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ENDOMETRIAL CANCER

female reproductive system anatomy 

Female reproductive system showing the endometrium lining

Endometrium is the inner membrane or lining of the uterus (womb). Endometrial cancer is cancer that starts in the endometrium.

Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year in the U.S. Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.

Endometrial cancer may sometimes be referred to as uterine cancer. However, different cancers may develop not only from the endometrium itself but also from other tissues of the uterus, including cervical cancer, sarcoma of the myometrium, and trophoblastic disease.

Causes and risk factors of endometrial cancer

Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to have a role. Estrogen helps stimulate the buildup of endometrium.

Risk factors include:

  • high levels of estrogen
  • estrogen replacement therapy without the use of progesterone
  • history of endometrial polyps or other benign growths of the uterine lining
  • endometrial hyperplasia
  • obesity
  • hypertension
  • polycystic ovary syndrome
  • infertility (inability to become pregnant)
  • never being pregnant
  • early menarche (onset of menstruation before age 12)
  • late menopause (cessation of menstruation after age 50)
  • endometrial polyps or other benign growths of the uterine lining
  • diabetes
  • Tamoxifen, a drug for breast cancer treatment
  • high intake of animal fat
  • pelvic radiation therapy
  • breast cancer
  • ovarian cancer
  • heavy daily alcohol consumption

Associated conditions include the following:

  • Colon or breast cancer
  • Hypertension
  • Polycystic ovarian disease

Signs and symptoms of endometrial cancer

  • Vaginal bleeding and/or spotting after menopause
  • Abnormal uterine bleeding, abnormal menstrual periods
  • Bleeding between normal periods before menopause
  • Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40 (may indicate premalignant changes)
  • Anemia, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.)
  • Lower abdominal pain or pelvic cramping
  • Thin white or clear vaginal discharge after menopause

Diagnostic exams and tests for endometrial cancer

A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.

Tests that may be done include:

  • Endometrial aspiration or biopsy
  • Dilation and curettage (D and C)
  • Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)

If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.

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.

Treatment of endometrial cancer

  • Surgery: A hysterectomy may be performed in women with the early stage 1 disease. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended. Abdominal hysterectomy is recommended over vaginal hysterectomy. This type of hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for a biopsy.
  • Radiation therapy: Surgery combined with radiation therapy is often used to treat 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. It is also used to treat women with stage 2 disease.
  • Chemotherapy: Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.

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