• Introduction
• Abortion
• Amenorrhoea
• Birth Control
• Bladder Symptoms
• Cancer in Women
  • What is cancer?
  • Cancer Staging
  • Prevalence
  • Familial Cancer
  • Symptoms, Signs, Diagnosis
  • Prevention
  • Screening
  • Emotional Effects
  • Counselling
  • Personality and Outcome
  • Holistic Approach
  • Breast Cancer
  • Ovarian Cancer
  • Cervical Cancer
  • Endometrial Cancer
  • Vulva, Vagina, Fall.Tubes
  • Treatments
  • Mortality
  • Support Groups
• Childbirth
• Children and Teenagers
• Diet / Weight Loss
• Dysmenorrhoea
• Endometriosis
• Fibroids
• HRT
• Hirsutism
• Hysterectomy
• Infections
• Infertility
• Medication Drugs
• Menopause
• Menorrhagia
• Miscarriage
• Painful Sex
• Pap Smear Test
• PCOS
• Pelvic Pain
• PMS
• Postpartum
• Pregnancy
• Self Esteem
• Sexual Problems
• Vaginal Discharge
• Vaginal Prolapse
• Vulval Symptoms

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Endometrial Cancer - Introduction

Endometrial Cancer (Cancer Of The Endometrium - Cancer of The Uterus) is mostly diagnosed in women aged over 50 years with very few women diagnosed under the age of 35. Incidence rises rapidly to a peak of about 65 per 100,000 females among those aged 60-69 years. Uterine cancer incidence rates decline slowly after the age of 70 (Figure 32.20)

In contrast to cervical cancer, there is a higher incidence in more affluent society and those with few children. Being overweight increases the chance of endometrial cancer. Women with PCOS are at increased risk of endometrial cancer partly as these women tend to be overweight and also because they may have anovulatory cycles, which are characterised by oestrogen unopposed by progesterone. Endometrial cancer is the ninth commonest cancer in women and the third commonest . The incidence of endometrial cancer tends to peak between the ages of 50 and 65 years.

Tamoxifen, used in the treatment of breast cancer can increase the risk of endometrial cancer; some recommend annual endometrial sampling. The relationship between endometrial cancer and oestrogens is discussed elsewhere (Q 27.14 ;27.15 ;32.43). Modern HRT, which would always include progestogen if the uterus is present, is associated with an overall decreased incidence of endometrial cancer (Q 27.19).

 

Screening

There are currently no specific screening tests routinely undertaken for endometrial cancer. Early in the disease process, however, irregular bleeding occurs between periods before the menopause or there is otherwise postmenopausal bleeding. Fortunately symptoms occur early so that the prognosis is relatively good provided these symptoms are investigated without undue delay. Heavy periods after the age of forty or intermenstrual bleeding are indications for evaluating the endometrium usually by hysteroscopy and D and C  is clearly advisable.Q24.12). Pre-malignant changes occur that are described as varying degrees of hyperplasia. When there is severe atypical hyperplasia, there is a 50% risk of cancer developing;hysterectomy  is clearly advisable.

Tamoxifen is an anti-oestrogen commonly used in the treatment of breast cancer. It also has some oestrogenic properties and this may lead to endometrial cancer.

The levonorgestrel IUS (Mirena)  reduces endometrial activity. It is theoretically possible that it could reduce endometrial pathology resulting from tamoxifen. The early results of a study have shown that it reduces the incidence of endometrial polyps at 12 months.

Related Medical Abstracts - Click on the paper title:-

• A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women.(2007-01)

Endometrial Cancer - Symptoms - Signs - Diagnosis

Bleeding after the menopause or irregular bleeds in the forties and fifties requires careful assessment by a gynaecologist. Before the menopause, hysteroscopy and endometrial biopsy or curettage are required (Q 24.12). Transvaginal ultrasound can be of value after the menopause. If the endometrium is no more than 4mm thick and appears normal, further investigation may not be required.

Treatment of Endometrial Cancer

Surgery

Surgery (removing the cancer in an operation) is the most common treatment for endometrial cancer. The following surgical procedures may be used:

• Total hysterectomy: A surgical procedure to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
• Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
• Radical hysterectomy: A surgical procedure to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or hormone treatment after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Traditionally, surgery for endometrial cancer has been performed by laparotomy. Minimally invasive techniques, notably laparoscopy, have become increasingly popular. Recently, robotic surgery has been applied. This has the benefits of reduced post-operative pain, earlier return to normal activities and an improved scar. ⁰⁸⁰¹

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Treatment Options by Stage

Stage I Endometrial Cancer - Treatment

Treatment of stage I endometrial cancer may include the following:

• Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy). Lymph nodes in the pelvis and abdomen may also be removed for examination under a microscope to check for cancer cells.
• Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen) followed by internal radiation therapy or external radiation therapy to the pelvis. After surgery, a plastic cylinder containing a source of radiation may be placed in the vagina to kill any remaining cancer cells.
• Radiation therapy alone for patients who cannot have surgery.
• Clinical trials of radiation therapy and/or chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I uterine corpus cancer.

Stage II Endometrial Cancer - Treatment

Treatment of stage IIA endometrial cancer is usually a combination of therapies, including internal and external radiation therapy and surgery.

Stage IIA Treatment

Treatment of stage IIA endometrial cancer may include the following:

• Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy). Lymph nodes in the pelvis and abdomen may also be removed for examination under a microscope to check for cancer cells.
• Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen) followed by internal radiation therapy or external radiation therapy to the pelvis. After surgery, a plastic cylinder containing a source of radiation may be placed in the vagina to kill any remaining cancer cells.
• Radiation therapy alone for patients who cannot have surgery.
• Clinical trials of radiation therapy and/or chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Stage IIB Treatment

Treatment of stage IIB endometrial cancer may include the following:

• Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy, and removal of lymph nodes in the pelvis and abdomen for examination under a microscope to check for cancer cells) followed by radiation therapy.
• Internal radiation therapy and external radiation therapy, followed by surgery (hysterectomy and bilateral salpingo-oophorectomy, and removal of lymph nodes in the pelvis and abdomen for examination under a microscope to check for cancer cells).
• Surgery (radical hysterectomy with or without removal of lymph nodes in the pelvis for examination under a microscope to check for cancer cells).

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II uterine corpus cancer.

Stage III Endometrial Cancer - Treatment

Treatment of stage III endometrial cancer may include the following:

• Surgery (radical hysterectomy and removal of lymph nodes in the pelvis for examination under a microscope to check for cancer cells) followed by internal radiation therapy and external radiation therapy.
• Radiation therapy alone for patients who cannot have surgery.
• Hormone therapy for patients who cannot have surgery or radiation therapy.
• Clinical trials of chemotherapy.
• Clinical trials of new therapies.

Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III uterine corpus cancer.

Stage IV Endometrial Cancer - Treatment

Treatment of stage IV endometrial cancer may include the following:

• Internal radiation therapy and external radiation therapy.
• Hormone therapy.
• Clinical trials of chemotherapy.

Treatment Options for Recurrent Endometrial Cancer

Treatment of recurrent endometrial cancer may include the following:

• Radiation therapy as palliative therapy to relieve symptoms and improve the patient’s quality of life.
• Hormone therapy.
• Clinical trials of chemotherapy.

Related Medical Abstracts - Click on the paper title:-

• Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta-analysis.(2007-01)

Support Groups

Members of a support group, provide each other with various types of help and information for a particular shared difficulty.

The support may take the form of providing relevant information,

• relating personal experiences,
• listening to others' experiences,
• providing sympathetic understanding and
• establishing social networks.

A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy.

Support groups maintain interpersonal contact among their members in a variety of ways.

Support groups also maintain contact through printed information rich newsletters, telephone chains, internet forums, and mailing lists.

Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.

Evaluation of the quality of Web sites is discussed in(Q4.27) . You may find that several general women's health sites may help you (internet information). The following are more specialised relevant Web sites:-