The endometrium is a lining of the uterus and when cancerous cells develop in this region, women suffer from endometrial cancer. This must be distinguished from cancer of the uterine muscles that is called cancer of the uterus. The most common form of endometrial cancer is adenocarcinoma that affects the glands of the endometrium. In the US, according to the American Cancer Society, around 7780 women die from endometrial cancer each year.
Endometrial cancer affects postmenopausal women between the ages of 50-65. Risk factors include obesity, diabetes, hypertension, pelvic radiation therapy done for other medical problems, family history of ovarian or breast cancer, endometrial cancer among 1st degree relatives or hereditary nonpolyposis colorectal cancer.
A person who has been on medication to reduce the risk of breast cancer can also develop symptoms of endometrial cancer. Women who have had early onset of menstrual periods (before the normal age of 12 ) or late menopause (after the normal age of 51 ) and who have never been pregnant are all at risk. This has to do with exposure of the uterus to estrogen that poses a greater risk. Estrogen replacement therapy and socioeconomic status also increase the risk (poor women are less likely to develop this cancer).
Symptoms of endometrial cancer
It is important to know the symptoms of endometrial cancer, so that anyone who has them must get tested at once.
Abnormal uterine bleeding: More than 90% of women who suffer from endometrial cancer have abnormal uterine bleeding. This could be either postmenopausal or pre-menopausal recurrent metrorrhagia (irregular and spotted bleeding between expected menstrual periods). The bleeding can sometimes last for even longer than a week. Around 1/3 of women who have endometrial cancer will have abnormal uterine bleeding.
Some women could have a vaginal discharge that is abnormal, blood tinged or watery a few weeks or months before this postmenopausal bleeding. Sometimes the vaginal discharge will continue even when bleeding starts, therefore mixing with the blood. If normal pre-menopausal women have such a vaginal discharge, any abnormal, heavy or discolored discharge must be reported at once to the physician.
Pelvic pain is another hallmark symptom of endometrial cancer. Pelvic pain takes place in the pelvis that is the region between the hip bones and below the stomach. The pain arises because of pain in the reproductive organs like uterus, vagina, fallopian tubes and ovaries. The pain can range from dull to sharp or you can experience severe cramping pain or pain when you urinate, have bowel movements or sex.
Abdominal pain is pain that is felt in the abdominal region between the chest and groin. Pain can be generalized and felt all over the abdomen, localized in a specific area, cramp-like or colic-type of pain. For endometrial cancer, abdominal pain has nothing to do with the abdomen but due to an inflammation of pelvic region and the reproductive organs found there.
Pain during intercourse is also a symptom of irritation or inflammation of the uterus and must not be ignored.
Anemia: Some patients with endometrial cancer can become anemic and suffer from symptoms such as weakness, lightheadedness, breathlessness, fatigue and extreme pallor. Anemia is caused when RBC count is low – in this case, it could be because of excessive loss of blood due to abnormal uterine bleeding. They can also lose weight rapidly.
Painful urination affects women more than men and could be due to various causes like urinary tract infection, age, pregnancy, endometrial cancer etc.
What to do?
It is important that those who display any of the above symptoms visit a doctor immediately,. Before visiting the doctor, you can prepare by making a detailed list of all your symptoms, all the medications you are taking and other pertinent details. Take a family member with you and write down questions you wish to ask the doctor regarding tests, treatment, prognosis etc.
Treatment of Endometrial cancer
Doctors will conduct a pelvic examination and order a Pap test. While the Pap test will not show the formation of cancer cells on the endometrium, it will tell the doctor if your vaginal and cervical cells are normal.
To determine the chances of a patient suffering from endometrial cancer, the doctor performs either of the following procedures. An endometrial biopsy will be done that provides a sample of endometrial tissue for analysis. This procedure takes just about a minute. The D&C (Dilation and curettage) procedure provides sample of endometrial tissues by first dilating the cervix and then scraping off tissues using special instruments. This procedure takes approximately one hour.
The biopsy results inform the doctor if there are cancerous cells. Depending on the stage of cancer, age and general health of the patient, appropriate treatment will be suggested.
Four primary treatment options are available. The patient undergoes a hysterectomy to remove the uterus and pelvic lymph nodes. If surrounding tissues are removed, it is called a radical hysterectomy. Sometimes, the fallopian tubes and ovaries may also be removed if the cancer has spread.
Radiation therapy is the next treatment options and high-energy X-rays are used to shrink tumors and kill cancer cells.
Chemotherapy uses IV, IM, or oral drugs to kill cancer cells. This is a systematic treatment and the drugs penetrate all cancerous cells and are useful when the cancer has spread beyond the endometrium.
Hormone therapy involves taking hormones as pills. These can kill cancer cells by changing the way hormones that help cancer cells grow function. For endometrial cancer, progesterone could be used to slow the growth of cancer cells.
Endometrial cancer : Prevention and Precaution
The prognosis for endometrial cancer depends on the stage at which the symptoms are recognized and the treatment is commenced. When the cancer is caught in the early stage, 95% may survive for 5 years if the cancer has not spread. If it has spread to other organs, 23% may survive for 5 years.
There is no way to prevent endometrial cancer and no effective screening tests are available. All women who are at risk should be closely monitored and undergo frequent Pap smear tests, pelvic exams and sometimes even undergo an endometrial biopsy.
Birth control pills used for at least a year can reduce the risk of endometrial cancer. Women who are on estrogen replacement therapy without accompanying progesterone therapy will also be at risk and must undergo regular check-ups.
Women in the high risk category who display symptoms of endometrial cancer must get treatment at once to improve their prognosis.