Endometrial Cancer

Causes and Risk Factors

The exact cause of endometrial cancer is not fully understood, but several risk factors have been identified that increase a woman’s likelihood of developing the disease:

1. Hormonal Imbalances:
   • The most significant risk factor for endometrial cancer is exposure to estrogen without the balancing effect of progesterone. Estrogen stimulates the growth of the endometrial lining, and if this is not counteracted by progesterone (as occurs during a woman’s natural menstrual cycle), it can lead to abnormal cell growth and potentially cancer.
   • Conditions that result in high levels of estrogen or estrogen dominance can increase the risk of endometrial cancer, including:
     • Obesity: Fat cells produce estrogen, so overweight women have higher levels of estrogen.
     • Polycystic ovary syndrome (PCOS): A hormonal disorder that can lead to irregular ovulation and an imbalance of estrogen and progesterone.
     • Hormone replacement therapy (HRT): Particularly when used without progesterone, estrogen replacement therapy (often used during menopause) can increase the risk.
     • Menstrual irregularities: Women who experience infrequent periods, late menopause, or never had children may have prolonged exposure to estrogen.
2. Age:
   • Endometrial cancer is most common in women over 50, particularly those who have gone through menopause. The risk increases with age, especially after 60.
3. Family History:
   • A family history of endometrial cancer, ovarian cancer, or breast cancer (particularly related to BRCA mutations) can increase the risk, as some genetic factors contribute to an increased risk of cancer in the uterus.
4. Diabetes:
   • Women with diabetes are at an increased risk of endometrial cancer, likely due to the link between insulin resistance, obesity, and hormonal imbalances.
5. Never having been pregnant:
   • Women who have never had children are at a higher risk, likely because of prolonged exposure to estrogen.
6. Previous cancer treatments:
   • Some women who have had breast or ovarian cancer, particularly those who received certain types of hormone therapy or radiation, may be at a higher risk for endometrial cancer.
7. Lynch syndrome (Hereditary non-polyposis colorectal cancer, HNPCC):
   • This genetic condition increases the risk of several cancers, including endometrial cancer. Women with Lynch syndrome may develop endometrial cancer at an earlier age, often before 50.

Symptoms

Endometrial cancer often presents with symptoms in its early stages, which can make it easier to detect early. The most common symptom is:

• Abnormal vaginal bleeding: This is the most common symptom of endometrial cancer. It may include:
  • Bleeding between periods
  • Postmenopausal bleeding (bleeding that occurs after a woman has gone through menopause)
  • Heavier or longer-than-usual menstrual periods
  • Spotting or watery discharge from the vagina
  • In some cases, women may experience no symptoms at all until the cancer has spread.

Other potential symptoms include:

• Pelvic pain or pressure: Pain or a feeling of fullness in the pelvic area, though this is more common in later stages of the disease.
• Unexplained weight loss: Some women may lose weight unintentionally as the cancer progresses.
• Pain during intercourse: In more advanced stages, women may experience pain during sex or discomfort in the pelvic region.

Any abnormal bleeding or symptoms should be evaluated by a healthcare provider, as they may be indicative of endometrial cancer or other conditions.

Diagnosis

If endometrial cancer is suspected, a doctor will conduct several tests to confirm the diagnosis and determine the extent of the disease:

1. Pelvic Exam: The doctor will manually check for abnormalities in the uterus, ovaries, and other pelvic structures.
2. Transvaginal Ultrasound: This imaging test uses sound waves to create an image of the uterus and can help identify thickening of the endometrium, which may be indicative of cancer.
3. Endometrial Biopsy: The definitive test for diagnosing endometrial cancer. During an endometrial biopsy, a small sample of tissue is taken from the uterine lining and examined under a microscope for cancerous cells.
4. D&C (Dilation and Curettage): In some cases, a D&C may be performed to remove tissue from the uterus for examination if an endometrial biopsy is inconclusive or if the doctor needs more tissue for analysis.
5. Hysteroscopy: A procedure that uses a thin, lighted tube (hysteroscope) inserted through the cervix into the uterus to examine the uterine lining directly. If any abnormalities are detected, a biopsy can be performed during the procedure.
6. CT scan, MRI, or PET scan: Imaging tests may be used to determine whether the cancer has spread (staging) to other areas of the body, such as the pelvic lymph nodes, abdomen, or distant organs.

Staging

Endometrial cancer is staged using the FIGO system (International Federation of Gynecology and Obstetrics), which is based on the extent of spread. The stages range from Stage I (localized) to Stage IV (advanced). The stages are:

• Stage I: Cancer is confined to the uterus.
  • Stage IA: Cancer is confined to the endometrium or the inner part of the uterus.
  • Stage IB: Cancer has spread to the muscle layer of the uterus (myometrium).
• Stage II: Cancer has spread to the cervix but not beyond the uterus.
• Stage III: Cancer has spread beyond the uterus to nearby structures, such as the pelvic lymph nodes, vagina, or ovaries.
• Stage IV: Cancer has spread to distant organs, such as the bladder, rectum, or other areas outside the pelvis.

Treatment

Treatment for endometrial cancer depends on the stage, the woman’s health, and whether she wishes to preserve fertility. The main treatment options include:

1. Surgery:
   • The most common treatment for endometrial cancer is surgery, often involving a hysterectomy (removal of the uterus). If the cancer is advanced, a radical hysterectomy (removal of the uterus, cervix, and surrounding tissues) may be needed, along with the removal of lymph nodes in the pelvic and abdominal areas.
   • In some cases, a laparoscopic (minimally invasive) surgery may be an option, which involves smaller incisions and quicker recovery time.
2. Radiation Therapy:
   • Radiation is often used after surgery to kill any remaining cancer cells, especially if there is a higher risk of recurrence. It may also be used in cases where surgery is not possible or if the cancer has spread locally (e.g., to the vagina or pelvic area).
   • Brachytherapy is a form of radiation therapy that involves placing a radioactive source directly into the uterus.
3. Chemotherapy:
   • Chemotherapy may be used for more advanced or high-risk cancers, particularly if cancer has spread to other areas of the body. It involves the use of drugs that kill cancer cells or stop their growth.
4. Hormone Therapy:
   • For certain types of endometrial cancer, especially those that are estrogen receptor-positive, hormone therapy (using progesterone or progestin) can be used to block estrogen and slow the growth of cancer cells.
5. Targeted Therapy and Immunotherapy:
   • In some cases, targeted therapies that attack specific molecules involved in cancer growth or immunotherapy to boost the body’s immune system may be options for advanced or recurrent cancers.

Prognosis

The prognosis for endometrial cancer depends on the stage at diagnosis:

• Early-stage (Stage I): The survival rate for women diagnosed with early-stage endometrial cancer is very high. The 5-year survival rate for Stage I endometrial cancer is approximately 90% or higher.
• Advanced-stage: For women with advanced or metastatic endometrial cancer (Stage III and IV), the prognosis is less favorable, but treatment options such as chemotherapy, radiation, and targeted therapies can help improve outcomes and quality of life.

Prevention

There is no guaranteed way to prevent endometrial cancer, but several steps can reduce the risk:

• Maintain a healthy weight: Obesity is a major risk factor for endometrial cancer, so maintaining a healthy weight through diet and exercise is important.
• Control diabetes: Managing diabetes and reducing insulin resistance may help lower the risk.
• Use of birth control: Oral contraceptives (birth control pills) can help regulate hormonal levels and lower the risk of endometrial cancer by reducing the number of menstrual cycles and the duration of estrogen exposure.
• Consider a hysterectomy: For women at very high risk (e.g., those with Lynch syndrome), a prophylactic hysterectomy may be considered to prevent the development of endometrial cancer.

Conclusion

Endometrial cancer is one of the most common cancers affecting the uterus, but it is often diagnosed early due to its symptoms, particularly abnormal bleeding. With early detection and treatment, the prognosis is generally good. Regular check-ups, a healthy lifestyle, and awareness of risk factors can help reduce the risk of developing this cancer. If you have concerns about your health or risk factors, it’s essential to speak with a healthcare provider for guidance and appropriate screening.