imaging)

MRI uses a powerful magnet to generate images. A computer makes a series of detailed pictures of areas inside the body. The procedure is similar to a CT scan, except the MRI does not deliver radiation unlike CT scan.

CT scan (also called CAT scan)

It is a painless procedure and is used to capture detailed images of inside the body from different angles. A CT scan is performed to examine your pelvis, abdomen, and chest. A radiologist reviews the results and prepares a report.

Stages of endometrial cancer

After the diagnosis of with endometrial cancer is done, her doctor will do tests to determine if it has spread, and if so, how far it has grown. This process is called staging. The stage of an endometrial cancer identifies the extent of growth of endometrial cancer in the body. It also helps determine how serious the endometrial cancer is and what are best options to treat it.

Staging is one of the most important factors in considering and evaluating the available treatment options for any cancer for a patient.

How are stages for endometrial cancer defined?

Endometrial cancer stages are defined from stage I (1) through IV (4). The lower the number, the less the cancer has spread to outside the original site. A higher number, such as stage IV, indicates cancer has advanced much. And within a stage, an earlier letter means a lower stage. Although each person’s cancer is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

  • Stage I endometrial cancer indicates that the cancer is in the uterus lining and/or the muscle layer of the uterus only.
  • Stage II endometrial cancer indicates that the cancer has spread within the uterus to cervical tissue (but not beyond it), or to the glands where the cervix and uterus meet.
  • Stage III endometrial cancer indicates that the cancer has progressed beyond the uterus and cervix. But it is limited within the pelvic region only. In stage III, the cancer may have advanced to the surrounding and connective tissues, the fallopian tubes, ovaries, vagina, and lymph nodes.
  • Stage IV endometrial cancer indicates that the cancer has spread beyond the uterine area and pelvic organs into other parts of the body, such as the abdomen, intestine, and/or lymph nodes in the groin. In some cases, the cancer may spread into the liver, lungs, or bones.

How is the stage for endometrial cancer determined?

There are 2 systems that are generally used for staging endometrial cancer:

  • FIGO (International Federation of Gynecology and Obstetrics) system
  • American Joint Committee on Cancer TNM staging system

These systems of FIGO and American Joint Committee classify the endometrial cancer on the basis of these factors:

  • The extent (size) of the tumor (T): such as how far has the cancer grown within or beyond the endometrium?
  • The spread to nearby lymph nodes (N): such as whether the cancer has progressed to the nearby lymph nodes in the pelvis or around the aorta.
  • The spread (called metastasis) to distant sites (M): whether the cancer has grown to distant lymph nodes or distant organs. This is called metastasis (metastatic cancer).

The letters after T, N, and M provide details about each of these factors. Higher numbers mean the cancer is more advanced and have grown further into the tissues beyond the original site. If the values of the T, N, and M for a patient have been determined, an overall stage may be associated for the cancer of that patient.

Grade (G) of endometrial cancer

Doctors may describe the cancer by its grade (G). This indicates how much the cancer cells resemble healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissues. If the cancer appears similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue appears significantly different from the healthy tissue, it is called poorly differentiated or a high-grade tumor.

Symbols used for designations are:

GX: The grade cannot be evaluated

G1: The cells are well differentiated

G2: The cells are moderately differentiated

G3: The cells are poorly differentiated

Prognosis and outlook: Endometrial Cancer Survival Rates by Stage

Survival rates tell you what percentage of people with the same type and stage of cancer are still alive a certain length of time (generally 5 years) after they were diagnosed with cancer. These numbers can’t exactly predict how long you will live, but they may give an understanding about how likely it is that your treatment will be successful.

What is a 5-year survival rate for endometrial cancer?

Generally, data on the outlook and prognosis for a certain type and stage of endometrial or other type of cancer are defined as 5-year survival rates. But this does not mean people can live for 5 years only. Many people live much longer than 5 years.

The 5-year survival rate is the percentage of people who live at least 5 years after the diagnosis of the cancer. As an example, a 5-year survival rate of 70% means that 70 out of every 100 people who have that type of cancer are still alive 5 years after they were diagnosed with that cancer.

Relative survival rates are a more accurate way to estimate the effect of cancer on survival. These rates compare people with cancer to people in the overall population. For example, if the 5-year relative survival rate for a particular type and stage of cancer is 50%, it means that people who have that type of cancer are, on an average, about 50% as likely as people who don’t have that cancer to live for at least 5 years after the diagnosis of their cancer.

Survival rates for endometrial cancer

The numbers below are taken from the National Cancer Data Base as published in the AJCC Staging Manual in 2017, and are based on people diagnosed between 2000 and 2002.

  • The 5-year survival rate for women with stage 0 endometrial cancer is 90%
  • The 5-year survival rate for women with stage IA endometrial cancer is 88%
  • The 5-year survival rate for women with stage IB endometrial cancer is 75%
  • The 5-year survival rate for women with stage II endometrial cancer is 69%
  • The 5-year survival rate for women with stage IIIA endometrial cancer is 58%
  • The 5-year survival rate for women with stage IIIB endometrial cancer is 50%
  • The 5-year survival rate for women with stage IIIC endometrial cancer is 47%
  • The 5-year survival rate for women with stage IVA endometrial cancer is 17%
  • The 5-year survival rate for women with stage IVB endometrial cancer is 15%

Note: The new staging system that went into effect January 2018 no longer includes Stage 0 cancers.

Factors that affect prognosis (chance of recovery) and treatment options

  • The stage of the cancer (whether it is in the endometrium only, or involves the uterus wall, or has spread to other places in the body) too
  • How the cancer cells appear in a microscopic view
  • Whether your cancer cells are affected by progesterone

Treatment of Endometrial Cancer

If you are diagnosed with endometrial cancer, your medical team will discuss available treatment options that are suitable for your case with you. You may want to weigh the benefits of each treatment option against the possible risks and side effects.

How do we treat endometrial cancer?

Endometrial cancer is one of the most common gynecologic diseases that are diagnosed in women in the United States. If you are diagnosed with this cancer, your care team knows how to create a unique treatment plan for you. They will consider all aspects of your health, history and your future when making recommendations. The treatment of endometrial cancer requires a multi-disciplinary approach, requiring a multidisciplinary team that may include surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, and social workers.

The treatment of endometrial cancer depends on the stage of the cancer you suffer with at the time of the diagnosis. Surgery is generally performed for all stages of the disease, and most patients undergo surgery to remove the uterus and cervix.

Minimally-invasive surgery may be the preferred treatment option in early stages. In later stages with more extensive and advanced cancer, more extensive surgeries are needed to remove the cancer outside from the uterus and cervix. Chemotherapy and radiation therapy may be required too at different stages.

What are the available treatments for endometrial cancer?

The four basic types of treatment for women with endometrial cancer are:

  • Surgery
  • Radiation therapy
  • Hormonal therapy
  • Chemotherapy

Surgery for endometrial cancer

Surgery for stage 1 endometrial cancer

If you have stage 1 cancer, you'll be likely recommended a hysterectomy. Hysterectomy involves removing both the ovaries and the fallopian tubes as well as the uterus.

The surgeon may collect some samples from the lymph nodes in the pelvis and abdomen and other nearby tissue for examination in the laboratory to identify if the cancer has spread further such as nearby organs and lymph nodes.

In hysterectomy, the surgeon may make one large cut across your stomach to access the womb and remove it.

Sometimes, a minimally invasive procedure may be considered by the surgeon. This is called a laparoscopic hysterectomy, also known as a keyhole hysterectomy. This requires several small-sized cuts to allow a special tool (called laparoscope) and other surgical instruments to be inserted into the site for access and viewing. In this procedure, the surgeon can remove the womb through the vagina with little scarring.

Surgery for stage 2 or 3 endometrial cancer

If you have stage 2 or 3 cancer, it is likely that the cancer has spread to the nearby regions or lymph nodes in the pelvis. You may require a radical or total hysterectomy.

In a total hysterectomy, the cervix, top portion of your vagina and the pelvic lymph nodes may be removed. You may also be delivered radiotherapy or chemotherapy after the surgery to reduce the risk of return of the cancer.

Surgery for stage 4 endometrial cancer

If you have advanced cancer, you may require surgery to remove as much of the cancer as possible. This is called debulking surgery. At this stage, the cancer cannot be cured. The treatment helps to ease some of the symptoms.

Radiotherapy for endometrial cancer

Radiotherapy is recommended if there's a risk of the cancer to return. Sometimes, it is used to slow the progress of cancer when a surgical approach is not possible.

There are two types of radiotherapy to treat endometrial cancer:

  • internal radiotherapy (also called brachytherapy): in this procedure, a plastic tube is inserted inside the uterus and radiation treatment is delivered through the tube into the target site
  • external radiotherapy: in this procedure, a machine is used to deliver pulses of radiation to the pelvic region

External radiotherapy is usually given for five days a week with a break in-between. The procedure takes a few minutes. The whole course of radiotherapy may last about four weeks depending on the stage of the cancer.

Side effects of radiotherapy

Radiotherapy has some side effects. It can cause the skin in the treated area to become red and sore. You may lose hair as a result of it. Radiotherapy to the pelvic area can also affect your bowel and you may have bowel problems such as diarrhoea.

Most of these side effects will go away after some time. However, some women experience some long-term side effects too such as diarrhoea and bleeding from the rectum for longer periods.

Chemotherapy for endometrial cancer

If your cancer is in stage 3 or 4, you may be given a course of chemotherapy.

Chemotherapy can be used after surgery to prevent the return of the endometrial cancer. In some advanced cancer cases, it may be used to slow down the progress of the cancer and ease some of the symptoms. Chemotherapy may be given as an injection into the vein (intravenously).

Side effects of chemotherapy

Side effects of chemotherapy can include such as:

  • nausea
  • vomiting
  • hair loss
  • fatigue and tiredness
  • increased risk of an infection developing in your bloodstream (sepsis)

The side effects of chemotherapy generally go away after the treatment for endometrial cancer is complete.

Hormone therapy for endometrial cancer

Hormone therapy generally replaces a hormone called progesterone, which naturally occurs in your body. Artificial progesterone is used and is usually given as tablets.

It is used to treat advanced-stage endometrial and womb cancers, or cancer that has come back. The treatment may have some side effects, such as vomiting, nausea, muscle cramps, and weight gain etc.

Endometrial cancer treatment according to stage of the cancer

The treatment of endometrial cancer depends on the stage of the cancer at the time of diagnosis.

  • Stage 1 endometrial cancer: Surgery is preferred to remove the cancerous tumor and it may be the only treatment necessary at this stage. Sometimes, other therapies may be suggested in addition to surgery, such as radiation therapy or chemotherapy.
  • Stage 2 endometrial cancer: Surgery is preferred to remove your uterus and cervix, and possibly both ovaries and fallopian tubes. In some cases, radiation therapy may follow the surgery to eliminate any remaining cancer cells. Chemotherapy is rarely necessary in this stage.
  • Stage 3 endometrial cancer: A combination of surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes, radiation therapy, and chemotherapy may be needed.
  • Stage 4 endometrial cancer: Surgery to remove the uterus, ovaries, fallopian tubes, and lymph nodes is not always needed or possible at this stage. Combinations of chemotherapy, hormonal therapy, radiation therapy are preferred approaches.

Making treatment decisions about endometrial cancer

It’s very important to discuss all possible options of treatment with your care team. You should talk about the goals of treatments, possible side effects, risks, benefits associated with the various options to help make an informed decision that best suits your needs. You should not hesitate to ask questions if there is anything you’re not sure about or are concerned about.

Here are a few things for your considerations in this regard:

  • Seek a second opinion
  • Evaluate possibilities of participating in a clinical trial
  • Consider complementary and alternative methods
  • Seek help from support groups and personal networks

Concerns after the treatment of endometrial cancer (post-treatment concerns)

If you suffer with endometrial cancer and you are a cancer survivor, you would know that cancer survivors are affected by many health problems. Perhaps the greatest concern these survivors have is the fear of returning the cancer again after successful treatment. Cancer that comes back after treatment is called a recurrence. Some cancer survivors may develop a new, unrelated cancer too. This is called a second cancer.

Every type of cancer you might have had can possibly cause another new cancer to occur and can even return after the treatment. People who have had endometrial cancer and had treated it successfully can still get the same cancer again. But certain types of cancer and their treatments are thought to bear a higher risk of causing second cancers.

If you are a survivor of endometrial cancer, you can get any type of second cancer. But you will be at an increased risk of these cancers:

You should speak to your doctor about the chances of recurrence and the possibilities of second new cancers if you are an endometrial cancer survivor.

How can you lower your risk of getting a second cancer?

You should follow these steps to lower the risk of getting the second cancer and stay healthy.

  • Maintain a healthy body weight
  • Stay physically active and exercise regularly
  • Eat a healthy diet
  • About alcohol
  • Quit smoking
  • Regularly meet your care team for follow-ups and any regular screening as recommended
  • Take medicines as prescribed without fail
  • Report any symptoms as soon as you observe after the treatment of your endometrial cancer

Post-treatment care and considerations

Women with endometrial cancer generally have a hysterectomy. This is a major operation and recovery may take about 8-12 weeks.

During this recovery time you must avoid lifting things and doing heavy household work. You should avoid driving at least for five weeks after the operation. But, ask your doctor before you begin driving as to whether you are in good health for it. Sometimes, your doctor may ask to avoid driving for a longer time.

Most women require 4 to 10 weeks off from the work after a hysterectomy. The recovery time will depend on the type of surgery you have, whether or not any complications develop, and what type of work you will return to.

Some treatments for endometrial cancer, such as radiotherapy, can make you very tired. You may need to take a break from some of the activities for a while.

Follow-up after endometrial cancer treatment

After you have a successful treatment of the endometrial cancer, you should still regularly meet your doctor. You should observe any new symptoms that you note and report them to the doctor as soon you see them. Sometimes, the symptoms could be due to the cancer recurring even after the treatment is complete or because they could be caused by the cancer spreading to nearby regions, or by a new disease or second cancer.

Endometrial cancer survivors are also at high risk of developing certain types of second cancers. Therefore, they should follow the guidelines provided by their care team to ensure proper screening can be done on time and find those cancers early, when they are likely to be treated more successfully.

Living with endometrial cancer: Living as an Endometrial Cancer Survivor

A diagnosis of endometrial cancer can be very challenging for women. Your cancer stage and the treatment options define how it is going to affect your life and of course the life of your caretakers.

No matter which stage you are in and what treatments you go through, there are ways to get help coping with endometrial cancer. Not all of them work for everybody, but one or more should be helpful for you. Here are some good tips to consider:

  • Stay in contact with your friends and family as they can provide a powerful support in your life.
  • Communicate with others in the same situation. Find others who are suffering with similar cancers in your society or community or through online support systems.
  • Learn more about your condition. Awareness about cancer helps build ways to cope with the disease.
  • Set your goals in life.
  • Take out time for yourself.