Endometrial cancer?

Endometrial cancer starts when cells in the inner lining of the uterus (endometrium) begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread.

The picture below shows where the uterus is located.

About the uterus and endometrium

The uterus is a hollow organ, which is normally about the size and shape of a medium-sized pear. The uterus is where a fetus grows and develops when a woman is pregnant. The uterus has 2 main parts:

The cervix is the lower end of the uterus that extends into the vagina.

The upper part of the uterus is called the body or the corpus. (Corpus is the Latin word for body.)

Although the cervix is technically part of the uterus, when people talk about cancer of the uterus (Patheghar, in Nepali), they usually mean the body, not the cervix (Pathegharko Mukh, in Nepali).

Lifetime chance of getting endometrial cancer:

Endometrial cancer affects mainly postmenopausal women. The average age of women diagnosed with endometrial cancer is 60. It is uncommon in women under the age of 45.

This cancer is slightly more common in white women, but black women are more likely to die from it. There are more than 600,000 survivors of endometrial cancer.

Endometrial cancer risk factors:

1. Age: The risk of endometrial cancer increases as a woman gets older.

2. More years of menstruation: Starting menstruation at an early age  before age 12 or beginning menopause later increases the risk of endometrial cancer. The more periods you've had, the more exposure your endometrium has had to estrogen.

3. Obesity: Having more fat tissue can increase a woman's estrogen levels, which increases her endometrial cancer risk

4. Diet and exercise: A high-fat diet can increase the risk of several cancers, including endometrial cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity

5. Diabetes: Endometrial cancer may be as much as 4 times more common in women with diabetes. Diabetes is more common in people who are overweight, but even people with diabetes who are not overweight have a higher risk of endometrial cancer.

6. Tamoxifen: Endometrial cancer may develop in breast cancer patients who have been  treated with tamoxifen for breast cancer. A patient taking this drug should have a pelvic exam every year and report any vaginal bleeding (other than menstrual bleeding) as soon as possible. 

7. Family history : having close relatives with endometrial or colorectal cancer

8. Having been diagnosed with breast or ovarian cancer in the past: A certain type of ovarian tumor, the granulosa cell tumor, often makes estrogen.:

9. Having been diagnosed with endometrial hyperplasia in the past: If the hyperplasia is called “atypical,” it has a higher chance of becoming a cancer.

10. Treatment with radiation therapy to the pelvis to treat another cancer: 

Some of these, like 

Pregnancy: The hormonal balance shifts toward more progesterone during pregnancy. So having many pregnancies protects against endometrial cancer. Women who have never been pregnant have a higher risk, especially if they were also infertile (unable to become pregnant).

Birth control pills: Using birth control pills (oral contraceptives) lowers the risk of endometrial cancer. However, it is important to look at all of the risks and benefits when choosing a contraceptive method;  

use of an intrauterine device Information about this protective effect is limited to IUDs that do not contain hormones.:

are linked to a lower risk of endometrial cancer, while many are linked to a higher risk.  

Early detection tests

Early detection (also called screening) refers to the use of tests to find a disease such as cancer in people who do not have symptoms of that disease.

Women at average endometrial cancer risk

At this time, there are no screening tests or exams to find endometrial cancer early in women who are at average endometrial cancer risk and have no symptoms.

Signs and symptoms of endometrial cancer

There are a few symptoms that may point to endometrial cancer, but some are more common as this cancer becomes advanced.

Unusual vaginal bleeding, spotting, or other discharge

About 90% of women diagnosed with endometrial cancer have abnormal vaginal bleeding, such as a change in their periods or bleeding between periods or after menopause. This symptom can also occur with some non-cancerous conditions, but it is important to have a doctor look into any irregular bleeding right away. If you have gone through menopause already, it’s especially important to report any vaginal bleeding, spotting, or abnormal discharge to your doctor.

Non-bloody vaginal discharge may also be a sign of endometrial cancer. Even if you cannot see blood in the discharge, it does not mean there is no cancer. In about 10% of cases, the discharge associated with endometrial cancer is not bloody. Any abnormal discharge should be checked out by your doctor.

Pelvic pain, a mass, and weight loss

Pain in the pelvis, feeling a mass (tumor), and losing weight without trying can also be symptoms of endometrial cancer. These symptoms are more common in later stages of the disease. 

Tests that examine the endometrium are used to detect (find) and diagnose endometrial cancer.

Because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap test. For this reason, a sample of endometrial tissue must be removed and checked under a microscope to look for cancer cells. One of the following procedures may be used:

Endometrial biopsy : The removal of tissue from the endometrium (inner lining of the uterus) by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples. A pathologist views the tissue under a microscope to look for cancer cells.

Dilatation and curettage : A procedure to remove samples of tissue from the inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped instrument) is inserted into the uterus to remove tissue. The tissue samples are checked under a microscope for signs of disease. This procedure is also called a D&C.

Other tests and procedures used to diagnose endometrial cancer include the following:

Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual

Trans vaginal ultrasound exam:. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.

Endometrial cancer is highly curable.