Endometrial Cancer

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What is Endometrial Cancer?

Endometrial Cancer is a type of cancer that arises from the inner lining (endometrium) of the uterus. It is one of the most common cancers affecting the female reproductive organs.

Is Endometrial Cancer a Medical emergency?

Endometrial Cancer is not a medical emergency, however, early diagnosis and management prevent complications, morbidity, and mortality.

Types

Endometrial carcinoma may be of the following types:

  • Endometroid adenocarcinoma
  • Endometroid adenoacanthomas
  • Endometroid adenosquamous carcinoma
  • Endometroid clear cell adenocarcinoma: Associated with a poor prognosis
  • Endometroid papillary serous adenocarcinoma: Associated with a poor prognosis

Causes

Endometrial Cancer is caused when there is a mutation in the cells of the inner lining of the uterus and their rapid multiplication. While the exact cause is not fully understood, several risk factors can contribute to its development.

Risk factors

Some risk factors for the development of Endometrial Cancer include:

  • Obesity: As it is seen to increase the estrogen levels in the body.
  • Diabetes mellitus
  • Family history of carpus uterine cancer
  • Nulliparity: No childbirth
  • Late menopause (after 50 years)
  • Age: Mostly seen in postmenopausal women (55-65 years)
  • Unopposed estrogen: High levels of estrogen:
    • Estrogen therapy
    • Polycystic ovarian disease
    • Granulosa cell tumors
    • Anovulation
  • Tamoxifen: An anticancer drug used for the treatment of breast cancer is associated with adenocarcinoma of the endometrium
  • History of breast cancer
  • History of colon cancer (hereditary nonpolyposis colon cancer)
  • History of ovarian cancer
  • Radiotherapy to the pelvis
  • Genetic disorders such as Lynch Syndrome, Cowden Syndrome

Signs & symptoms

The symptoms and signs of Endometrial Cancer may include:

  • Vaginal bleeding between periods
  • Vaginal bleeding in postmenopausal women
  • Pain in the lower back and the pelvic region
  • Fatigue and weakness

Investigations

Some investigations that are done for Endometrial Cancer include:

  • Laboratory tests:
    • CBP & ESR
    • Liver and renal function tests
    • Coagulation profile and blood typing
    • Blood glucose/HbA1c
  • Imaging tests:
    • Vaginal ultrasound
    • Hydroultrsonography
  • Procedures:
    • Endometrial biopsy
    • Hysteroscopically guided biopsy
    • Dilatation and curettage

Diagnosis

A diagnosis of Endometrial Cancer is established based on medical history, clinical evaluation, and results of the investigations done.

Course & stages

The staging of carpus uterine cancer is as follows:

  • Stage I: Partial or more than half of the uterine muscle wall invasion is present
  • Stage II: Tumor does not extend beyond the uterus
  • Stage III: Local and/or regional spread of the tumor
  • Stage IV: Tumor invasion of the bladder and/or bowel mucosa and/or distant metastases, intrabdominal and/or inguinal lymph nodes

Grading of carpus uterine cancer is done as follows:

  • Grade 1: Solid growth is less than 5%
  • Grade 2: Solid growth pattern is 6-50%
  • Grade 3: Solid growth pattern is more than 50%

Treatment options

Treatment of Endometrial Cancer is to remove disease and prevent its spread. Surgical intervention is the primary treatment in combination with medical management and radiotherapy.

Medical management

Medical management of Endometrial Cancer includes:

  • Chemotherapy: This is usually done in advanced stage carpus uterine cancer with metastasis to the bladder, bowel, etc.
  • Hormone therapy: This is usually done in advanced carpus uterine cancer

Interventional including surgery and indications for surgery

Surgical intervention is the treatment of choice upon diagnosis of corpus uterine cancer and the following procedures are done:

  • Total Hysterectomy with salpingo-oophorectomy: Removal of the uterus with the fallopian tubes and the ovaries. Additionally, all the lymph nodes that are involved are also removed

Radiation

Radiotherapy is done for Endometrial Cancer as an adjunct to surgical intervention and with chemotherapy in advanced corpus uterine cancer. Radiotherapy is not required for stage I & II Endometrial Cancer after surgery. Radiotherapy may include:

  • Vaginal brachytherapy: For grade 3 tumors that have not invaded the muscle wall of the uterus and for grade 1 and 2 tumors with high-risk factors
  • Pelvic external beam radiation therapy: When there is an extensive disease involving the uterine muscle wall, or involvement of the ovaries, fallopian tubes, bladder, bowel, or rectum

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Some measures that can help in the prevention of Endometrial Cancer include:

  • Use of combination contraceptive pills
  • Maintain an ideal body weight
  • Keep diabetes under control
  • Postmenopausal hormone therapy only under medical supervision

Complications

Some complications of corpus uterine cancer and surgical interventions for its treatment include:

  • Severe anemia
  • Spread of cancer to distant organs
  • Multi-organ failure
  • Bleeding
  • Infections
  • Deep vein thromboembolism
  • Death

Prognosis

The prognosis for corpus uterine cancer that is identified and treated early is generally very good. The prognosis of corpus uterine cancer that is diagnosed in later stages, and of cancers with certain cell types are generally poor.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if the symptoms and signs of corpus uterine cancer are noticed.

Indications for hospitalization if required

Hospitalization will be required for the surgical management of corpus uterine cancer.

Screening methods

Screening for corpus uterine cancer via regular and periodic check-ups, imaging, and biopsies is recommended in women who are at high risk such as those having a history of Hereditary Nonpolyposis Colon Cancer, ovarian cancer, or breast cancer, etc.

Suggested clinical specialist/ Departments to consult for this condition

Endometrial Cancer will be treated by specialists from the department of gynecological oncology, gynecology, & obstetrics.

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