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Endometrial Cancer

Endometrial Cancer

Endometrial Cancer

Endometrial cancer is a type of cancer that affects the lining of the uterus (the endometrium). It is also known as uterine cancer. The exact cause of endometrial cancer is not known, but certain risk factors can increase a person’s chances of developing the disease.

Causes and Risk Factors

The exact cause of endometrial cancer is not fully understood, but several factors have been identified that may increase the risk of developing the disease. Here are some of the causes and risk factors of endometrial cancer:

  1. Age: The risk of endometrial cancer increases as women get older, with the majority of cases occurring in women over the age of 50.
  2. Hormonal factors: Hormones play a significant role in the development of endometrial cancer. Women who have a history of irregular periods, early onset of menstruation (before age 12), late onset of menopause (after age 55), or those who have never given birth are at increased risk.
  3. Obesity: Obesity is a significant risk factor for endometrial cancer. Fat cells produce estrogen, which can stimulate the growth of endometrial cells.
  4. Family history: Women who have a family history of endometrial cancer or other cancers of the reproductive system, such as ovarian cancer, may be at increased risk.
  5. Diabetes: Women with diabetes are at higher risk of developing endometrial cancer, likely due to insulin resistance and high levels of insulin in the blood.

Endometrial Cancer

6. Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that can lead to irregular periods and high levels of estrogen. Women with PCOS may be at increased risk of endometrial cancer.

7. Inherited colon cancer syndrome: Hereditary nonpolyposis colorectal cancer (HNPCC) is a condition that increases the risk of colon cancer and other types of related cancer including endometrial cancer.

8. Tamoxifen use: Tamoxifen is a medication used to treat breast cancer. However, it can also increase the risk of endometrial cancer, particularly in women who take it for more than five years.

9. Radiation therapy: Women who have had radiation therapy to the pelvis, such as for the treatment of another cancer, may be at increased risk of developing endometrial cancer.

Also, it is important to consider that having one or more of these risk factors does not mean that a woman will definitely develop endometrial cancer, and many women with endometrial cancer do not have any known risk factors.

Symptoms

The most common symptom of endometrial cancer is abnormal vaginal bleeding, especially after menopause or in between periods. Other symptoms may include –

  1. Pelvic pain or pressure
  2. Painful intercourse
  3. Abnormal vaginal discharge
  4. Difficulty emptying the bladder
  5. Weight loss without trying
  6. Fatigue or weakness
  7. Swelling in the abdomen

However, these symptoms can also be caused by other conditions, so it is essential to consult a healthcare provider if you experience any of these symptoms. Early detection of endometrial cancer can improve the chances of achieving successful treatment and recovery.

Diagnosis and Tests

Endometrial cancer is usually diagnosed through a combination of tests and procedures, including:

  1. Medical History and Physical Exam: The doctor will ask questions about your medical history and any symptoms you may be experiencing. A physical exam may also be conducted to check for any abnormalities or signs of cancer.
  2. Pelvic Exam: A pelvic exam may be performed to look for any abnormalities in the uterus, ovaries, or other reproductive organs.
  3. Transvaginal Ultrasound: This procedure involves using a small wand-like device inserted into the vagina to produce images of the uterus and surrounding tissues.
  4. Biopsy: A tissue sample is taken from the uterus and examined under a microscope to check for the presence of cancer cells. This is the most definitive way to diagnose endometrial cancer.
  5. Imaging Tests: Other imaging tests like CT scan, MRI, or PET scan may also be used to determine if cancer has spread beyond the uterus.
  6. Endometrial Sampling: This procedure involves taking a sample of the endometrial tissue with a thin tube or suction device that is inserted into the uterus through the cervix. This procedure is less invasive than a biopsy and can be done in the doctor’s office.

If endometrial cancer is diagnosed, further testing will be done to determine the extent of cancer and to develop a treatment plan.

Staging 

Endometrial cancer is typically staged using the FIGO (International Federation of Gynecology and Obstetrics) staging system, which takes into account the extent of tumor invasion and spread beyond the uterus. The stages of endometrial cancer are as follows:

Stage 0: Cancer is only found in the innermost layer of the uterus (the endometrium).

Stage I: Cancer is confined to the uterus.

  • Stage IA: Cancer is found only in the endometrium or less than halfway through the myometrium (the muscular layer of the uterus).
  • Stage IB: Cancer has spread to more than halfway through the myometrium.

Stage II: Cancer has spread to the cervix but not beyond the uterus.

  • Stage IIA: Cancer has spread to the cervical stroma (connective tissue in the cervix).
  • Stage IIB: Cancer has spread to the cervical stroma and the adnexa (ovaries, fallopian tubes, and ligaments of the uterus).

Stage III: Cancer has spread outside the uterus but not beyond the pelvis.

  • Stage IIIA: Cancer has spread to the serosa (outermost layer) of the uterus and/or ovaries/fallopian tubes.
  • Stage IIIB: Cancer has spread to the vagina.
  • Stage IIIC: Cancer has spread to nearby lymph nodes.

Stage IV: Cancer has spread beyond the pelvis to other parts of the body.

  • Stage IVA: Cancer has spread to the bladder or rectum.
  • Stage IVB: Cancer has spread to distant organs such as the lungs, liver, bones, or brain.

The stage of endometrial cancer is an important factor in determining treatment options and predicting prognosis.

Treatments 

There are several treatment options available for endometrial cancer, depending on the stage and severity of cancer, as well as the patient’s overall health and preferences.

  1. Surgery: The primary treatment for endometrial cancer is surgery. This typically involves a total hysterectomy (removal of the uterus and cervix) and bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries). In some cases, pelvic and/or para-aortic lymph node dissection may also be performed where lymph nodes are removed from the pelvic area and checked under a microscope to find the signs of cancer.
  2. Radiation therapy: Radiation therapy may be recommended in addition to surgery or as an alternative to surgery for some patients. It can be administered externally (external beam radiation therapy) or internally (especially brachytherapy) to relieve symptoms for improving the quality of life in patients.
  3. Chemotherapy: Chemotherapy may be recommended for patients with advanced or recurrent endometrial cancer. Chemotherapy drugs can be administered orally or intravenously, and they work by targeting and destroying cancer cells that help in stopping the spread of cancer in other parts of the body.
  4. Hormone therapy: Hormone therapy may be used for endometrial cancer that is hormone receptor-positive. It works by blocking the effects of estrogen, which can stimulate the growth of some types of endometrial cancer cells.
  5. Targeted therapy: Targeted therapy is a newer type of cancer treatment that targets specific proteins or genes that are involved in the growth and spread of cancer cells. It may be used in combination with other treatments for advanced endometrial cancer.

The choice of treatment will depend on the stage and grade of cancer, as well as the patient’s overall health and personal preferences. It’s important to discuss all available treatment options with a qualified healthcare provider to determine the best course of action for each individual case.

Prevention

It can often be prevented or detected early through regular checkups and healthy lifestyle habits. Here are some steps that can help in the prevention of endometrial cancer:

  1. Maintain a healthy weight: Obesity increases the risk of endometrial cancer. Therefore, maintaining a healthy weight by exercising regularly and eating a balanced diet is essential.
  2. Take oral contraceptives: Taking birth control pills for at least one year can reduce the risk of endometrial cancer.
  3. Avoid hormone therapy: Hormone therapy with estrogen alone increases the risk of endometrial cancer. If you need hormone therapy, your doctor may prescribe a combination of estrogen and progesterone to reduce the risk.
  4. Regular exercise: Regular physical activity can reduce the risk of endometrial cancer. Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking, most days of the week.
  5. Healthy diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can help reduce the risk of endometrial cancer.
  6. Regular checkups: Regular pelvic exams and Pap tests can detect early signs of endometrial cancer. If you experience abnormal bleeding or discharge, contact your doctor immediately.
  7. Genetic testing: If you have a family history of endometrial cancer, you may consider genetic testing to determine if you have a higher risk of developing the disease. If you are at high risk, your doctor may recommend more frequent checkups or preventive measures.

Conclusion 

Endometrial Cancer is the most common type of uterine cancer that affects mostly women after menopause. 

The prognosis for endometrial cancer varies depending on the stage at diagnosis and other factors, such as the patient’s age and overall health. Early-stage endometrial cancer has a high cure rate, with five-year survival rates of over 90%. However, advanced-stage endometrial cancer has a poorer prognosis, with lower survival rates.

Regular gynecological check-ups and early detection can help in the successful management of endometrial cancer. Women should talk to their healthcare provider if they have any symptoms, such as abnormal vaginal bleeding or discharge, pelvic pain or pressure, or unexplained weight loss.

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