Endometrial cancer is the most common gynecological cancer in women after breast, colorectal and lung cancer. It is a disease of the elderly and postmenopausal women. 70% of the cases are between the ages of 45-74. Despite the lack of Effective screening test for the detection of the disease, 75% of them are detected at early stages since the disease present the symptoms earlier. Admitting to a physician due to a vaginal bleeding which occurred after menopause or spotting may provide detection of the cancer at an early stage. 5-year survival is around 84% on average for all stages, this ratio is even higher if the disease is detected early.
When uterine cancer (endometrial cancer) is mentioned, cancers originating from the endometrium forming the inner layer of the uterus are understood.
- Being over the age of 60,
- Obesity (obesity)
- the long-term use of hormone drugs containing only estrogens, but not progesterone
- Starting menstruation at an early age and having menopause at further ages
- Never giving birth or a history of infertility,
- The presence of bowel cancer or endometrial cancer
- in personal or family history of
- History of breast or ovarian cancer
- Ovarian diseases
- Usage of Tamoxifen (a hormone used to treat breast cancer drug)
- Diabetes (diabetes mellitus),
- Diet rich in animal fat,
- Hypertension (high blood pressure),
- Menstrual irregularities
- Estrogen replacement therapy
Factors that reduce the risk of endometrial cancer:
- Prolonged contraceptive use reduces the risk , the protection of the drug continues for 10 years after stopping the pills.
- The physician should be consulted if intense, excessive or irregular bleeding develop in menstruating women.
- Vaginal bleeding after menopause is the earliest signs of endometrial cancer, it must be checked without wasting time.
- Some types of cases of endometrial hyperplasia (atypical complex hyperplasia) have a tendency to turn into cancer if left untreated. In this case, the surgical removal of the uterus can prevent it.
- In the presence of Hereditary Nonpolyposis Colon Cancer or increased risk in terms of it, endometrial biopsy every year from the age of 35 or the removal of the uterus if child request is not the subject anymore may be recommended.
- Since Tamoxifen which is used to treat breast cancer increases the risk of endometrial cancer, patient should be made aware of this issue and routine gynecologic examinations should not be disrupted.
- Being at a healthy weight, balanced diet, taking control of the present diabetes and high blood pressure
There is no screening test recommended for detecting cervical cancer in women who have no complaint or carry any familial risk. But in most women with endometrial cancer have early symptoms. These symptoms are:
Abnormal vaginal bleeding, spotting or discharge:
It is particularly important for women in menopause. In women who are still menstruating, irregular bleedings occur. The women with postmenopausal bleeding or increased vaginal bleeding after the age of 40 should contact a physician for the probability of cervical cancer. Measurement of the inner membrane (endometrium) thickness with transvaginal ultrasound during periodic gynecological examination can give an idea about uterine cancer. If a thickened endometrium in post-menopausal years is detected, it should be evaluated for cancer . Non-bloody vaginal discharge may be a finding, too. 10% of the discharges related to endometrial cancer are not bloody.
Burning while urinating, pain during sexual intercourse,
Pain in the pelvic area or mass
In the presence of any of the above symptoms should be referred to a gynecologist. When the gynecologist suspects endometrial cancer, he obtains some amount of tissue by endometrial biopsy or curettage and sent for pathologic examination. If cancer is present when the sample is examined by the pathologist, its type and grade are reported. The greater the degree of cancer, spread of the disease and recurrence is likely.
In the diagnosis of endometrial cancer, and imaging techniques such as transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) can be performed if necessary.
When the Endometrial cancer spreads, firstly it advances towards the tubes, ovaries and lymph nodes. Advanced cancer may involve urinary bladder and the colon as well.
When deciding the treatment of endometrial cancer, the type, grade, stage of the cancer, the patient's general state of health and personal preferences are considered. The aim of surgery in patients with endometrial cancer is to remove cancerous tissue from the body as much as possible. Therefore, the total removal of the uterus (hysterectomy) is a basic principle. Tubes and ovaries are removed. In cases at very early stage (the tumor is limited in the uterus and deep myometrial invasion doesn’t exist) removing only the uterus and ovaries (TAH + BSO) and cytological examination of the peritoneal lavage fluid may be sufficient. In the remaining stages, pelvic and para-aortic lymph node biopsy is performed and the dissemination of the disease is determined by pathological assessment. According to the findings adding chemotherapy and/or radiotherapy to the treatment in postop period is planned.
Endometrial Cancer Staging (FIGO 2009 staging):
Stage I Tumor is limited within uterus
IA: The depth of the tumor doesn’t extend the half of myometrium
IB: The depth of the tumor reaches or extends the half of myometrium
Stage II: The tumor has spread cervical stroma but were not extended outside the uterus.
Stage III: Local or regional spread of the tumor is exists.
IIIA: Tumor has spread over serosa layer of the uterus and / or adnexa.
IIIB: vaginal and / or parametrial spread exists.
IIIC: Metastasis exists in pelvic and / or para-aortic lymph nodes
IIC1: Pelvic lymph node spread
IIIC2: paraaortic lymph node spread and / or pelvic lymph node involvement
Stage IV: Involvement of the urinary bladder and / or rectal mucosa, and / or spread to distant organs
IVA: Spread to urinary bladder and / or rectum mucosa
IVB: distant metastasis includes the spread of intra-abdomen and / or inguinal lymph node
If the cancer has not spread outside the uterus, a complete recovery is possible with surgical treatment.
However if it has spread to other organs or lymph tissues, it will require additional treatment. Postoperative radiation therapy is applied in advanced ovarian cancers.
Chemotherapy are the drugs used to kill cancer cells. Place of chemotherapy in endometrial cancer is limited. Generally these drugs are used in combinations.