What Is Endometrial Cancer?
Cancer of the uterine endometrium, also known as endometrial cancer, is a type of cancer that starts in the inner lining of your uterus. This lining is called the endometrium.
According to the National Cancer Institute, endometrial cancer accounts for about 6 percent of all types of cancers in American women. It’s also the most common type of uterine cancer.
When Should I See My Doctor?
You should make an appointment with your doctor if you have any symptoms associated with endometrial cancer. However, keep in mind that these symptoms can also be caused by several other noncancerous conditions.
The most common symptom is unusual vaginal bleeding or spotting. This symptom often occurs as a normal part of the menopause process, but should still be brought up to your doctor as a precaution.
However, you should always call your doctor right away if you experience vaginal bleeding after you have completed menopause.
Postmenopausal bleeding is defined as bleeding that occurs after 12 months of no menstrual periods in a woman who is at the expected age of menopause.
Other symptoms include:
- thin clear or whitish discharge if you’ve been through menopause
- bleeding in between periods or having periods that last longer than usual
- heavy bleeding, bleeding that lasts a long time, or frequent bleeding if you’re over 40
- lower abdominal or pelvic pain
- painful intercourse
Causes of Endometrial Cancer
The exact cause of endometrial cancer is unknown. Some experts suspect that high levels of estrogen might be responsible for this disease. Progesterone and estrogen are female sex hormones produced in the ovaries. When the balance of these two hormones changes, the endometrium can change. Research has shown that increased estrogen without corresponding increased progesterone can thicken the endometrium and potentially increase the likelihood of cancer.
What scientists know for sure is that cancer begins when a genetic mutation causes normal cells in your endometrium to become abnormal. These cells then multiply rapidly and form a tumor. In advanced cases, cancer cells metastasize or spread to other parts of the body.
Am I At Risk?
Age and Menopause
Most cases of endometrial cancer occur in women who are between 60 and 70 years old. If you fall into this age range or have already gone through menopause, some other factors can further raise your risk. These include:
Hormone replacement therapy that contains estrogen, but not the other female hormone known as progesterone, has been known to increase the risk for endometrial cancer. This type of therapy is sometimes used to treat the symptoms of menopause.
Menopause that starts at a later age has been associated with a greater risk for endometrial cancer, due to the body’s longer exposure to estrogen.
Exposure to Estrogen
If you got your first menstrual period before you were age 12, you have an increased risk of endometrial cancer because of your body’s increased exposure to estrogen over your lifetime. Your exposure to estrogen is also greater if you’re infertile or have never been pregnant
Certain conditions or diseases lead to changes that affect the balance between the estrogen and progesterone levels in your body. These changes can result in the thickening of the uterine lining and a subsequent increased risk for cell abnormality and cancer.
Hormonal risk factors include:
- polycystic ovarian syndrome
- endometrial polyps or other benign growths in the endometrium
- hormone therapy with tamoxifen for breast cancer
- ovarian tumors that release estrogen
Women who are obese or overweight are 2 to 4 times more likely to develop endometrial cancer than women who aren’t. Experts believe this is because fat tissues produce high levels of estrogen.
Diabetes and Hypertension
Women who have diabetes or hypertension are more likely to develop endometrial cancer. Researchers originally believed this was because these conditions are often caused by obesity. However, research published by the American Heart Association and the American Cancer Society has shown that both of these conditions can independently cause endometrial cancer.
People who have hereditary nonpolyposis colorectal cancer (HNPCC) have a higher-than-normal risk of developing endometrial cancer.
Diagnosing Endometrial Cancer
Your doctor might run urine or blood tests and give you a physical exam to check your overall health. Other tests might include:
Your doctor will check your uterus, vagina, rectum, and bladder for abnormalities such as lumps.
This test checks for atypical cells from your cervix and the upper part of your vagina.
This test uses high-frequency sound waves to create a picture of your uterus.
This surgical procedure involves your doctor removing a tissue sample from your endometrium.
Staging Endometrial Cancer
After your diagnosis, the next step is to figure out how far your cancer has advanced.
The tests that are commonly used for endometrial cancer staging are blood tests, chest X-rays, and computerized tomography (CT) scans. CT scans show a cross-sectional view of your body taken from several X-rays. In some cases, your doctor might not be able to find out what stage your cancer is at until after you’ve had surgery.
The stages are:
- Stage 1: Cancer is only in your uterus.
- Stage 2: Cancer is in your uterus and cervix.
- Stage 3: Cancer is also found outside your uterus and possibly in your pelvic lymph nodes, but not in your bladder or rectum
- Stage 4: Cancer has spread outside your pelvic area and might invade your rectum, bladder, and other parts of your body.
What Are My Treatment Options?
There are several ways to treat endometrial cancer. Your treatment options depend on which stage of cancer you have, your overall health, and your personal preferences.
Most women with this cancer have a hysterectomy, which removes the entire uterus. Another common procedure is a salpingo-oophorectomy, which involves removing the ovaries and fallopian tubes. Having surgery also gives your doctor a chance to check around your uterus to see if the cancer has spread.
This type of treatment uses high-energy beams to destroy cancer cells. There are two different types of radiation therapy available. The first is called external beam radiation therapy, in which the radiation is delivered to the tumor from a machine that is outside of your body. The second is called brachytherapy, which involves placing radioactive material inside your vagina or uterus.
The radiation that is used in brachytherapy only works in short distances. This allows your doctor to give you a high dose of radiation and have less of an effect on your healthy tissues.
Brachytherapy is used in early stage disease after surgery, and is combined with chemotherapy in later stage disease when the risk of the cancer growing back after surgery is high. If you are unable to have surgery due to other medical conditions, radiation combined with chemotherapy may be an option.
Chemotherapy drugs contain chemicals that destroy cancer cells. They can be taken in pill form or through your veins from an intravenous line. Some treatment plans involve one drug, while others involve two or more drugs. This form of treatment may be used alone or combined with radiation.
This type of treatment uses medications to change your hormone levels. Your doctor might recommend hormone therapy if you have a more advanced stage of cancer. Some medications increase your progesterone levels, which can help prevent cancer cells from growing rapidly. Other medications lower your estrogen levels, to decrease the growth of cancer cells. This treatment is not commonly used, as it has not been shown to be as effective as other available treatments.
Coping and Finding Support
If you’re having trouble dealing with your diagnosis, look for a support group in your area. Being around others who share similar concerns can be a source of comfort. You should also find out as much as you can about your condition. This will help you feel more in control of the treatment process. Don’t be afraid to ask your doctor questions or seek a second opinion on treatment options.
How Can I Lower My Risk for Endometrial
Pelvic Exams and Pap Smears
See your gynecologist for regular pelvic exams and Pap smears, especially if you are undergoing estrogen replacement therapy. These tests can help your doctor find signs of abnormalities. If you have any risk factors for endometrial cancer, let your doctor know. Your doctor might want to see you more often for pelvic exams and Pap smears.
Taking oral birth control pills for at least one year might lower your risk of having endometrial cancer. This is because they balance estrogen and progesterone levels. The preventive effects can last for several years after taking the pills. Ask your doctor about potential side effects before taking them.