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  • Michael Frey, MD

Endometrial Cancer (Cancer Of The Uterus)

Endometrial cancer is a cancerous growth of the endometrium.


Causes Endometrial cancer is the most common type of uterine cancer. The exact cause of endometrial cancer is not known. An increased level of estrogen hormone may play a role. This stimulates the buildup of the lining of the uterus. This can lead to abnormal overgrowth of the endometrium and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70. A few cases may occur before age 40.

The following factors related to your hormones increase your risk for endometrial cancer:

  • Estrogen replacement therapy without the use of progesterone

  • History of endometrial polyps

  • Infrequent periods

  • Never being pregnant

  • Obesity

  • Diabetes

  • Polycystic ovary syndrome (PCOS)

  • Starting menstruation at an early age (before age 12)

  • Starting menopause after age 50

  • Tamoxifen, a drug used for breast cancer treatment


Women with the following conditions also seem to be at a higher risk for endometrial cancer:

  • Colon or breast cancer

  • Gallbladder disease

  • High blood pressure



Symptoms Symptoms of endometrial cancer include:

  • Abnormal bleeding from the vagina, including bleeding between periods or spotting/bleeding after menopause

  • Heavy, or frequent episodes of vaginal bleeding after age 40

  • Lower abdominal pain or pelvic cramping


Exams and Tests


  • During the early stages of the disease, a pelvic exam is often normal.

  • Pap smear

  • Endometrial biopsy: Using a small or thin catheter (tube), tissue is taken from the lining of the uterus (endometrium). The cells are examined under a microscope to see if any appear to be abnormal or cancerous.

  • Hysteroscopy: A thin telescope-like device is inserted through the vagina and the opening of the cervix. It lets the provider view the inside of the uterus.

  • Ultrasound: Sound waves are used to make a picture of the pelvic organs. The ultrasound may be performed abdominally or vaginally. An ultrasound can determine if the lining of the uterus appears abnormal or thickened.

  • Sonohysterography: Fluid is placed in the uterus through a thin tube, while vaginal ultrasound images are made of the uterus. This procedure can be done to determine the presence of any abnormal uterine mass which may be an indication of cancer.

  • Magnetic resonance imaging (MRI): In this imaging test, powerful magnets are used to create images of internal organs.

Stages of endometrial cancer

  • Stage 1: The cancer is only in the uterus.

  • Stage 2: The cancer is in the uterus and cervix.

  • Stage 3: The cancer has spread outside of the uterus, but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).

  • Stage 4: The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.

Cancer is also described as grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive. Aggressive means that the cancer grows and spreads quickly.


Treatment Treatment options include:

  • Surgery

  • Radiation therapy

  • Chemotherapy


Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer.

Surgery combined with radiation therapy is another treatment option. It is often used for women with stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3 or Stage 2 disease.


Chemotherapy or hormonal therapy may be considered in some cases, most often for those with stage 3 and 4 disease.

Outlook (Prognosis) Endometrial cancer is usually diagnosed at an early stage. If the cancer has not spread, 95% of women are alive after 5 years. If it has spread to distant organs, about 25% of women are still alive after 5 years.

Possible Complications Complications may include any of the following:

  • Anemia due to blood loss (before diagnosis)

  • Perforation (hole) of the uterus, which may occur during a D and C or endometrial biopsy

  • Problems from surgery, radiation, and chemotherapy


Prevention

  • Maintaining a normal weight

  • Using birth control pills for over a year

  • Pap smears

  • Pelvic exams yearly


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