Definition and Overview

Endometrial carcinoma is cancer that begins in the lining of the uterus or womb (endometrium). Sometimes loosely referred to as uterine cancer, it is the most common gynaecologic malignancy in the United States, accounting for more than 6% of all cancers in women. Although very common, it is curable in many cases especially when diagnosed early and treated when cancer cells haven’t spread to other parts of the body yet. According to the National Cancer Institute, the five-year survival rate for localised endometrial cancer is 95.3%

The uterus is a hollow muscular organ responsible for the development and nourishment of the embryo and foetus during pregnancy. It is connected to the cervix, fallopian tubes, and the vagina.

Endometrial carcinoma, also known as endometrial cancer, is caused by the abnormal growth of cells in the endometrium that results in the development of malignant (cancerous) tumours.

95% of endometrial cancers are endometrial adenocarcinoma, which means that the cancerous cells originated from glandular tissues. A small number of cases are carcinomas, which means that cancer started in the epithelium or the layer of cells that line the endometrium.

There are many different types of uterine cancer. Endometrioid adenocarcinoma is the most common. Although it accounts for as much as 75% of all uterine cancer cases, it is commonly detected early. Thus, it has a high cure rate. Meanwhile, about 10% of cases are serous adenocarcinoma. These are tumours that typically spread to lymph nodes and other parts of the body. Rare types of this disease are adenosquamous carcinoma (has elements of both carcinoma and adenocarcinoma of the squamous cells) and carcinosarcoma (has elements of both sarcoma and adenocarcinoma).

Causes of the Condition

Although it has been established that endometrial cancer is the result of the abnormal growth of cells in the endometrium, what causes the cells to behave in such a way is yet to be determined. However, doctors theorise that the following have a role to play:

  • Breast cancer

  • Never having a child

  • Increasing age

  • Obesity

  • Diabetes mellitus

  • Late menopause

  • High level of oestrogen

  • Genetic disorders, such as inherited colon cancer syndrome

  • Oestrogen replacement therapy during menopause

  • Treatment for other forms of cancer

  • Smoking

  • Metabolic syndromes

  • Endometrial hyperplasia

  • A family history of endometrial cancer

Key Symptoms

Endometrial cancer is one of the few types of cancer that is often detected early. This is because it produces worrying signs. More than 90% of patients experience extremely heavy or frequent episodes of bleeding or abnormal menstrual cycles. Aside from bleeding, other endometrial cancer symptoms are rather uncommon. In advanced cases, patients may also suffer from an enlarged uterus, pelvic cramping, or lower abdominal pain especially when cancer has already spread to surrounding areas. Difficulty urinating and painful sexual intercourse are also less common uterine cancer symptoms. Only about 10% of women who experience them have cancer.

Who to See and Types of Treatments Available

Patients with symptoms of uterine cancer are highly advised to see their doctors as soon as possible. Early diagnosis significantly increases their chances of successful treatment.

Doctors can make an initial assessment and order diagnostic tests to determine if symptoms are caused by endometriosis cancer. They typically start with a pelvic examination and inspect the outer portion of the vulva as well as the cervix using a device called a speculum. Other tests may include transvaginal ultrasound (to assess the texture and thickness of the endometrium), hysteroscopy (to examine the endometrium and the inside of the uterus), and a biopsy in which the doctor obtains a small amount of cells from the inside of the uterus for laboratory analysis. If more sample cells are needed, doctors may perform a surgical procedure called dilation and curettage (D&C). If test results suggest the presence of endometrial cancer, the patient is referred to a gynaecologic oncologist, a doctor who specialises in the treatment of cancers of the female reproductive system.

The standard treatment for endometrial carcinoma is surgery to remove the malignant tumour. This is often combined with adjuvant therapy, such as chemotherapy and radiotherapy to kill remaining cancer cells and lower the risk of recurrence. The type of surgical procedure that the patient undergoes depends on the severity of her condition and whether or not cancer cells have already spread to different parts of the body. The goal of each procedure is to remove all organs and structures that contain cancer cells. These procedures include total hysterectomy (uterus and cervix removal), bilateral salpingo-oophorectomy (removal of fallopian tubes and ovaries), radical hysterectomy (removal of the cervix, uterus, and part of the vagina), and lymphadenectomy (removal of lymph nodes from the pelvic area).

For patients with low-risk stages I and II cancer and who are relatively healthy to undergo a surgical procedure, their treatment is usually a combination of bilateral salpingo-oophorectomy and total hysterectomy followed by either internal or external radiation therapy. For stage III endometrial cancer, radical hysterectomy is typically combined with bilateral salpingo-oophorectomy and chemotherapy. For advanced and recurrent cases, treatment includes the removal of lymph nodes, radical hysterectomy, and adjuvant therapy as well as targeted therapy. If the patient is physically weak to undergo any surgery or if the risks of any surgical procedure outweigh possible benefits, palliative care is advised. The goal of this treatment is to improve the patient’s quality of life through symptom management.

Uterine Cancer Prognosis

When compared to other types of cancer, the prognosis for endometrial carcinoma is generally good because it is often diagnosed early. The five-year survival rate for localised cases is 95%. This goes down to 69% for cancer that has spread to nearby organs or structures. If cancer has metastasised (spread) to distant organs, the rate further goes down to 17%.

References:

  • National Cancer Institute. SEER stat fact sheets: endometrial cancer. Surveillance, Epidemiology, and End Results (SEER) Program. Available at http://seer.cancer.gov/statfacts/html/corp.html.

  • Bernstein L, Deapen D, Cerhan JR, et al. Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Cancer Inst. 1999 Oct 6. 91(19):1654-62. [Medline].

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