Endometrial Cancer

Endometrial Cancer: A Comprehensive Guide

Introduction

Endometrial cancer, also known as uterine cancer, is a type of cancer that develops in the lining of the uterus (endometrium). It is the most common gynecologic cancer in the United States, with an estimated 65,620 new cases and 12,550 deaths in 2023.

Risk Factors

The exact cause of endometrial cancer is not fully understood, but certain risk factors can increase the likelihood of developing the disease:

• Age: The risk of endometrial cancer increases with age, particularly after menopause.
• Obesity: Excess weight can lead to elevated levels of estrogen, which can stimulate the growth of endometrial cells.
• Diabetes: Diabetes is associated with higher levels of insulin, which can also promote cell growth.
• Unopposed estrogen: Prolonged exposure to estrogen without the balancing effect of progesterone (e.g., due to using estrogen-only hormone replacement therapy or having polycystic ovary syndrome) can increase the risk.
• Family history: A family history of endometrial cancer can suggest an inherited genetic predisposition.
• Tamoxifen use: This drug, used to treat breast cancer, can slightly increase the risk of endometrial cancer.

Symptoms

The most common symptom of endometrial cancer is abnormal vaginal bleeding. This can include:

• Bleeding after menopause
• Irregular bleeding between periods
• Heavy or prolonged periods
• Bleeding after intercourse

Other symptoms may include:

• Pelvic pain
• Vaginal discharge
• Weight loss
• Fatigue

Diagnosis

Endometrial cancer is typically diagnosed through a procedure called endometrial biopsy. This involves removing a small sample of tissue from the lining of the uterus for microscopic examination. Other diagnostic tests may include:

• Transvaginal ultrasound: A wand-like instrument is inserted into the vagina to create images of the uterus and surrounding structures.
• Hysteroscopy: A thin, lighted tube is inserted into the uterus to visualize the uterine lining directly.
• Magnetic resonance imaging (MRI): This imaging technique can provide detailed views of the uterus and its surrounding tissues.

Staging

Once endometrial cancer is diagnosed, it is staged to determine the extent of the disease. The staging system is based on:

• The size and location of the tumor
• Whether the cancer has spread to surrounding tissues or organs
• The presence of cancerous cells in regional lymph nodes

The staging system ranges from I (confined to the uterus) to IV (spread to distant organs).

Treatment

The treatment for endometrial cancer depends on the stage of the disease and the patient’s overall health. Common treatment options include:

• Surgery: Surgery to remove the uterus (hysterectomy) is the primary treatment for endometrial cancer. In some cases, the fallopian tubes and ovaries may also be removed.
• Radiation therapy: Radiation uses high-energy beams to kill cancer cells. It can be used before or after surgery, or as a sole treatment for early-stage cancer.
• Hormonal therapy: Medications like progestin are used to inhibit the growth of cancer cells that feed on estrogen.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells throughout the body. It is typically used for advanced or recurrent endometrial cancer.

Prognosis

The prognosis for endometrial cancer depends on various factors, including the stage of the disease and the patient’s age and overall health. In general, the survival rate for endometrial cancer is high.

• Stage I: The 5-year survival rate is approximately 95%.
• Stage II: The 5-year survival rate is around 80%.
• Stage III: The 5-year survival rate is approximately 60%.
• Stage IV: The 5-year survival rate is less than 20%.

Prevention

There is no sure way to prevent endometrial cancer, but certain lifestyle factors may reduce the risk:

• Maintain a healthy weight: Being overweight or obese can increase estrogen levels.
• Control blood sugar: Diabetes is associated with higher insulin levels, which can promote cell growth.
• Limit alcohol consumption: Excessive alcohol intake can raise estrogen levels.
• Avoid unnecessary estrogen therapy: Prolonged estrogen exposure without progesterone can increase the risk of endometrial cancer.
• Get regular checkups: Women over the age of 50 should have regular pelvic exams and endometrial biopsies as recommended by their doctor.

Conclusion

Endometrial cancer is a common gynecologic cancer, but it is often curable with timely diagnosis and treatment. Understanding the risk factors, symptoms, diagnostic procedures, and treatment options empowers women to take proactive steps in their health. By maintaining a healthy lifestyle, being aware of potential symptoms, and undergoing regular screening, women can help reduce their risk of developing endometrial cancer and improve their overall health.