Endometrial cancer

What Is Endometrial Cancer?

Endometrial cancer is a type of uterine cancer that begins in the layer of cells forming the lining (endometrium) of the uterus. A study on epidemiology of endometrial cancer quoted that it is the most frequently diagnosed gynecologic malignancy. According to wrcf.org, endometrial cancer is the sixth most commonly occurring cancer in women. Though Endometrial cancer is common, it can usually be cured because in most cases its gets detected in an early stage. Symptoms like abnormal vaginal bleeding and pelvic pain give a clear hint to look for abnormalities. A visit to the doctor can lead to diagnostic tests that give precise results. Explore more about endometrial cancer symptoms, causes, prevention, screening, staging, treatment, statistics, survival rates and researches.

What is endometrial cancer?

Endometrial cancer is the abnormal growth of malignant cells in the inner lining of the uterus. Because the endometrium is a part of the uterus, endometrial cancers are also referred as uterine cancer. Around 92 percent of uterine cancers are found in the endometrium.

Recent statistics of endometrial cancer cases reveal a sharp surge in the number of occurrences mostly because of the increased incidence of obesity, which is a major risk factor for this disease.

Types of endometrial cancer

Endometrial cancers are classified into two types –

  1. Estrogen dependent (Type I)
  2. Estrogen independent (Type II)

About 85% of endometrial cancers belong to type I. As the name suggests, these cancer cases are a result of an imbalance in the levels of estrogen. It is more common in obese women and is typically preceded by complex atypical hyperplasia. Also, this type is usually confined to the uterus with minimal invasion.

The estrogen-independent endometrial cancer is most likely to occur in thin, older patients with an atrophic endometrium. It is rare but patients commonly have early metastasis. Approximately half of all endometrial cancer relapses are reported in patients with type II tumours.

The endometrium

The endometrium is the inner epithelial layer lining the uterus in which the implantation takes place. It is a hollow, muscular organ that sits in a woman’s pelvis. The endometrium has two layers – basal layer (inner layer) and functional layer (outer layer).

This outer functional layer experiences morphologic and functional changes throughout the monthly cycle. The endometrium is also closely associated with the cyclic release of sexual hormones.

Function of endometrium layer

After puberty, every month the ovaries release an egg that travels into the uterus and has the potential to be fertilized. During the weeks prior to menses, the endometrium thickens to provide a place for a fertilized oocyte to grow and develop.

The functional layer of the endometrium undergoes proliferation and differentiation to prepare for this process. If the egg is not fertilized then the functional layer of the endometrial lining is shed and the unneeded blood supply is passed through the birth canal.

In absence of this periodic cycle, that means, before puberty or after menopause, the endometrium maintains a constant morphology and thickness.

Symptoms caused by a large size of the tumor

Endometrial cancer is often diagnosed in the early stages because of early symptoms. The following enlists the common endometrial cancer symptoms; however, these symptoms might vary or there may not be any prominent initial symptom at all.

What Are The General Causes Of Endometrial cancer?

The exact cause of endometrial cancer for every case is not yet certain. That means, doctors cannot pinpoint the exact causative factor responsible for endometrial cancer in a particular patient.

Till now all that’s known is – mutations in the DNA of cells in the endometrium causes endometrial cancer. Now, there are several possible factors that can trigger these changes. Some of the common factors are enlisted below –

This imbalance in the hormonal levels can be caused by irregular ovulation process, Polycystic ovary syndrome, obesity and diabetes. Taking hormonal medicines containing estrogen but not progesterone also increases the risk of endometrial cancer.
In other words, women who endure more menstrual cycles in their lifetime have an increased risk of endometrial cancer. Those with early periods starting before 12 years and going through menopause after 50 years are at high risk.
Irregular menstrual cycles and infertility also may be related to imbalances in estrogen and progesterone levels, and this hormone imbalance may increase the risk for Endometrial Cancer.
Most cases of endometrial cancer are reported in post-menopausal women.
Obese people having a BMI more than 30 are three times more likely to develop Endometrial cancer. Fat tissue can further convert other types of hormones like androgens into estrogen.
If the doctor prescribes this medicine, then please discuss the possible side-effects. Though it’s a risk factor for endometrial cancer, the benefits of tamoxifen outweigh the small risk of endometrial cancer.
If a family member has been diagnosed with inherited colon cancer syndrome, then please discuss the risk with a doctor. Ask your doctor about the cancer screening tests that you shall take.
This condition most often occurs in women after menopause and may be caused by an imbalance of excess estrogen. Women with obesity issues, medical conditions or family history are at an increased risk of Endometrial hyperplasia and thus endometrial cancer.

Familial history of other cancer types like colon, ovarian or breast cancer may also put you at a higher risk of developing Endometrial Cancer. Knowing your genetics and family history help in making aware decisions about screenings and preventions.

These conditions increase the probability of getting endometrial cancer and are termed as a ‘risk factors’. Though none of these risk factors are a guaranteed contributor of cancer, but it is better to keep the chances low.

Please consult your doctor and go for regular screenings if you ticked any of these risk factors.

Can Endometrial cancer Be Prevented?

Though most causatives of Uterine Cancer are natural and cannot be controlled yet a few precautionary measures help lower the risk. Having good health in general and leading a healthy lifestyle are definitely sure shot ways to shield the risk.  

Here are a few things that all women should adapt despite being in risk or not –

Maintain weight
As already stated, obesity is a big risk factor for endometrial cancer. Eating a healthy diet, exercising regularly and maintaining a healthy weight help reduce Endometrial cancer risk.
Birth control
Birth control pills that combine estrogen and progesterone can lower the risk of endometrial cancer. Using a progestin-secreting intrauterine device (IUD) may also reduce the risk of endometrial cancer. But again, discuss the risks and benefits of using birth control with your doctor.
Awareness plays a big role in the prevention of endometrial cancer. Being aware of the family history, the symptoms and possible risk factors helps in making important decisions on cancer screenings and diagnosis.
Diabetes management
Diabetes is an underlying causative of many types of cancers including endometrial cancer. Proper management of diabetes and keeping the blood sugar levels under control may help reduce the risk of uterine cancer.

What Are The Stages Of Endometrial cancer?

All cancerous growths are categorized into different stages based on their spread and severity. In medical terminology, cancer is categorized as T, N, M – T stands for tumor, N denotes node and M is for metastases.

The tumor is further staged from 0 to IV wherein the severity goes on increasing in ascending order. Nodes are numbered as 1,2 and 3. Metastases is indicated by 1 or 0, where in 0 means negative and 1 means that cancer has metastasized.   

The staging of uterine cancer is elaborated below:

Stage I – T1, N0, M0 –At this stage, cancer cells are found only in the endometrium. The most common symptom at this stage is unusual bleeding. Doctors might suggest surgery or progestin therapy for treatment.

Stage II (T2, N0, M0) – At this stage, cancer cells are found in both the uterus and cervix but they have not spread outside of the uterus. It is also absent in lymph nodes or distant sites.

Bleeding, spotting and unusual discharge are the most common signs. The doctor might suggest a radical hysterectomy to remove the uterus and the upper part of the vagina. The doctor might also remove the fallopian tubes and ovaries. Along with surgery, radiation therapy or vaginal brachytherapy may also be used.

Stage III (T3, N0, M0)-  Cancer has spread beyond the uterus, but not beyond the pelvis. Cancer cells are found in the ovaries, fallopian tubes, vagina and lymph nodes. But it has not affected the bladder or the rectum.

At this stage, the patient may complain of pelvic pain, bloating, pain during sex, changes in bowel and bladder habits and weight loss. Some might also feel the tumor in the belly.

The doctor might suggest total or radical hysterectomy, also known as pelvic washing in which the fallopian tubes and ovaries are removed. This is followed by radiation or chemotherapy.

Stage IV (T4, any N, M0) or (any T, any N, M1)- Cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of the body. The symptoms can be same as stage III. Some might also complain of pain in the bones or shortness of breath at this stage.

At this stage, doctor might or might not proceed with surgery. Radiation therapy is usually used to treat cancer at this stage. The doctor might also suggest Hormone therapy, targeted therapy, chemotherapy, and immunotherapy.

Survival Rates Of Endometrial cancer?

Stage Survival Rate
0 90%
IA 88%
IB 75%
II 69%
IIIA 58%
IIIB 50%
IIIC 47%
IVA 17%
IVB 15%

Test For Endometrial Cancer Diagnosis

Endometrial cancer is often diagnosed when the patient visits a gynaecologist complaining of bleeding or spotting or any other symptom mentioned above. If the gynaecologist suspect cancer then he or she may suggest the following

What Are The Treatments Available For Endometrial cancer?

The choice of treatment may vary depending on multiple factors like the stage of cancer, general health of the patient, age of patient and preference of the patient. The most commonly opted treatment for endometrial cancer is surgery to remove the uterus, fallopian tubes and ovaries.

Another option is radiation therapy with powerful energy. The doctor might also use chemotherapy, hormone therapy, targeted therapy or immunotherapy depending on several aspects.

During the surgery, the doctor also looks around the uterus to check if the cancer has spread.

Is There Any Curative Treatment For Endometrial cancer?

Endometrial cancer in most cases is curable. Because of the early symptoms, it is often detected early when the cancer is concentrated in one place. Doctors may conduct surgery to remove the cancer cells and then radiation or chemotherapy is given to kill any remaining cancer cells.

But in some cases, when the cancer does not show symptom, or the patient ignore the early symptoms, then more aggressive treatment options are opted for. However, in most cases, the survival and prognosis of endometrial cancer is good!


How Frequently Should One Visit Doctor For Early Diagnosis?

If you encounter any of the symptoms or tick any of the risk factors then consulting a doctor is the smartest move though the symptom might not necessarily indicate the presence of the fatal disease.


How Can I As A Patient Know It Early?

Being vigilant is always the key. Keep a track of your periods, check the flow, check for abnormal or untimely bleeding, bleeding after menopause or bleeding between periods. Also, check for vaginal discharge, discomfort, pelvic pain or any other abnormalities in the body.

Being vigilant and aware of the symptoms will help the patient take the right step without wasting any time. Visit a gynaecologist at the earliest and discuss your risk factors and symptoms in details.

If you are worried that it might be cancer, then ask the doctor to conduct an examination. Also, visit your doctor regularly and get your cancer screenings done from time to time.