|
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).
Most uterine cancers are 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)
Figure 32.20
cancerresearchuk.org
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(hysterectomy) is clearly advisable.
Recommended Books:
The Official Patient's Sourcebook on Endometrial Cancer
Prevention
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:-
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.
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:-
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:-
DISCLAIMER
The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.
   
Women's Health Home Page
|
|
|
