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Uterine (Endometrial) Cancer

endometrial cancer

The uterus (womb) is in the lower abdomen behind the bladder. The inside of the uterus is where a baby grows if you become pregnant. The inside lining of the uterus is called the endometrium. This builds up and is then shed each month as a period in women who have not yet gone through the menopause. The thick body of the uterus is called the myometrium and is made of specialised muscle tissue.  The lowest part of the uterus is called the cervix (the neck of the womb) which pushes just into the top part of the vagina. At the top of the womb are the right and left Fallopian tubes which carry the eggs (released from the ovaries) to inside the womb.

What is uterine cancer?

Most uterine cancers develop from cells in the endometrium (endometrial cancer). Cervical cancer (cancer of the cervix) is quite different to uterine cancer. The rest of this leaflet deals only with endometrial cancer of the uterus.

Endometrial cancer

Most cases develop in women aged in their 50s and 60s. It rarely develops in women under the age of 50.

Type and grade of endometrial cancer

Most cases of endometrial cancer are called endometrioid adenocarcinomas. These arise from cells which form the glandular tissue in the lining of the endometrium.

Grade 1 (low grade) - the cells look reasonably similar to normal endometrial cells. The cancer cells are said to be well differentiated. The cancer cells tend to grow and multiply quite slowly and are not so aggressive.
Grade 2 - is a middle grade.
Grade 3 - the cells look very abnormal and are said to be poorly differentiated. The cancer cells tend to grow and multiply quite quickly and are more aggressive.

What causes endometrial cancer?

A cancerous tumor starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. There are risk factors which are known to increase the risk of endometrial cancer developing.

These include the following:

Increased exposure to oestrogen. These include:

  • If you have never had a baby.
  • If you are overweight or obese.
  • If you have certain rare oestrogen-producing tumours.
  • If you have a late menopause (after the age of 52) or started periods at a young age.

Endometrial hyperplasia. This is a benign (non-cancerous) condition where the endometrium builds up more than usual. It can cause heavy periods or irregular bleeding after the menopause.

Tamoxifen. This is a drug which is used in the treatment of breast cancer. The risk of developing endometrial cancer from tamoxifen is very small - about 1 in 500.

Diabetes.

Polycystic ovary syndrome.

Diet.

Genetic factors. In a small number of cases, a faulty gene (which can be inherited) may trigger the disease. This disorder is called hereditary nonpolyposis colon cancer (HNPCC).
Women who take the combined oral contraceptive pill have a lower risk of developing endometrial cancer.

What are the symptoms of endometrial cancer?

Vaginal bleeding past the menopause. This can range from spotting to more heavy bleeds. This is the most common symptom of endometrial cancer.

Bleeding after having sex (postcoital bleeding).

Bleeding between normal periods (intermenstrual bleeding) in women who have not gone through the menopause.

Early symptoms that occur in some cases are: pain during or after having sex, vaginal discharge, and pain in the lower abdomen.

In time, if the cancer spreads to other parts of the body, various other symptoms can develop.

How is endometrial cancer diagnosed and assessed?

To confirm the diagnosis

Ultrasound scan of the uterus. This is usually the first test that is done.

Endometrial sampling. This is where a thin tube is passed into the uterus. By using very gentle suction, small samples of the endometrium can often be obtained. This is done in the outpatient clinic, without an anaesthetic.

Hysteroscopy. This is where a doctor uses a hysteroscope, which is a thin telescope that is passed through the cervix into the uterus. The doctor can see the lining of the uterus and take biopsies (samples) of abnormal-looking areas.

Assessing the extent and spread

CT scan, an MRI scan, a chest X-ray, blood tests, an examination under anaesthetic of the uterus, bladder or rectum, or other tests. The aim of staging is to find out:

  • How much the tumour has grown, and whether it has grown to other nearby structures such as the cervix, bladder or rectum.
  • Whether the cancer has spread to local lymph glands (nodes).
  • Whether the cancer has spread to other areas of the body (metastasised).

Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for endometrial cancer?

Surgery is the main treatment for endometrial cancer. Radiotherapy or chemotherapy are also used in some circumstances. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread) and your general health.

Surgery

An operation to remove the uterus (hysterectomy) and ovaries is a common treatment. It is common for the Fallopian tubes and both ovaries to be removed as well. Many operations are now performed laparoscopically (key-hole). If the cancer is at an early stage and has not spread, then surgery alone can be curative.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying. Radiotherapy alone can be curative for early-stage endometrial cancer and may be an alternative to surgery. In some cases radiotherapy may be advised in addition to surgery.

Chemotherapy

Chemotherapy is a treatment of cancer using anti-cancer drugs. They kill cancer cells, or stop them from multiplying. Chemotherapy is not a standard treatment for endometrial cancer but may be given in certain situations (usually in addition to radiotherapy or surgery).

Hormonal treatments

Treatment with progesterone is used in some types of endometrial cancer. It is generally not used in the initial treatments, but may be considered if the cancer spreads or comes back after those treatments.

What is the outlook (prognosis)?

There is a good chance of a cure if endometrial cancer is diagnosed and treated when the disease is at an early stage. This is when the cancer is confined to the uterus and has not spread. For women who are diagnosed when the cancer has already spread, a cure is less likely but still possible. Even if a cure is not possible, treatment can often slow down the progression of the cancer.


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