Endometrial Cancer
About the Disease
Endometrial cancer affects the lining of the uterus or endometrium. It is the most common cancer of the female reproductive organs but is highly curable when diagnosed early. About three quarters of all endometrial cancers are adenocarcinomas.
Endometrial cancer is most common in women 50-65 but can occur at any age. Researchers believe that high estrogen levels may trigger this disease and that factors which affect estrogen production play a role in determining who gets endometrial cancer. In the last year for which there were statistics more than 350 Alberta women were diagnosed with the disease. By comparison, 1800 individuals were diagnosed with breast cancer in the same time frame.
Risk Factors
Risk factors are determined by analyzing the numbers of patients with cancer in a larger population and trying to find differences in the characteristics or behaviors between those individuals who develop cancer and those who do not. The Tomorrow Project, for instance, is tracking more than 50,000 Albertans over a fifty-year period to learn more about who develops cancer and why.
Women who begin to menstruate early, before the age of 12, and continue to have periods into their mid-fifties are at higher risk of developing endometrial cancer. That’s because the longer a women has had periods, the longer her endometrium has been exposed to estrogen. For that reason, child-bearing history also plays a role in determining the likelihood of getting the disease.
Other factors that may increase the risk of developing endometrial cancer include:
- Infertility
- Obesity (fat tissue changes hormones into estrogen)
- Previous cancer treatments (the use of tamoxifen for treatment of breast cancer or radiation therapy for pelvic cancer)
- Polycystic ovary syndrome, where fluid-filled sacs from on the ovaries
- Estrogen replacement therapy (ERT) for longer than one year
- Diet (high in animal fats)
- Diabetes
- High blood pressure
- Few or no children
- Age (risk increases after the age of 40)
- Race (Caucasians are more likely to be diagnosed with the disease but black women are more likely to die from it).
- Factors that may decrease the risk of developing endometrial cancer include:
- A diet high in fruits and vegetables
- Maintaining a healthy body weight
- Using oral contraceptives for a lengthy period can decrease the risk of endometrial cancer even up to ten years after use has been discontinued
- Maintaining normal blood pressure
- Regular pelvic exams and pap smears
Genetic Links
The chances of developing endometrial cancer increase if there is a family history of colon or endometrial cancer. Patients who have experienced cancer of the breast or ovaries are also at increased risk.
Detection and Diagnosis
The most common symptom of endometrial cancer is abnormal vaginal bleeding with associated pain.
Physicians who suspect endometrial cancer will likely order a pap test to assess cervical abnormalities, and proceed to an endometrial biopsy or a D & C * to obtain the tissue sample necessary to confirm a diagnosis of endometrial cancer.
* A D&C, or a dilation and curettage, is a minor operation that involves scraping the lining of the cervical canal and uterine lining to obtain a sample for microscopic examination.
Treatment
Treatment options for endometrial cancer include surgery, chemotherapy and radiation therapy, sometimes in combination depending on the extent of the disease.
Surgery
Surgical treatment is a total abdominal hysterectomy (surgical removal of the uterus) and bilateral salpingo-oophorectomy (surgical removal of the fallopian tubes and ovaries). The physician may also recommend a pelvic lymph node dissection, or the sampling of lymph nodes from the pelvis.
Chemotherapy may be used in certain types of endometrial cancer depending on the results of surgery.
Radiation therapy using concentrated beams of high-energy X-rays, is sometimes used to treat the pelvis in women who have a higher risk of recurrence.
Hormonal therapy is sometimes of use because this cancer comes from tissue that is sensitive to hormones. Treatment with progestin can be an option for women with early stage cancer who wish to keep the ability to have children.This would be done under the supervision of a gynecologic oncologist.
Factors Affecting Prognosis
Early detection is the key factor affecting survival of endometrial cancer. When diagnosed early more than 80 per cent of women will live more than five years and most will be completely cured.
