Endometrial Cancer

Recent estimates from the American Cancer Society show that each year in the United States, over 45,000 women will be diagnosed with some form cancer of the uterus. About 95% of all uterine cancer is cancer of the endometrial lining called endometrial cancer. Most women - 96 percent – who have endometrial cancer that hasn’t spread beyond the uterus will be alive in five years. Yet, over 8,000 of these women will die from the disease. It is the third most common gynecologic cancer behind cervical and ovarian cancers. Endometrial cancers are usually carcinomas that start in endometrial cells that line the inside of the uterus.  These cells provide the optimal environment of a fertilized egg to implant in the uterus after conception.  The uterus expels this layer of the endometrium during a woman's menstrual cycle.  Most endometrial cancers occur in post-menopausal women between the ages of 60 to 70. This is likely due to increased exposure to estrogen during a woman's lifetime. But, there are certain types that can occur in younger women around age 40. While there is no known single cause of endometrial cancer, several risk factors have been identified. These risk factors include estrogen replacement therapy without progesterone, a history of endometrial polyps (benign growths), diabetes, infertility ,as well as never being pregnant, obesity, polycystic ovary syndrome (PCOS), starting menopause after 50, an early menarche (first menstrual period before age 12), and exposure to the anti-breast cancer drug tamoxifen. Other risk factors include a high intake of animal fats in the diet, hypertension, and heavy daily intake of alcohol. Women who have had breast or ovarian cancer are also at an increased risk. Symptoms of endometrial cancer usually begin with abnormal vaginal bleeding. Any vaginal bleeding in women who have already gone through menopause is abnormal. Pre-menopausal women may experience abnormal or heavy menstrual bleeding, usually between menstrual periods.  Postmenopausal women may also experience a clear, thin white vaginal discharge as well. Lower abdominal pain and pelvic cramping are also common. Usually, women are not routinely screened for endometrial cancer, as the disease is highly curable in the early stages. As the disease advances, some women may notice a change in the size or shape of her uterus, along with the above mentioned symptoms. Diagnosis is typically started with endometrial curettage, which provides a sample of the endometrium for pathologic diagnosis. hysteroscopy allows visualization inside the uterus, which can aid in biopsy and identifying lesions. A newer method called TruTest can sample the entire lining of the uterus and is less painful than biopsy. Treatment usually begins with a total abdominal hysterectomy. A surgeon will remove the entire uterus, the ovaries and fallopian tubes. The surgeon will then take a look inside the abdomen to take samples of abdominal fluid and inspect the lymph nodes for signs of metastasis. Radiation therapy is usually given to women whose disease has a high likelihood of returning or has spread into the abdomen. Chemotherapy is usually not given unless a woman has advanced disease. For women whose disease has not spread beyond the uterus, the survival rate is very high, up to 96% in some instances. Unfortunately, the survival rate drops considerably as the disease moves to other organs. The best way to reduce the risk of endometrial cancer is to live a healthy lifestyle. Avoid obesity, heavy alcohol intake, high fat diets and have regular Pap smears and pelvic examinations as recommended by a gynecologist.

The exact cause of endometrial cancer is unknown. Why one woman develops it and another does not is also unknown. We do know that women with certain risk factors may be more likely than others to develop endometrial cancer. A risk factor is something that may increase the chance of getting a disease. These are the most common risk factors for endometrial cancer:

• Obesity. Women who are obese have a greater chance of developing endometrial cancer.
• Reproductive and menstrual history. Women are at increased risk of endometrial cancer if any of the following holds true for them:
• History of taking estrogen alone: The risk of endometrial cancer is higher among women who used estrogen without progesterone as menopausal hormone therapy for many years.
• History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of endometrial cancer.
• Family health history. Women with a mother, sister or daughter with endometrial cancer are at increased risk of developing the disease.

 Many women who get endometrial cancer have none of these risk factors, and many women who have known risk factors don’t develop the disease.

See your doctor for abnormal vaginal bleeding or spotting, especially after menopause, or pelvic pain. Early evaluation of unusual bleeding leads to highly effective treatment.