Uterine cancer, one of the most common cancers in women, can usually be detected at an early stage. There is a good chance of recovery if the cancer is caught at an early stage.

What is it?

Uterine cancer, one of the most common cancers in women, is known as endometrial cancer, uterine cancer and endometrial cancer. Endometrial (uterus)cancer arises from cells of the endometrium, which lines the uterus.

Healthy cells grow and divide in an orderly manner to keep the body functioning normally. However, sometimes cells become abnormal (they mutate) and grow out of control. Cells then continue dividing even when new cells are not required. These abnormal cells may invade and destroy nearby tissues and even have the ability to travel to other parts of the body where they begin to grow. This development is seen in endometrial cancer. Cancer cells develop in the lining of the uterus before they start to invade other organs of the body. It is not entirely known why these cancer cells develop. However, it is believed that estrogen levels play a role in the development of endometrial cancer.

In addition, ongoing research is devoted to studying changes in certain genes that may cause the cells in the endometrium become cancerous.

What are the risk factors?

The factors increasing the estrogen levels;

• Many years of menstruation: Women who begin menstruating at an early age (before 12 years of age) or who go through menopause at an older age have an increased risk of uterine cancer. The longer the patient has had periods, the more her endometrium was exposed to estrogen.

• Never having been pregnant: Pregnancy appears to reduce the risk of endometrial cancer, although expert are not sure exactly why. The body produces more estrogen during pregnancy, but also produces more progesterone. Increased production of progesterone may offset the effects of the rise in estrogen levels.

• Irregular ovulation: Ovulation, the monthly release of an egg from an ovary in menstruating women, is regulated by estrogen. Irregular ovulation or failure to ovulate increases the exposure to estrogen. Ovulation irregularities have many causes, including obesity and a condition known as polycystic ovary syndrome (PCOS). Treating obesity and managing the symptoms of PCOS may help restore monthly ovulation and the menstruation cycle, reducing the risk of endometrial cancer.

• Obesity: Ovaries are not the only source of estrogen. Fat tissue may produce estrogen. Obesity may increase the level of estrogen in the body, placing the patient at a higher risk of endometrial cancer.

• A high-fat diet: This type of diet may add to the risk of endometrial cancer by promoting obesity. On the other hand, fatty foods may directly affect estrogen metabolism, further increasing a woman’s risk of endometrial cancer.

• Diabetes: Endometrial cancer is more common in women with diabetes, possibly because obesity and diabetes often go hand in hand. However, even women with diabetes who are not overweight are at an increased risk of endometrial cancer.

• Estrogen-only replacement therapy (ERT): Estrogen stimulates growth of the endometrium. Replacing estrogen alone after the menopause may increase the risk of endometrial cancer. Taking the hormone progesterone with estrogen – combination hormone replacement therapy - causes the lining of the uterus to shed and lowers the risk of endometrial cancer.

• Ovarian tumors: Some tumors of the ovaries may themselves be a source of estrogen, increasing estrogen levels.

• Ageing: The majority of endometrial cancer occurs in women older than 55.

• A personal history of breast cancer or ovarian cancer.

• Use of tamoxifen: One in every 500 women whose breast cancer was treated with tamoxifen will develop endometrial cancer. Tamoxifen has some estrogen-like effects on the endometrium and may cause the uterine lining to grow. Women who use tamoxifen should go to the doctor for an annual pelvic examination due to the increased risk of endometrial cancer.

• Hereditary nonpolyposis colorectal cancer (HNPCC): This inherited disease is caused by an abnormality in a gene important for DNA repair. Women with HNPCC have a significantly higher risk of endometrial cancer as well as colon cancer.

Even those at risk based on the above risk factors will not necessarily contract endometrial cancer, but they should be alert to possible signs and symptoms of the disease.

What are the symptoms?

Most cases of endometrial cancer develop in postmenopausal women. Abnormal vaginal bleeding may be an early signal that something may be wrong. Signs and symptoms of endometrial cancer may include bleeding after menopause, prolonged periods or bleeding between periods, an abnormal non-bloody discharge from the vagina, pelvic pain, pain during intercourse and unintended weight loss.

What are the diagnostic methods?

Firstly, the doctor will conduct a complete review of the patient’s medical history and perform a physical and pelvic examination, and then perform a transvaginal ultrasound. At this stage, the thickness and texture of the endometrium is evaluated. Then, to establish a final diagnosis, the patient will undergo an endometrial biopsy. This is performed in the doctor’s surgery and does not require anesthesia. If the biopsy does not produce enough tissue, the patient will undergo a dilatation and curettage. This procedure requires the patient to be in an operating room. In this procedure, tissue is scraped from the lining of the uterus and sent for pathological examination. The final diagnosis is established after examining the tissue under a microscope. If endometrial cancer is found, the patient is referred to a gynecological oncologist. More tests (X-ray, CT, blood tests) may be performed if required to determine if the cancer has spread. In endometrial cancer, final staging is performed through a surgical procedure and is performed at the same time as any surgical treatment.

How is it treated?

Endometrial cancer can be treated when discovered early. The 5 year survival rate for endometrial cancer, provided it has not spread, is 95%. Endometrial cancer is most commonly treated through surgery, as well as radiotherapy and chemotherapy.

• Surgery: The most common treatment for endometrial cancer is surgery, involving the surgical removal of the uterus, fallopian tubes and ovaries. Lymph nodes in the area should also be removed during surgery along with other tissue samples. The first surgery is considered to be most important treatment for the patient, and it is strongly recommended that the surgery is performed by a gynecological oncologist. However, if the cancer has spread to other parts of the patient’s body, the patient may need additional treatment.

• Radiotherapy: If the doctor believes there is a high risk of a recurrence of the cancer, they may recommended has radiation therapy following a hysterectomy (the surgical removal of the uterus). 

• Hormone therapy: If the cancer has spread to other parts of your body, a high dose of progesterone may stop the tumor growing.

• Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs are often used in combination. If the patient has an aggressive form of endometrial cancer or if the cancer has spread to other parts of the body, the patient will receive chemotherapy drugs through the veins. These drugs enter the bloodstream and then travel through the body, killing cancer cells outside the uterus. After treatment for endometrial cancer, the doctor will likely recommend regular follow-up examinations and checkups that may include a physical examination, a pelvic exam examination, a chest X-ray and laboratory tests.