Endometrial Cancer

The Causes, Symptoms, Treatment and Prevention of Endometrial Cancer

patient on gynelogical exam table
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Endometrial cancer is a type of cancer that develops in the endometrium, the lining of the uterus in women. It is the most common form of uterine cancer, although other cancers occur in the uterus.

Endometrial cancer is most often diagnosed in women who have gone through menopause, but younger women may also develop the disease. It is most often found in the early stages, when the disease is most treatable.

Causes and Risk Factors of Endometrial Cancer

Studies suggest that a woman's level of estrogen and her long term exposure to estrogen may be associated with endometrial cancer development. Genetic mutations of certain genes is also being explored as a cause.

These are the most significant risk factors for endometrial cancer:

  • never being pregnant
  • beginning menstruation before age 12 and continuing through age 50 or more
  • being diabetic
  • obesity
  • use of estrogen replacement therapy (ERT)
  • personal or family history of breast or ovarian cancer
  • use of Tamoxifen, a breast cancer adjuvant therapy

Symptoms of Endometrial Cancer

Abnormal vaginal bleeding is the most common and usually first experienced symptom of endometrial cancer. Vaginal bleeding is considered abnormal when

  • periods are heavy and prolonged
  • heavy spotting occurs between periods
  • there's more than one period in a cycle month
  • bleeding occurs before and/or after sex
  • bleeding occurs in women who are post-menopausal

Women with endometrial cancer may also experience pain during sexual intercourse; a watery, blood-tinged discharge; pelvic pain; and unintentional weight loss.

Diagnosing Endometrial Cancer

If endometrial cancer is suspected, a thorough pelvic exam will first be done by a gynecologist.

This is an excellent time to discuss personal and family medical history and symptoms. If you haven't had a recent Pap smear and are due for one, the gynecologist may do one at this time, along with the pelvic exam. Pap smears very rarely, if ever detect endometrial cancer, but one may be done to rule out cervical conditions.

To confirm the presence or absence of cancer, an endometrial biopsy is necessary. An endometrial biopsy can be done in the gynecologist's office and takes only a few moments to complete. Most women report feeling moderate pain and cramping that lasts only through the biopsy and some mild cramping following the biopsy.

Another method of obtaining endometrial tissue samples is through a dilation and curettage (D&C). During a D&C, the uterus is scraped with a instrument called a curette. You are given an anesthetic so you will not feel anything during the procedure, but you can expect mild cramping afterward.

If biopsy samples reveal endometrial cancer, then the cancer is staged.

Staging refers to how far the cancer has spread to nearby tissue or organs. There are four stages of endometrial cancer. Most endometrial cancers are diagnosed at stage I or II; the first stages of the disease are when it is most treatable.

Treating Endometrial Cancer

Treatment options depend heavily on the stage of endometrial cancer, but surgery is the most common type of treatment. Surgery is also used when some cases of endometrial cancer have been staged. Surgery treatment for endometrial cancer include:

  • hysterectomy - surgical removal of the uterus
  • hysterectomy with bilateral salpingo oopherectomy - surgical removal of the uterus, fallopian tubes and ovaries
  • lymph node dissection - removal of pelvic lymph nodes during hysterectomy that are later screened for cancer
  • tumor debulking - removal of large tumors that have spread throughout the pelvis; done in cases of advanced endometrial cancer

Radiation therapy is also an option for treating endometrial cancer. This type of treatment uses certain types of high-energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.

Chemotherapy may be prescribed to treat endometrial cancer in women whose cancer has spread beyond the uterus. There are several chemotherapy drugs used to treat endometrial cancer, but many times, a combination of different drugs is prescribed.

Chemotherapy drugs work by eliminating rapidly multiplying cancer cells. However, there are other healthy cells in the body that multiply just as quickly, such as hair follicle cells. Many chemotherapy drugs do not discern between cancer cells and rapidly-multiplying healthy cells. They attack both and cause side effects such as hair loss.

Hormone therapy may also be used to slow the growth of endometrial cancer or to prevent or treat its recurrence. Use of progestins, drugs similar to the hormone progesterone, slow the growth of cancer cells. Progestins are prescribed in a pill or injection form.

Endometrial Cancer Prevention

Long-term use of birth control pills has been shown to decrease a woman's risk of endometrial cancer. An added benefit is that the decrease in risk can continue for as long as 10 years after discontinuing their use.

Studies also show that keeping a healthy weight may decrease a woman's risk. Body fat tissue can increase the levels of estrogen, which can increase your risk of endometrial cancer. Maintaining a healthy weight also prevents many other types of diseases and conditions, not just endometrial cancer.

Combined hormone therapy that uses progestin along with estrogen appears to lower the risk of endometrial cancer. This type of hormone therapy can have side effects and is not for everyone.

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