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Endometrial Cancer
By peace | July 21, 2006
Uterine cancer is also referred to as endometrial cancer. Uterine cancer is the cancer of the inside lining of the uterus. It is common knowledge that menstrual periods are caused by the monthly crumbling of the skin of this endometrium. Women post-menopause are at a high risk of being affected by uterine cancer but few younger women also have been diagnosed of uterine cancer. Uterine cancer symptoms develop most commonly in association with unopposed estrogen, meaning estrogen without progesterone. Women who have not had children are also at a risk.
Uterine cancer is the most common gynecologic cancer (i.e., cancer that originates in female reproductive system). It develops in the body of the uterus, or womb, which is a hollow organ located in the lower abdomen. The wall of the uterus is comprised of an inner lining (called the endometrium) and an outer layer of muscle tissue (called the myometrium).
Endometrial cancer, which originates in the inner lining of the uterus, accounts for about 90% of uterine cancers. Uterine sarcoma originates in the myometrium and accounts for less than 10% of cases.
Types
Adenocarcinoma, which originates in surface cells of the endometrium, accounts for approximately 90% of cases of endometrial cancer. Adenocarcinomas are more common during perimenopause (i.e., transitional years preceding and following actual menopause) and usually are associated with an early onset of symptoms.
Other types of endometrial cancer include papillary serous carcinoma and clear cell carcinoma. These types usually develop in postmenopausal women and are more likely to metastasize (spread) and recur.
Types of uterine sarcoma include carcinosarcoma (most common type), leiomyosarcoma (develop in the muscular tissue of the myometrium), and endometrial stromal sarcoma (develop in supporting connective tissue).
Incidence and Prevalence
According to the National Cancer Institute (NCI), uterine cancer is the most common type of gynecologic cancer. In the United States, approximately 37,000 cases are diagnosed and about 6000 women die from the disease each year.
Incidence of uterine cancer increases after menopause and approximately 75% of cases are diagnosed in postmenopausal patients. The average age at diagnosis is about 60 years. In the United States, endometrial cancer is more common in Caucasian women and uterine sarcoma is more common in African American women.
Causes and Risk Factors
The cause of uterine cancer is unknown. Chronic exposure to estrogen (i.e., a female hormone produced by the ovaries) increases the risk for developing the disease and estrogen often affects tumor growth. The following factors increase estrogen exposure:
- Early menarche (beginning menstruation before age 12)
- Hormone replacement therapy (HRT) with exogenous estrogen (i.e., without progesterone)
- Late menopause (after age 52)
- Presence of an estrogen-secreting tumor (e.g., some types of breast cancer)
- Nulliparity (having never given birth) or low parity
Endometrial hyperplasia is a condition that increases the risk for uterine cancer. About one-third of patients with hyperplasia develop endometrial cancer. Symptoms of endometrial hyperplasia include heavy or prolonged menstrual periods, bleeding between menstrual periods, and prolonged amenorrhea (i.e., absence of menstruation for longer than 90 days). Postmenopausal women with hyperplasia may experience vaginal bleeding or spotting.
Long-term use of tamoxifen (e.g., Nolvadex®) increases the risk for uterine cancer. Tamoxifen is used to treat breast cancer and to decrease the risk for the disease in certain high-risk patients. Women undergoing treatment with tamoxifen are monitored carefully for uterine abnormalities.
Medical conditions such as obesity, gall bladder disease, diabetes mellitus, and high blood pressure (hypertension) increase the risk for cancer of the uterus.
Other risk factors include the following:
- Age (more common after age 50)
- Family history of uterine cancer
- Personal history of breast, colorectal, or ovarian cancer
- Prior pelvic radiation therapy
- Race (endometrial cancer is more common in Caucasian women and uterine sarcoma is more common in African American women)
Early uterine cancer usually is asymptomatic (i.e., does not cause symptoms). Abnormal vaginal bleeding, which is the most common symptom, may also result from a condition called dysfunctional uterine bleeding (DUB).
Other symptoms of uterine cancer include the following:
- Abnormal vaginal discharge
- Painful or difficult urination
- Pelvic pain
- Pain during intercourse
Advanced uterine cancer may cause weight loss, loss of appetite, and changes in bladder and bowel habits. Diagnosis of Endometrial cancer is made by microscopic exam of the cells of the uterine lining, obtained by suction of scraping biopsy.
- The definitive diagnosis is made by an endometrial biopsy, which involves a small scraping of the uterus and is usually performed in the doctor’s office. A dilation and curettage (D&C) is required for some women who can’t have an endometrial biopsy done in the office because of a small cervical opening or discomfort.
- Hysteroscopy should not be performed in women in whom cancer is part of the differential– as the fluid used to distend the uterine cavity for visual inspection can disseminate the cancer cells through the fallopian tubes into the peritoneal cavity.
- A pelvic sonogram can reveal the possibility of uterine cancer if the lining of the uterus cavity demonstrates either normal or increased thickness. If an endometrial stripe is very thin, 4mm or less, most studies indicate that no cancer exists, and no biopsy is needed.
Endometrial Cancer Treatment
Women with the early stage 1 disease may be candidates for treatment with surgical hysterectomy, but removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended for two reasons. Tumor cells can spread to the ovaries very early in the disease, and any dormant cancer cells that may be present could possibly be stimulated by estrogen production by the ovaries.
Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.
Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with radiation. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.
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