Endometrial Cancer: Health InformationGeneral Information

Endometrial Cancer: Health InformationGeneral Information

Endometrial cancer is the most common cancer affecting the female reproductive organs. It begins in the endometrium, which is the layer of tissue lining the inside of the uterus, or womb. The uterus is the hollow, pear-shaped organ where a foetus develops during pregnancy.

Structure of the Uterus

The uterus has two main parts:

  • The Cervix: The lower, narrower part that extends into the vagina (birth canal).
  • The Body of the Uterus (Corpus): The upper, larger part. This body has two layers: the muscle wall (myometrium) and the inner lining (endometrium).

Before a menstrual period, the endometrium thickens. If pregnancy does not occur, this tissue is shed as menstrual flow. This cycle ceases after menopause.

Endometrial and Uterine Cancer Types

Almost all uterine cancers originate in the endometrium. The most common form is Endometrial Adenocarcinoma, which forms from the cells lining the inside of certain organs.

Less common types of uterine cancer include:

Uterine Sarcoma

A rare cancer that forms in the muscle wall of the uterus, not the endometrium.

Uterine Carcinosarcoma

Cancer cells that appear as a mix of adenocarcinoma and sarcoma cells.

Uterine Serous Carcinoma

An uncommon and malignant form of endometrial cancer, usually affecting women who have gone through menopause.

Clear Cell Carcinoma (CCC)

A rare and aggressive subtype, making up less than 5% of all uterine carcinomas.

Statistics and Risk Factors

While many women in India are diagnosed with uterine cancer each year (with most being endometrial cancers), nearly 80% of cases are diagnosed in women aged 55 or older. However, diagnoses in younger women are increasing.

Endometrial cancers often develop over several years, sometimes starting as a pre-cancerous condition like endometrial hyperplasia (an overgrowth of cells in the uterine lining). Fortunately, many cases are detected early due to clear warning signs like abnormal or postmenopausal bleeding, which often leads to successful treatment.

Factors that increase the risk of developing endometrial cancer include:

Obesity

Being overweight can raise your risk two to four times, as higher fat tissue increases oestrogen levels, which can stimulate endometrial growth.

Diet

Eating a diet high in fat.

Age

Over 95% of cases occur in women aged 40 and above.

Hormone Use

  • Tamoxifen: This breast cancer drug can cause the endometrial lining to grow. Any changes in periods or bleeding after menopause while taking Tamoxifen should be reported to a doctor.
  • Oestrogen Replacement Therapy (ERT): Taking ERT without progesterone if you still have a uterus. (Note: Birth control pills may lower your risk).

Medical History

  • • Personal or family history of endometrial, ovarian, or colon cancer, which may indicate Lynch syndrome.
  • • Ovarian diseases, such as Polycystic Ovarian Syndrome (PCOS).
  • • Complex atypical endometrial hyperplasia (a precancerous condition).
  • • Diabetes.
  • • Never having been pregnant.
  • • Breast or ovarian cancer.
  • • Pelvic radiation for other cancers (main risk factor for uterine sarcoma).

Menstrual History

Starting periods before age 12 or going through menopause late.

While risk factors increase your chance of developing the condition, having them does not guarantee a diagnosis. It is always wise to discuss any concerns with your doctor.

Symptoms

Endometrial cancer symptoms can vary.

For Postmenopausal Women

  • • Any vaginal bleeding, spotting, or unusual discharge.

For Premenopausal Women

If you experience any of the following symptoms for more than two weeks, you should consult your doctor:

  • • Unusual bleeding, such as bleeding between periods or a heavier menstrual flow.
  • • Abnormal vaginal discharge.
  • • Pelvic pain or pressure.
  • • Unexplained weight loss.

It is important to remember that these symptoms can also be signs of other health problems, but they must be discussed with your doctor to rule out cancer.

Diagnosis

Early and accurate diagnosis significantly improves the chance of successful treatment. The care team at SSCHRC uses advanced techniques and technology for diagnosis and staging to determine the most effective treatment plan.

Endometrial Cancer Diagnostic Tests

Biopsy

If your doctor suspects endometrial cancer, a biopsy is the first step, involving the removal and microscopic study of suspected tissue. Methods include:

  • Endometrial Biopsy: A small amount of tissue is removed from the uterus lining using suction through a thin, flexible tube inserted via the cervix.
  • Dilation and Curettage (D&C): This surgical procedure is done if a clinic biopsy is unsuccessful or does not provide enough tissue. The cervix is widened (dilated), and a tool called a curette is used to collect cells from the uterine lining.
  • Hysteroscopy: A thin, lighted, telescope-like device (hysteroscope) is inserted through the vagina to allow the doctor to view the uterus and take small tissue samples. It may be performed with a D&C.

Imaging Exams

If cancer is diagnosed, imaging helps determine the extent of the disease and check for spread outside the uterus. Tests may include:

  • • Ultrasound
  • • CT (Computed Axial Tomography) scans
  • • MRI (Magnetic Resonance Imaging) scans
  • • PET (Positron Emission Tomography) scans
  • • Chest X-ray

Blood Tests

These tests provide information on how your body is functioning and may include:

  • • Complete blood count (CBC)
  • • Complete metabolic panel (CMP)
  • • CA 125: This test measures levels of the CA 125 substance, which endometrial cancers sometimes release into the blood. High levels may suggest the cancer has spread or returned.

Genetic Testing

Genetic counselling may be recommended if you:

  • • Were diagnosed with endometrial cancer before age 50.
  • • Have had colorectal cancer.
  • • Have close relatives with colon, rectal, or endometrial cancer.
  • • Have a relative who has tested positive for a Lynch syndrome gene mutation.
  • • Have specific abnormalities or features shown in tests of the endometrial cancer tissue itself.

Treatment

Treatment for endometrial cancer is highly personalised at SSCHRC and is based on several factors, including the cancer's type, stage, molecular characteristics, and your general health. A collaborative team of specialists works together to ensure comprehensive care while minimising side effects.

One or more of the following therapies may be recommended:

Fertility Preservation

For women who wish to retain the ability to have children, options for preserving the uterus may include oral progesterone or a progesterone-eluting intrauterine device (IUD).

Surgery

Surgery is the main treatment for endometrial cancer and is crucial for staging the disease. Procedures may include:

  • Total Hysterectomy: Surgical removal of the uterus and cervix.
  • Bilateral Salpingo-oophorectomy: Removal of both ovaries and fallopian tubes.
  • Lymph Node Procedures:
    • - Sentinel lymph node mapping and biopsies: A procedure using a special dye to find the sentinel lymph node (the first lymph node where cancer may spread) for biopsy.
    • - Pelvic and para-aortic lymph node dissection: Removal of lymph nodes in the pelvis and lower abdomen along the aorta.
  • Radical Hysterectomy: An option in some cases, involving the removal of the uterus, cervix and surrounding tissue, and the upper vagina.

Surgery can be Minimally Invasive (using small incisions and a laparoscope or robotic surgery) for faster healing, or Open (using a large incision). If the cancer has spread to the abdomen, Tumour Debulking may be performed to remove as much cancer as possible before further treatment.

Radiation Therapy

This uses powerful, focused energy beams to kill cancer cells, accurately targeting the tumour while protecting healthy tissue. It may be used after a hysterectomy, as the primary treatment if surgery is not possible, or at other stages.

  • External Beam Radiation Therapy: Radiation is delivered from outside the body using a machine.
  • Brachytherapy: Radiation is given internally near the tumour or tumour bed using a device or temporary implant.

Chemotherapy

Drugs are used to kill cancer cells, control their growth, or relieve symptoms. It may involve a single drug or a combination, depending on the cancer type and growth rate.

Hormone Therapy

If tests show cancer cells have receptors for hormones, drugs can be used to reduce or block the hormones that cause the cancer to grow. These therapies may include:

  • • Progestins (oral or via IUD)
  • • Tamoxifen
  • • Aromatase inhibitors

Targeted Therapy

These drugs are designed to interfere with specific molecules (like proteins) that cancer cells need to survive, multiply, and spread.

Immunotherapy

This treatment improves the body's own immune system's ability to find and eliminate cancer cells.

Clinical Trials

SSCHRC often participates in clinical trials, offering patients access to new and promising treatment options.

Sri Shankara Cancer Hospital Footer Shankara Cancer Hospital & Research Center