Endometrial cancer is a type of uterine cancer. It is by far the most common gynecologic cancer
in the United States with about 65,000 new cases of endometrial cancer
every year and this number is rising rapidly.
Many of these cancers are now diagnosed in young women who have not had children yet.
What is uterine cancer?
Uterine or endometrial cancer is a cancer from the inside lining of the uterus.
This inside lining is called endometrium. The endometrium is the source of bleeding during normal menstruation.
When endometrial cancer develops, patients experience irregular or abnormal vaginal bleeding.
Any bleeding in menopause requires a careful examination of the uterus by an expert since it might indicate the presence of an endometrial cancer.
There are several types of endometrial cancer. The most common type is called endometrioid carcinoma.
It is typically related to hormones and in general has a good prognosis when treated correctly. Other
less frequent types of endometrial cancer include clear cell or serous carcinoma of the endometrium.
The uterus can also develop a so-called sarcoma which is another type of uterine cancer.
Sarcomas do not originate from the lining of the uterus but rather from the muscle tissue in the uterine wall.
Who is at risk?
The highest rate of endometrial cancer is diagnosed in women between 60 and 70 years of age.
We know about a number of factors that can increase the risk to develop endometrial cancer including:
obesity, diabetes and high blood pressure or hypotension.
We also know that hormonal imbalances can cause growth of the endometrium in cancer.
Estrogen for example is a hormone that is mainly produced by the ovaries, but also by fat tissue throughout the body.
Estrogen is involved in the development of the breast and gynecological organs.
Under some circumstances the body has too much estrogen which can increase
the risk of developing endometrial cancer. Some patients for example take hormones in menopause
which in general is safe when done correctly, but if there's too much estrogen intake
that can cause endometrial cancer. Finally, some women are born with mutations in their DNA or
certain genes that can greatly increase the risk. Women with so-called lynch syndrome for example
have such gene mutations and have a risk of endometrial cancer development of up to 60 percent
in their lifetime. These genes are also associated with cancers of the ovary and the colon.
How do we screen for uterine cancer?
There's no recommended screening for endometrial cancer at least not in the general population.
For women who have genetic mutations and are therefore at higher risk, screening with endometrial biopsies every one to two years is recommended.
In addition, these patients are counseled in regards to surgical removal of the uterus,
fallopian tubes, and ovaries prior to the development of endometrial or ovarian cancer.
Genetic testing allows the identification of these women at risk and is a very effective way to
reduce your risk if you have family members with cancer or lynch syndrome.
How do we treat uterine cancer?
The standard treatment for endometrial cancer is surgery which removes the uterus,
ovaries, fallopian tubes, and the lymph nodes nearby the uterus. The surgery serves two purposes
first, it removes all cancerous tissues and second, it provides important information
about possible spread of the cancer to other organs. Fortunately, most endometrial cancers are
diagnosed at early stages, since patients present with vaginal bleeding as an early symptom of the
disease. Any woman with abnormal vaginal bleeding, for example bleeding in menopause, need to undergo
an endometrial biopsy which is very accurate to diagnose endometrial cancer. Some patients might
need additional treatment after surgery which could involve chemotherapy, radiation therapy,
or at times both. After completion of all treatments patients are followed closely with
public exams every three months for two years and afterwards every six months or annually.
The close follow-up is meant to ensure that any possible recurrence of cancer is discovered
early and therefore can be treated successfully.
What is on the horizon for endometrial cancer?
We have made significant progress in the treatment of endometrial cancer. Immunotherapy for example is
very effective and has provided many patients with advanced disease with better outcomes. Many other
therapies under development that have already shown promising results. So, in summary endometrial
cancers are usually diagnosed at early stages and cure rates are therefore high, with over 90 percent.
Some types of uterine cancer such as clear cell carcinoma or uterine sarcoma
have however a poorer prognosis. The number of endometrial cancers is steadily rising.
In part because of the high rate of obesity in many parts of the world.
Please, reach out to your doctor if you have more questions about endometrial cancer.