Endometrial Cancer
Endometrial Cancer - Dr. Snita Sinukumar
An Overview:
Endometrial cancer is cancer of the lining of the uterus (called the endometrium).
• The uterus (or womb) is where a baby grows during pregnancy. The fallopian tubes on both sides of it connect it to the ovaries and the cervix connects it to the vagina.
• These reproductive organs are located in the pelvis, close to the bladder and rectum.
• The endometrium is the inside lining of the uterus that grows each month during the childbearing years.
Risk factors for endometrial cancer
- Include use of estrogen without progesterone,
- Diabetes, hypertension.
- Tamoxifen use.
- Later age of menopause .
Heredity also plays a role in a small percentage of women with endometrial cancer.
The most common warning sign for uterine cancer, including endometrial cancer, is abnormal vaginal bleeding. Recognition of this symptom often affords an opportunity for early diagnosis and treatment. In older women, any bleeding after menopause may be a symptom of endometrial cancer. Younger women are also at risk, and should note irregular or heavy vaginal bleeding as
This can be symptoms of endometrial cancer.
Symptoms for endometrial cancer include:
- Vaginal bleeding or spotting after menopause
- New onset of heavy menstrual periods or bleeding between periods
- A watery pink or white discharge from the vagina
- Two or more weeks of persistent pain in the lower abdomen or pelvic area
- Pain during sexual intercourse
When a woman experiences concerning symptoms, a pelvic exam, including a rectogvaginal exam, and a general physical should be performed. If the exam is abnormal, the woman should undergo an endometrial biopsy, ultrasound and/or and a D&C (dilation and curettage) procedure.
Endometrial cancer may be treated with surgery, radiation therapy, chemotherapy or hormonal therapy.
Your specific treatment plan will depend on several factors, including:
- The stage, grade and specific subtype (histology) of your cancer
- The size and location of your cancer
- Your age and general health
The most common treatment for endometrial cancer is surgery. Several types of surgery can be performed.
HYSTERECTOMY:
involves removal of the uterus and cervix and is the standard procedure for treating endometrial cancer. The uterus and cervix can be removed in one of three ways:
- Total abdominal hysterectomy: the uterus and cervix are taken out through an incision in the abdomen.
- Radical abdominal hysterectomy: in addition to the uterus and cervix, the tissue next to the uterus and cervix, as well as part of the upper vagina, are also removed.
- Minimally invasive hysterectomy (laparoscopic-assisted vaginal hysterectomy and robotic total laparoscopic hysterectomy): the uterus and cervix are taken out through the vagina with the assistance of a laparoscope or robotic device (a small tube-like viewing instrument) that is placed through the abdomen via a small incision.
In most cases, both ovaries and both fallopian tubes must also be removed. This procedure is called a bilateral salpingo-oophorectomy. Lymph nodes in the abdomen and pelvis may also be taken out to see whether they contain cancer.
Side effects of surgery:
Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing any pain. Other possible side effects are:
- Nausea and vomiting
- Infection, fever
- Wound problems
- Fullness due to fluid in the abdomen
- Shortness of breath due to fluid around the lungs
- Anemia
- Swelling cause by lymphedema, usually in the legs
- Blood clots
- Difficulty urinating or constipation
- Shortening of the vagina
Talk with your doctor if you are experiencing any of the side effects listed above.
When endometrial cancer is diagnosed, it is vital to determine if the cancer has spread beyond the endometrium. Your treatment team may do more tests to determine if the cancer has spread. In addition, during surgery, certain additional steps should be performed to determine the extent of disease. This process is called staging. Staging helps to determine the exact extent of your
cancer and what treatment plan is best for you. It is important that your surgery be performed by a Surgical oncologist.
Following surgery, your cancer will be categorized into one of the following stages:
Stage I: The cancer is found only in the uterus. It has not spread to the cervix (opening of the uterus).
Stage II: The cancer has spread from the uterus to the cervix (opening of the uterus), but it has not gone any farther.
Stage III: The cancer has spread outside the uterus itself. It may have spread to nearby lymph nodes, ovaries, fallopian tubes and vagina, but it has not gone outside the pelvic area. It has not spread to the bladder or rectum.
Stage IV: The cancer has spread into the bladder or rectum and/or to other body parts outside the pelvis, such as the abdomen or lungs.
Radiation therapy (also called radiotherapy) uses high-energy x-rays, or other types of radiation, to kill cancer cells or stop them from growing Radiation therapy is commonly used
- After surgery, to kill any cancer cells that may have been left behind (called adjuvant therapy).
Two types of radiation therapy are used to treat endometrial cancer:
- External radiation therapy uses a machine that directs the x-rays toward a precise area on the body. The therapy is usually given every day for about 6 weeks. It does not hurt and only takes a few minutes each day. You can be treated at a clinic, hospital or radiation oncology office.
- Internal radiation therapy (also called brachytherapy) involves placing a small capsule of radioactive material inside the vagina.
Side effects of radiation
The side effects of radiation therapy depend on the dose used and the part of the body being treated. Common side effects include:
- Dry, reddened skin in the treated area
- Fatigue
- Diarrhea
- Discomfort when urinating
- Narrowing of the vagina
- Anemia
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for endometrial cancer is usually given intravenously (injected into a vein). Chemotherapy is usually given in cycles. Periods of chemotherapy treatment are alternated with rest periods when no chemotherapy is given. Most women with endometrial cancer receive intravenous chemotherapy that is usually given after surgery, but may be given prior to hysterectomy surgery is some circumstances.
Side effects of chemotherapy
Each person responds to chemotherapy differently. Some people may have very few side effects while others experience several. Most side effects are temporary. They include:
- Nausea
- Loss of appetite
- Mouth sores
- Increased chance of infection
- Bleeding or bruising easily
- Hair loss
- Fatigue
Some types of endometrial cancer need hormones to grow. In these cases, hormone therapy is a treatment option. Hormone therapy removes female hormones or blocks their action as a way of preventing endometrial cancer cells from getting or using the hormones they may need to grow. It is usually taken as a pill, but can be given as a shot.
Side effects of hormone therapy
The side effects of hormonal therapy depend on the type of hormones being used. Some women retain fluid and have a change in appetite, or have hot flashes.