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Everything You Need To Know About Endometrial (Uterine) Cancer

Team AckoSept 23, 2022

The most common type of cancer in a female reproductive system is endometrial or uterine cancer. Endometrial cancer develops when healthy cells in the uterus change and grow uncontrollably, causing a mass or a tumour to form. Even though the exact cause of endometrial cancer is unclear, increased estrogen levels play a significant role in the development of the disease. Leaving this disease untreated can cause it to spread to other organs of the body as well.

Endometrial Cancer

The goal of this blog is to discuss endometrial cancer and its symptoms so that you can avoid complications in the future, as well as the treatment options available after a diagnosis.

What Is Endometrial Cancer?

Endometrial cancer occurs when malignant (cancer) cells form within the tissue of the endometrium, the lining of the uterus. Endometrial cancer is also known as uterine cancer. It can spread to other organs without treatment, such as the bladder, rectum, ovaries, and fallopian tubes. However, endometrial cancer grows slowly and is usually detected early for treatment.

Types of Endometrial Cancer

Endometrial cancer or carcinomas can be classified into different categories depending on how the cells look under a microscope. These types are called histologic types.

  • Adenocarcinoma

  • Uterine carcinosarcoma or CS 

  • Transitional carcinoma

  • Squamous cell carcinoma

  • Small cell carcinoma

  • Serous carcinoma

Symptoms of Endometrial Cancer

Abnormal vaginal bleeding is the most common symptom of endometrial cancer. 

This can include:

  • Menstrual cycle changes in length or heaviness

  • Blood spotting between menstruations or vaginal bleeding

  • Postmenopausal vaginal bleeding

Endometrial cancer may also cause the following symptoms:

  • Vaginal discharge that is watery or bloody

  • Lower abdominal or pelvic pain

  • Sex-related pain

  • Losing weight unintentionally

Make an appointment with your doctor if you experience any of these symptoms. Although these symptoms aren't necessarily signs of a serious condition, they should nonetheless be evaluated. Several noncancerous conditions can cause abnormal vaginal bleeding, including menopause. In some cases, it may indicate endometrial cancer or another type of uterine cancer. See your doctor as soon as possible to identify your symptoms' cause and recommend the appropriate treatment.

Causes of Endometrial Cancer

Typically, endometrial cancer cannot be pinpointed to a specific cause. Nevertheless, experts believe that low estrogen and high progesterone levels are often among the most prominent causes. The fluctuations in these hormone levels affect your endometrium, leading the endometrial cells to multiply and divide in response to increased estrogen levels. It is possible for endometrial cells to become cancerous if certain genetic changes occur. Researchers continue to study the changes that cause normal endometrial cells to become cancerous.

Risk Factors for Endometrial Cancer

Endometrial cancer can be associated with some of the following factors:

  • Hormone imbalance: The ovaries produce estrogen and progesterone, the two main female hormones. These hormones fluctuate in balance, which affects the endometrium. Endometrial cancer is more likely to occur in women who make more estrogen than progesterone. 

  • Early first menstruation or late menopause: Endometrial cancer is more likely in women who start menstruating early (before 12) or enter menopause later in life. The endometrium has been exposed to more estrogen as you have had more periods.

  • Never having been pregnant: Those who have never been pregnant are at greater risk of endometrial cancer than those who have been pregnant at least once.

  • Older age: You are more likely to develop endometrial cancer as you age. Most endometrial cancers occur after menopause.

  • Obesity: A woman's risk of developing endometrial cancer increases if she is obese. Being overweight may alter your body's hormonal balance due to excessive body fat.

  • Hormone therapy for breast cancer: Breast cancer hormone therapy drug tamoxifen has been associated with an increased risk of endometrial cancer. You should discuss this risk with your doctor if you are taking tamoxifen.

  • A history of cancer: If other family members have had endometrial cancer, you are more likely to develop it. A family history of Lynch syndrome also increases your risk of endometrial cancer. 

Endometrial Cancer Stages

In time, endometrial cancer may spread to other parts of the body from the uterus.

According to how much it has progressed, cancer is classified into the following stages:

  • Stage 0: Endometrial cancer remains on the inner lining of the uterus, where it started.

  • Stage 1: Cancer has spread into the endometrium and may have reached the middle layer of the uterus wall, the myometrium.

  • Stage 2: The tumour has progressed to the cervix.

  • Stage 3: Tissue near the uterus, such as the vagina or lymph nodes, has been affected by the tumour.

  • Stage 4: Cancer has spread to the bladder, intestines, bones, liver, and lungs.

Endometrial cancer treatment options and long-term outcomes are affected by the stage of the disease. Early detection of endometrial cancer makes treatment easier.

Treatments for Endometrial Cancer

There are several treatment options available for endometrial cancer. Your doctor's treatment plan will vary based on your cancer subtype, stage, and overall health. Each treatment option carries its own set of risks and benefits. It is important to understand each approach's potential benefits and risks with the help of your doctor.

Surgery

The most common surgical treatment for endometrial cancer is hysterectomy. A hysterectomy involves removing the uterus. Additionally, ovaries and fallopian tubes may be removed as part of a bilateral salpingo-oophorectomy (BSO). BSO and hysterectomy are typically performed simultaneously.

A surgeon will also remove nearby lymph nodes to determine if the cancer has spread. The procedure is called lymphadenectomy or dissection of lymph nodes. Depending on the extent of the cancer's spread, the surgeon may recommend additional surgery.

Radiation Therapy

Radiation therapy aims to kill cancer cells by using high-energy beams. Endometrial cancer can be treated with two types of radiation therapy:

  • External beam radiation therapy: Radiation is focused from outside your body onto the uterus by an external beam radiation machine.

  • Internal radiation therapy: Radioactive materials are injected inside the vagina and uterus, also called brachytherapy.

Depending on your doctor's recommendation, you may need either or both types of radiation therapy after surgery. This might help kill any remaining cancerous cells. There are rare cases in which radiation therapy might be recommended before surgery, as removing the tumours by shrinking them would be easier.

You may be given radiation therapy as your main treatment if you cannot undergo surgery due to poor overall health or other medical conditions.

Chemotherapy

The goal of chemotherapy is to kill cancer cells by using drugs. Some types of chemotherapy treatment use one drug, and others may use a combination of drugs. There are various types of chemotherapy, wherein the drugs might be given orally or intravenously (IV). Combinations of agents (called regimens) are usually recommended for high-risk endometrial cancer patients. The two drugs used are carboplatin and paclitaxel.

Your doctor may recommend chemotherapy if you have endometrial cancer, which has spread elsewhere in your body or returned after you've been treated.

Targeted Therapy and Immunotherapy

This is a relatively new way to treat endometrial cancer called targeted therapy, which involves drugs that target certain changes in cancer cells. Many of these targeted therapy drugs are still in clinical trials, so only a few are currently available.

A more individualised approach is immunotherapy, in which drugs help your immune system recognise and destroy cancer cells. Sometimes, targeted therapies and immunotherapy are used together or in combination with chemotherapy.

Hormone Therapy

Hormone therapy aims to change the body's hormone levels by using hormone-suppressing drugs. This helped slow down the spread of endometrial cancer cells. Your doctor may suggest hormone therapy for stage III or stage IV endometrial cancer. It may also be recommended for recurrent endometrial cancer. Chemotherapy and hormone therapy are often combined for a more effective treatment plan.

Conclusion

Consult your doctor if you have symptoms that might indicate endometrial cancer or another gynaecological disease. The main sign of endometrial cancer is abnormal vaginal bleeding, but this can also indicate other conditions. The earlier you address changes in your health, the better it will be since early diagnosis and treatment can make a big difference in many cancers, especially endometrial cancer.

Frequently Asked Questions

How can you lower your risk of endometrial cancer?

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You can reduce your risk of endometrial cancer by following these strategies:

  • Lose weight: If you lose weight and maintain that loss, it can lower your risk of endometrial cancer and any cancer recurrence.

  • Get regular exercise: Regular physical activity reduces endometrial cancer risk.

  • When abnormal vaginal bleeding occurs, seek medical attention: Make an appointment with your doctor if you experience abnormal vaginal bleeding. Ask your doctor about treatment options if the bleeding is caused by endometrial hyperplasia.

  • Consult your doctor about the benefits of contraceptives: Contraceptive pills and intrauterine devices (IUDs) are associated with a reduced risk of endometrial cancer. Using these contraceptives may have benefits and risks, which your doctor can explain.

  • Check your family history for cancer: Ask your doctor if genetic testing is recommended if your family history includes certain types of cancer (such as colon or ovarian cancer).

What foods reduce the risk of endometrial cancer?

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Keeping a low-fat diet can reduce your risk of developing such cancers. A healthy diet should also contain plenty of fresh vegetables, fruits, and soy products.

How quickly does endometrial cancer grow?

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Generally speaking, the most common form of endometrial cancer, Type 1, grows slowly. Whereas type 2 cancer grows faster and spreads more rapidly.

What is endometrial intraepithelial neoplasia?

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A condition called endometrial intraepithelial neoplasia (EIN) can lead to type 1 endometrial cancer. In EIN, the endometrium becomes too thick and shows cancer-like changes.

References:

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152311/

- https://www.mayoclinic.org/diseases-conditions/endometrial-cancer/symptoms-causes/syc-20352461#:~:text=Signs%20and%20symptoms%20of%20endometrial,Pelvic%20pain

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