Endometrial cancer begins in the endometrium, which is the layer of cells lining the inside of the womb (or uterus). Essentially, it’s a type of cancer that starts in the uterus.
Many cancers of the uterus begin as endometrial cancer. However, there’s another kind called uterine sarcoma. Uterine sarcoma begins in the muscles or other uterus tissues, rather than the endometrium. The treatments for uterine sarcoma and endometrial cancer are usually different because they are different types of cancers.
In the U.S., cancer of uterine sarcoma is the most typical cancer affecting the female reproductive organs. In 2020, the NCI (National Cancer Institute) estimated that around 65,620 people were diagnosed with endometrial cancer, and about 12,590 people died from this disease that year.
Symptoms
In the early stages, endometrial cancer may present with uncommon bleeding. This includes bleeding after menopause or in the middle of periods. Another early symptom can be discomfort in the area of the pelvis, which may sometimes occur during sexual practice. Additionally, some individuals might experience discomfort when urinating or have trouble fully evacuating the bladder.
As endometrial cancer advances, it may cause a range of other symptoms. These include a sensation of heaviness or mass in the pelvic area, unintentional weight loss, extreme tiredness, nausea, and pain in various parts of the body such as the back, legs, and pelvic region.
It is important to note that these signs can also be associated with benign conditions like endometriosis, fibroids, polyps, and endometrial hyperplasia in the lining of the uterus. Therefore, it is crucial to consult a healthcare provider to eliminate endometrial cancer if similar symptoms are present.
Stages
When cancer is detected, the healthcare provider will evaluate the tumor grade. This assessment helps determine how rapidly the cancer cells are splitting and how rapidly the cancer is possible to develop. Generally, a higher-grade tumor is aggressive, meaning it is more likely to grow rapidly and transmit to other areas of the body.
The treatment plan for endometrial cancer is influenced by the stage of the cancer, which indicates how far it has been transmitted. The stages are defined as follows:
- 0 Stage: Cancerous cells are confined to the surface of the uterus’s inner lining.
- 1st Stage: The cancer has spread from the inner lining of the uterus into the endometrium and may also have reached the middle layer of the uterine wall called the myometrium.
- 2nd Stage: The tumor has transmitted to the cervix.
- 3rd Stage: The cancer has spread beyond the uterus to surrounding tissues, which may include the lymph nodes or vagina.
- 4th Stage: The cancer has extended to distant organs, like the intestines or bladder, and may also involve other areas like the bones, lungs, or liver.
When endometrial cancer transmits from the endometrium to other areas of the body, it is referred to as “metastasized.”
For a visual representation of the endometrial cancer stages, you can explore an interactive 3D map using a touchscreen or mousepad. This can help in understanding how the cancer progresses through different stages.
Treatment Options
The choice of treatment for endometrial cancer depends on several factors, including the patient’s age, overall health, and the stage and grade of the tumor. The main treatment options include surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy. It is crucial for healthcare providers to explain these options in detail to help patients make informed decisions.
Surgery
Surgery typically includes a hysterectomy, which is the elimination of the uterus, ovaries, and fallopian tubes. For individuals who undergo a hysterectomy before menstruation will cease, menopause, and conception will no longer be possible. Post-surgery, patients may face menopause symptoms like vaginal dryness, night sweats, and hot flashes.
Radiation Therapy
Radiation therapy utilizes high-energy beams to destroy cancer cells by damaging their DNA, preventing them from multiplying. External radiation therapy involves directing radiation at the pelvis and other parts affected by cancer using a machine. Internal radiation therapy, or brachytherapy, entails placing a small radioactive device inside the vagina for brief periods.
Radiation therapy can also be used to drain a tumor pre-surgery, making it easier to eliminate, to rule out any lasting cancer cells post-surgery, or to relieve signs and enhance the quality of life when surgery is not an option.
Chemotherapy
Chemotherapy involves using medications to kill cancer cells. When combined with radiation therapy, it can help eradicate tumors or eliminate remaining cells post-surgery. Chemotherapy can also gradual the progression of the last stage of cancer and extend life expectancy. For endometrial cancer, chemotherapy is typically administered intravenously with breaks between sessions to allow the body to get well.
Targeted Therapy
Targeted therapy utilizes substances that specifically attack cancer cells. This approach can involve creating antibodies to fight cancer cells, halting the development of blood vessels that supply tumors, or obstructing signals that cause excessive cell reproduction. Not like radiation and chemotherapy, targeted therapies primarily affect cancerous cells and are less likely to cause widespread side effects.
Hormone Therapy
Hormone therapy aims to block or eliminate hormones that encourage cancer cell growth. Progestin is the primary hormone used, but other options include tamoxifen, aromatase inhibitors, and luteinizing hormone-releasing hormone agonists. Side effects vary depending on the medication used.
Hormone therapy is usually suggested for advanced endometrial cancer, often in combination with chemotherapy. However, some scientists suggest it may also be appropriate for women with early-stage, starting-stage tumors who want to preserve their fertility.
Risk Factors
Certain factors can increase the risk of developing endometrial cancer, particularly those related to high estrogen levels exposure. For example, people who have never had a pregnancy or who started their periods before age 12 might be at a higher risk. Additionally, experiencing menopause after the age of 55 can also contribute to increased risk.
Other factors that may raise the risk include:
- Hormone Therapy: Utilizing estrogen-only hormone therapy after menopause.
- Medications: Taking Nolvadex to treat or prevent breast cancer.
- Previous Treatments: Having received radiation therapy to the pelvic area.
- Family History: A family history of cancer of the uterus.
- Health Conditions: Having polycystic ovary syndrome, obesity, diabetes, hypertension, or other features of metabolic syndrome.
- Endometrial Hyperplasia: Endometrial hyperplasia, is a condition where the lining of the uterus becomes too thick.
These risk factors help identify individuals who might be more susceptible to developing endometrial cancer and guide preventive measures and monitoring strategies.
Causes
Healthcare providers don’t yet know exactly what causes endometrial cancer. However, they do understand that cancer starts when changes in the genes of cells lead them to grow uncontrollably rather than dying when they normally should.
Scientists are still researching what causes these genetic mutations. Meanwhile, health specialists have identified many factors that might increase the chance of developing endometrial cancer. These factors are still being studied, but they help us understand who might be more likely to develop this type of cancer.
Diagnosis
To determine endometrial cancer, a healthcare provider will start by reviewing the patient’s symptoms and enquiring about their family and personal medical histories. They will take a pelvic test, which involves inspecting and palpating the cervix, vagina, labia, and uterus to check for any changes or lumps in size or shape.
If further investigation is needed, the healthcare provider may order additional tests. One common test is a transvaginal ultrasound, which allows the healthcare provider to evaluate the shape and size of the uterus, as well as the thickness and texture of the endometrium. During this procedure, a transducer is inserted into the vagina, and the images are displayed on a monitor.
The examinations like blood tests can also be used to detect malignant cells in the body. Alternatively, a hysteroscopy may be performed.
Another diagnostic method is an aspiration biopsy, where a flexible, small tube is used to collect cells from the uterus for examination behind a microscope.
To observe the improvement of endometrial cancer, the healthcare provider might use a lymph node biopsy, a Pap test, or imaging tests like MRI scans. These methods help track the development of the cancer and guide treatment decisions.
Outlook
The outlook for endometrial cancer is generally positive. As stated by the American Cancer Society, the average five-year living rate for individuals with endometrial cancer is about 81.2 percent. This means that around 81 out of 100 people with endometrial cancer are expected to live at least five years after their diagnosis.
The survival rate is even higher if the cancer is identified early. When endometrial cancer is diagnosed at its earliest stage, the survival rate can be as high as 95 percent. This is because early detection often means the cancer has not spread and is easier to treat.
To help decrease the risk of developing endometrial cancer, the National Cancer Institute suggested a few key lifestyle changes. Regular exercise, a healthy and nutritious diet, and staying away from smoking can all contribute to lowering the risk of cancer and promoting overall health.
Summary
Endometrial cancer starts in the lining of the uterus and can transmit to surrounding tissues. It is most commonly treated with surgery, chemotherapy, radiation therapy, targeted therapy, and hormone therapy, depending on the stage and grade of the cancer. Risk factors include high estrogen levels, never being pregnant, early menstruation, and conditions like PCOS. Diagnosis involves reviewing symptoms, performing pelvic exams, and using tests like ultrasounds and biopsies. The average 5-year survival rate is 81.2%, but it increases to 95% with early detection. Lifestyle changes such as regular exercise and a balanced diet can help reduce risk.
