A type of cancer called endometrial cancer begins in the endometrium, the lining of the uterus. There are other types of cancer that can affect the uterus, such as uterine sarcoma, which is sometimes called uterine cancer. Due to abnormal vaginal bleeding, endometrial cancer is often detected early, which prompts women to consult with their physicians.
The exact cause of endometrial cancer is not known, but it is related to the balance of hormones in the body. Hormones are chemical messengers that regulate various functions and processes. The ovaries produce estrogen and progesterone, two hormones that affect the uterus.
As estrogen grows and thickens the endometrium, progesterone prepares it for pregnancy. In case pregnancy does not occur, the endometrium sheds during menstruation. In contrast, the endometrium can grow abnormally and become cancerous if there is too much estrogen and not enough progesterone.
Some factors that can increase the risk of endometrial cancer by affecting the hormone balance are:
Obesity: Fat tissue produces estrogen, which can increase the level of estrogen in the body.
Diabetes: High blood sugar can affect the production and use of insulin, which can influence the level of estrogen and progesterone.
Insufficient progesterone and excess estrogen can result from irregular ovulation due to conditions that affect the ovulation cycle, such as polycystic ovary syndrome (PCOS).
Progestin is a synthetic form of progesterone that counteracts estrogen's effects on the endometrium. Taking estrogen without progestin after menopause increases the risk of endometrial cancer.
Ovarian tumors: Some rare types of ovarian tumors can produce estrogen, which can stimulate the endometrium.
Other factors that can increase the risk of endometrial cancer are:
Age: Most cases of endometrial cancer occur in women over 50 years old.
Family history: Having a close relative with endometrial cancer can increase the risk of developing it.
Genetic syndromes: Some inherited conditions, such as Lynch syndrome, can increase the risk of endometrial cancer and other cancers.
Starting menstruation before 12 or beginning menopause later can increase estrogen and progesterone exposure to the endometrium.
The most common symptom of endometrial cancer is abnormal vaginal bleeding, which can include:
Bleeding after menopause
Bleeding between periods
Heavier or longer periods than usual
Spotting or discharge
Other symptoms of endometrial cancer may include:
Pelvic pain or pressure
Difficulty or pain when urinating
Pain during sexual intercourse
Unexplained weight loss
If you experience any of these symptoms, especially if they persist or are severe, you should see a doctor right away. Other conditions that can cause these symptoms include infections, fibroids, or polyps.
To diagnose endometrial cancer, the doctor will perform a physical exam, ask about your medical history and symptoms, and order some tests. These tests may include:
Pelvic exam: The doctor will examine the external and internal genital organs, and feel the uterus and ovaries for any abnormalities.
This is a procedure in which a sound wave is used to create images of the uterus and other pelvic organs that are inserted into the vagina. It can be used to determine the thickness and texture of the endometrium as well as any masses or growths in the uterus.
Through the vagina and cervix, the doctor inserts a thin, flexible tube with a light and a camera into the uterus. This allows them to see inside the uterus and take a biopsy if necessary.
In order to confirm the diagnosis of endometrial cancer, a small sample of tissue is removed from the endometrium and examined under a microscope.
Other imaging tests: Tests such as CT scan, MRI, or PET scan may be done to check if the cancer has spread to other parts of the body.
The treatment for endometrial cancer depends on the stage of the cancer, the characteristics of the cancer cells, the patient’s age, general health, and preferences. The main types of treatment are:
The most common treatment for endometrial cancer is surgery to remove the uterus, called a hysterectomy. The ovaries and fallopian tubes may also be removed, called a salpingo-oophorectomy. A lymph node dissection is also sometimes performed in order to remove lymph nodes near the uterus. Endometrial cancer that is contained within the uterus can be cured through surgery, but it also means that the patient cannot have children or menstruate anymore.
It kills cancer cells or shrinks tumors with high-energy rays or particles. In addition to external radiation therapy, radioactive materials can also be placed inside the vagina or uterus, which is delivered by a machine that directs radiation to the pelvic area. Radiation therapy can be used as a treatment before or after surgery, or as a primary treatment for patients who cannot undergo surgery or who have advanced cancer.
Drugs that block or lower hormone levels in the body, particularly estrogen, are used in hormone therapy. Endometrial cancer cells that depend on hormones can be slowed or stopped with hormone therapy. The medication can be given as pills, injections, or implants. Side effects from hormone therapy include hot flashes, vaginal dryness, mood changes, or bone loss.
During chemotherapy, cancer cells are killed or stopped from multiplying. Chemotherapy can be administered as pills, injections, or infusions. When endometrial cancer is advanced or recurrent, chemotherapy can be used alone or in combination with other treatments. It is possible to experience side effects such as hair loss, nausea, vomiting, fatigue, and infection.
During targeted therapy, drugs are administered that target specific features of cancer cells that make them different from normal cells, such as genes or proteins. By using targeted therapy, cancer cells can be stopped from growing and spreading, or made more susceptible to other treatments. It is possible to receive targeted therapy in the form of pills, injections, or infusions. Side effects of targeted therapy include skin rash, diarrhea, high blood pressure, and liver problems.
There is no sure way to prevent endometrial cancer, but some steps that may lower the risk are:
In addition to maintaining a healthy weight, being overweight or obese can increase estrogen levels, which can stimulate the endometrium. Losing weight can help balance hormones and reduce the risk of endometrial cancer.
Being physically active: Regular exercise can help lower the level of estrogen and insulin in the body, which can affect the growth of endometrial cancer cells. Moreover, physical activity can decrease the risk of endometrial cancer by reducing obesity, diabetes, and other health problems.
As a result of preventing ovulation and keeping the endometrium thin, oral contraceptives containing estrogen and progestin may reduce the risk of endometrial cancer. Although birth control pills provide protection for several years after they are stopped, they can also cause blood clots, strokes, and breast cancer, among other risks and side effects. If you are considering starting or stopping birth control pills, it is important to consult your doctor first.
IUDs: IUDs are small devices that are inserted into the uterus to prevent pregnancy. Some types of IUDs release progestin, which can help keep the endometrium thin and reduce the risk of endometrial cancer. However, IUDs can also have some risks and side effects, such as infection, bleeding, and perforation of the uterus. Talk to your doctor about it before you use it.
Take progestin with hormone therapy after menopause if you need it, or use a combination product that contains both estrogen and progestin. The effects of estrogen on the endometrium can be countered by progestin, lowering the risk of endometrial cancer. However, hormone therapy has some risks and side effects, including blood clots, strokesis important to talk to your doctor about the benefits and risks of hormone therapy, and use the lowest dose and shortest duration possible.
Checking your uterus and endometrium regularly: If you suffer from any risk factors or symptoms of endometrial cancer, see your doctor regularly. By detecting and treating the disease early, survival and quality of life can be improved.
