Endometrial cancer is one of the two types of uterine cancer. The other type of uterine cancer is uterine sarcoma. Endometrial cancer affects the lining of the uterus, while uterine sarcoma begins in the muscles of the uterus. The former is far more common than the latter. Following are the different stages of endometrial cancer:
Stage 0: This stage is also known as carcinoma in situ, i.e., the cancer is extremely early.
Stage I: In this stage, the cancer is found only in the womb.
Stage II: When the cancer spreads beyond the uterus (womb) into the cervical stroma, it is known as stage II endometrial cancer.
Stage III: The vagina, fallopian tubes, ovaries, and lymph nodes in the pelvic region are affected in the third stage.
Stage IV: The cancer spreads to other organs of the body beyond the pelvic area.
CAUSES
The exact cause of endometrial cancer is not known. Experts suggest that endometrial cancer is associated with an imbalance of estrogen & progesterone, i.e., when the level of estrogen is high compared to that of progesterone. The imbalance causes the endometrial lining to thicken up and allows cancer cells to grow.
RISK FACTORS
Obesity: Fat cells produce estrogen, which causes an imbalance of estrogen & progesterone.
Estrogen-only medications: Intake of estrogen without taking progesterone also results in the said imbalance.
PCOS (Polycystic ovary syndrome): PCOS can increase the levels of estrogen without affecting the levels of progesterone.
Naturally high levels of estrogen: In such cases, women often start having periods before the age of 12, and reach menopause only after 50.
SYMPTOMS
The most common symptom experienced by women is abnormal bleeding. Following are the symptoms related to endometrial cancer.
Abnormal bleeding related:
- Change in the period cycle.
- Bleeding between period cycles.
- Bleeding after reaching menopause.
Other symptoms:
- Pain in the pelvic area.
- Abnormal weight loss
- Abnormal vaginal discharge and spotting.
- Feeling fullness or mass near the pelvic area.
DIAGNOSIS
In order to ascertain endometrial cancer beyond doubt, an endometrial biopsy is done. Other tests include pelvic examination, transvaginal ultrasound, and D&C.
Pelvic examination:Pelvic examination is a routine screening test in which the doctor examines various organs, such as the vulva, ovaries, and uterus, from the outside. The doctor may also use a speculum, a device that helps the doctor view the patient’s cervix and inspect it for abnormalities.
Transvaginal Ultrasound: Ultrasound is an imaging technique that uses ultrasound waves to create an image/video of the patient’s internal organs. In transvaginal ultrasound, the doctor will insert the transducer into the patient’s vagina to inspect the uterus with the help of the video/image on screen. With the help of transvaginal ultrasound,, the doctor can determine the thickness of the endometrium and rule out other possibilities.
Hysteroscopy: Hysteroscopy is a procedure in which the doctor inserts a small, lighted instrument known as the hysteroscope through the patient’s natural orifices, in this case the vaginal opening. This instrument relays images on the screen, which helps the doctor inspect the patient’s inner organs.
Endometrial Biopsy: To confirm endometrial cancer, a biopsy is required. Here, the doctor will try to obtain sample tissues from the uterine lining for analysis. Most patients do not require anesthesia.
Dilation & Curettage (D&C): If the biopsy results are unclear or not enough sample tissue can be obtained, the doctor may recommend D&C. Dilation is performed to widen the cervix so that instruments can be inserted into the uterus. Curettage is the procedure of scraping the walls of the patient’s uterus.
TREATMENT
Depending on the endometrial cancer stage, an appropriate treatment method can be selected. Usually, endometrial cancer is detected early due to the symptom of vaginal bleeding. If it is detected early, surgery is recommended.
Hysterectomy: Hysterectomy is a procedure in which the patient’s uterus is removed. Therefore, childbirth is not possible after this procedure. The doctor may remove the fallopian tubes as well as the ovaries.
Chemotherapy: Patients having advanced-stage endometrial cancer may be treated with chemotherapy to kill any remaining cancerous cells. Chemotherapy is a form of cancer treatment wherein the patient is administered medicine and drugs through injections, abdominal opening, or both.
Other methods of treatment include:
- Radiation: During radiation, powerful energy beams are used to kill cancerous cells. There are two types of radiation therapy. In the first one, the machine is placed outside the patient’s body. In the other method, the device is placed within her body.
- Hormonal therapy: Hormonal therapy is used to bring a balance in estrogen-progesterone levels. It may involve medications either for increasing the progesterone levels or for decreasing the levels of estrogen.