Endometrial cancer: the most common type of uterine cancer

Leave a Comment / By /

Endometrial cancer is the most common type of uterine cancer that begins in the endometrium (inner lining of the uterus). Endometrioid Adenocarcinoma is the most common type of endometrial cancer.

It is the most common pelvic malignancy in females in the United States and Eastern Europe. In India, the total number of estimated new cases of endometrial cancer in 2018 was 13,328, with an estimated 5010 deaths.

It is primarily a disease of postmenopausal women, the peak incidence at onset being the 6th to 7th decades of life.

Endometrial cancer stages range from stage I through stage IV.

Stage I: cancer is found only in the uterus or womb and has not spread to other parts of the body.

Stage II: the tumor has spread from the uterus to the cervical stroma but not to other body parts.

Stage III:  cancer has spread beyond the uterus but is still only in the pelvic area.

Stage IV: cancer has metastasized to the rectum, bladder, and/or distant organs.

What Causes Endometrial cancer?

Though the cause of Endometrial cancer is unknown, it was found to be linked to DNA mutations.

What are the Risk factors?

Changes in the balance of female hormones in the body

1. Taking estrogen-only hormone replacement therapy (HRT) after menopause.

2. Having polycystic ovarian syndrome, obesity and diabetes.

More years of menstruation

1. Never giving birth (Infertility)

2. Starting menstruation early — before age 12

3. Beginning menopause later increases the risk of endometrial cancer.

•Family history of endometrial, ovarian, and/or colon cancers (hereditary nonpolyposis colorectal cancer – Lynch syndrome).

•The hormone therapy drug tamoxifen for breast cancer can increase the risk of developing endometrial cancer. read more: Signs of Breast Cancer: What to Look for?

•Endometrial hyperplasia.

•Prior radiation therapy for pelvic cancer 

•Older age

Signs and symptoms

•Vaginal bleeding or discharge unrelated to menstruation (periods) –  over 90 % of women diagnosed with endometrial cancer have abnormal vaginal bleeding.

•Vaginal bleeding after menopause.

•Difficult or painful urination.

•Painful sexual intercourse.

•Pain in the pelvic area.

What are the Complications?

Complications of uterine cancer include:

  • Anemia (low red blood cell count)
  • Bowel obstruction
  • Hemorrhage
  • Metastasis of cancer

Read more: Breast Cancer: What are the Symptoms and Treatment?

Diagnosis: How to diagnose Endometrial cancer?

  • Medical history – Check for symptoms and other risk factors.
  • Physical examination – Pelvic exam (manual examination of the abdomen and pelvic area to feel for any abnormal nodules).
  • Diagnostic tests – The tests performed are:
    • Endometrial biopsy: Thin, flexible tube is used to gently scrape a small amount of tissue from the endometrium for examination under a microscope to look for cancer cells ( Punch biopsy, LEEP, Conization, ECC).
    • Transvaginal ultrasound is a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
    • Dilatation and curettage: This is a minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). 
    • Hysteroscopy: A procedure to look inside the uterus for abnormal areas. A hysteroscope is a thin, tube-like instrument with a light and a lens for viewing. 
    • Cystoscopy – the thin tube is inserted into the bladder through the urethra to check for cancerous cells.
    • Proctoscopy – the thin tube is inserted in the rectum to check for cancerous cells.
  • Imaging tests: CT scan: A procedure that makes a series of detailed pictures of areas inside the body Chest x-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. MRI: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. PET scan :
    • A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein.
    • The PET scanner rotates around the body and takes a picture of where glucose is being used in the body.
    • Malignant tumor cells appear brighter in the picture because they are more active and take up more glucose than normal cells.
  • Other diagnosis test includes Blood tests.
    • 1. Complete blood count Endometrial cancer can cause bleeding, leading to low red blood cell counts (anemia).
    • 2. CA-125 blood test – CA-125 is an antigen released into the bloodstream by many, but not all, endometrial and ovarian cancers.
  • Testing for gene and protein changes in the cancer cells, like testing the cancer cells for dMMR, MSI-H, and/or a high tumor mutational burden (TMB-H).

Treatment: How is Endometrial cancer treated?

Surgery is the main treatment for endometrial cancer, and depending on the stage of the cancer, it can be combined with radiotherapy or chemotherapy.

  • Surgery: Hysterectomy –

Types of hysterectomy :

  1. Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus is removed through an incision (cut) in the abdomen, it is called a simple or total abdominal hysterectomy. If the uterus is removed through the vagina, it is known as a vaginal hysterectomy.
  2. Radical hysterectomy: Surgery to remove the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.

Surgeries are done along with hysterectomies –

  1. Bilateral salpingo-oophorectomy: A surgical procedure to remove ovaries and fallopian tubes.
  2. Lymph node biopsy removes all or part of a lymph node.

Other surgeries are done to check for cancer spread –

Omentectomy is a surgical procedure to remove the omentum (peritoneum tissue containing blood vessels, nerves, lymph vessels, and lymph nodes).

Peritoneal biopsies – Peritoneal biopsies remove small pieces of the peritoneal lining to check for cancer cells.

Peritoneal lavage (staging) – washing of abdominal and pelvic cavities with salt water and checking fluid for the presence of cancer cells.

  • Radiation therapy :

Recommended to reduce the risk of a cancer recurrence after surgery.
In certain situations, radiation therapy may also be recommended before surgery to shrink a tumor and make it easier to remove.

1. External radiation therapy uses a machine outside the body to send radiation toward cancer.

2. Internal radiation therapy uses a radioactive substance that is placed directly into or near cancer.

  • Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer that has spread beyond the uterus.
  • Chemotherapies used in endometrial cancer include – Platinum compounds: Cisplatin, carboplatin,
  • Antibiotic: doxorubicin,  Topoisomerase -1 inhibitors: topotecan,  Nitrogen mustard : ifosfamide, olaratumab and taxanes (docetaxel, paclitaxel). 
  • Hormone therapy Hormone therapy is a cancer treatment that slows the growth of certain types of uterine cancer cells that have receptors to the hormones on them. Hormone treatment for endometrial cancer can include:
    • Progestins (main hormone treatment used.)
    • Tamoxifen
    • Luteinizing hormone-releasing hormone agonists (LHRH agonists)
    • Aromatase inhibitors (AIs)
  • Targeted therapy

• 1. Angiogenesis inhibitor – Bevacizumab – binds to vascular endothelial growth factor (VEGF) – signals the growth of new blood vessels ( slows the spread of cancer)
• 2. Kinase inhibitor – Lenvatinib (Lenvima)
• 3. mTOR inhibitor therapy: mTOR inhibitors block a protein called mTOR, which helps control cell division. Everolimus treats stage III, stage IV, and recurrent endometrial cancer.
• Temsirolimus (Torisel)
• 4. Signal transduction inhibitor therapy: Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Metformin is being studied to treat stage III, stage IV, and recurrent endometrial cancer.

  • Immunotherapy

Immune checkpoint inhibitor– The immunotherapy drug pembrolizumab (Keytruda) is approved to treat tumors with either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor’s location in the body.

The Food and Drug Administration granted accelerated approval to dostarlimab (Jemperli, GlaxoSmithKline LLC) for adult patients with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer.

Prevention: Can we prevent it?

  • Prevention of Endometrial cancer –
    • Pregnancy and breast-feeding: Estrogen levels are lower during pregnancy and when breastfeeding.
    • Hormonal contraceptives: Taking hormonal contraceptives (birth control pills) that combine estrogen and progestin (combined oral contraceptives) decreases the risk of endometrial cancer
    • Weight loss
    • Physical activity
  • Living with Endometrial cancer –
    • Follow-up care ( doctor visits and tests)
    • Avoid smoking
    • Staying at a healthy weight
    • Regular physical activities

When to see a doctor? :

It is wise to consult with a gynecologist immediately if observed any symptoms, e.g., abnormal vaginal bleeding or pain in the pelvic area. The typical consultation fee for a gynecologist ranges from Rs. 500 to Rs. 1500 in India.

References:

Read more:

Related Posts

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top