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Endometrial Cancer Symptoms

Definition

The endometrium is the tissue forming the inner lining of the uterus. Endometrial cancer (also called uterine cancer) develops when the cells of the endometrium become abnormal and grow uncontrollably.

Description

Endometrial cancer is a common type of cancer among women. The incidence of this disease is higher in Caucasian women than in African-American women. The American Cancer Society estimates that in 1998, at least 36,000 new cases of endometrial cancer will be diagnosed. Approximately 6,300 women will die from the disease. This type of cancer generally occurs in women who have gone through menopause and are 45 years old or older. The average age of a woman when she is diagnosed is 60 years old.

The uterus (also called the womb) is the hollow female organ that supports the development and nourishment of the unborn baby during pregnancy. The uterus has a thick muscular wall and then an inner lining called the endometrium. The endometrium is very sensitive to hormones and it changes daily during the woman's menstrual cycle. This inner lining is designed to provide an ideal environment for the fertilized egg to implant itself and begin to grow. If pregnancy does not occur, the endometrium is shed at the time of the menstrual period. The bleeding that occurs during a woman's period is the shedding of the endometrium along with the accompanying blood and tissue. More than 95% of uterine cancers arise in the endometrium.

Causes & symptoms

Although the exact cause of endometrial cancer is unknown, there are several factors that increase a woman's risk of developing this particular cancer.

Endometrial cancers have a very good chance of being cured because there are symptoms that are evident very early on in the disease. The most common symptom of endometrial cancer is unusual bleeding or discharge. Especially in women who have gone through menopause, any vaginal bleeding should be brought to the attention of the doctor immediately. Any abnormal vaginal discharge should also be reported. Pain in the pelvic region and the presence of a lump (mass) are symptoms that occur late in the disease.

• Age. The risk is considerably higher in women who are over the age of 50 and have gone through menopause.
• Obesity. Being overweight is thought to be a very strong risk factor for this cancer. Fatty tissue can change other normal body chemicals into estrogen, which can promote endometrial cancer.
• Estrogen replacement therapy. Studies have shown that a woman receiving estrogen supplements after menopause can have a 12 times higher risk of getting endometrial cancer if she is not taking progesterone at the same time.
• Diabetes. Diabetics have twice the risk of getting this cancer as compared to normal women. At present, it is not very clear if this risk is due to the fact that many diabetics are also obese and hypertensive.
• Hypertension. High blood pressure (or hypertension) is also considered a risk factor for uterine cancer. Again, as with diabetes, it is not very clear if hypertension alone is responsible for increasing the risk of endometrial cancer, or if the risk is related to the fact that hypertensive women are also generally obese.
• Irregular menstrual periods. During a woman's menstrual cycle, there is interaction between the hormones estrogen (which can encourage endometrial cancer development) and progesterone (which can offer protection from endometrial cancer). Women who do not ovulate regularly are exposed to high estrogen levels for longer periods of time. If a woman does not ovulate regularly, this delicate balance is upset and may increase her chances of getting uterine cancer.
• Early first menstruation or late menopause. For unknown reasons, having a first period at a young age and going through menopause at a late age seem to put women at a slightly higher risk for developing endometrial cancer.
• Tamoxifen. This drug is used to treat breast cancer and it increases a woman's chance of developing endometrial cancer. In many cases, however, the value of tamoxifen for treating breast cancer and for preventing the cancer from spreading far outweighs the small risk of getting endometrial cancer from using the drug.
• Family history. Some studies suggest that endometrial cancer runs in certain families. However, more research needs to be done to prove that there is a hereditary link.

Diagnosis

If the doctor suspects endometrial cancer, they will conduct a series of tests to confirm the diagnosis. The first step will involve taking a complete personal and family medical history. A physical examination, which will include a thorough pelvic examination, will also be done.

The doctor may order an endometrial biopsy. This is generally performed in the doctor's office and does not require any anesthesia. The doctor inserts a very thin, flexible tube into the uterus through the cervix. A small piece of endometrial tissue is removed. The patient may experience some discomfort, which can be minimized by taking an anti-inflammatory medication (like Advil or Motrin) an hour before the procedure.

If an adequate amount of tissue was not obtained by the endometrial biopsy, or if the biopsy tissue looksabnormal but confirmation is needed, the doctor mayperform a procedure known as dilatation and curettage (D & C). This procedure is done in the outpatient surgery department of a local hospital and takes about an hour. The patient may be given general anesthesia. The doctor dilates the cervix and uses a special instrument to scrape tissue from inside the uterus.

The tissue that is obtained from the biopsy or theD & C is sent to a laboratory for examination. If cancer is found, then the pathologist in the laboratory will determine what type of cancer it is. The treatment and prognosis for cancer depends on the type and stage of the cancer.

Treatment

The standard treatments available for endometrial cancer are surgery, radiation therapy, hormonal therapy, and chemotherapy.

Surgery

Surgery is the best option when endometrial cancer is diagnosed at its very early stages. At this time, the location and the stage of cancer make removal easy. Sometimes patients are treated with a combination of surgery and radiation therapy. There are several surgical procedures that can be used and the choice of which procedure used depends on the type and stage of the cancer. The woman's age and general state of health are also taken into account.

Almost all women with endometrial cancer (except those with advanced, or stage IV, disease) are treated with hysterectomy. They may also receive additional treatment. A simple hysterectomy involves the removal of the uterus, making the woman unable to have children. In a procedure known as bilateral salpingo-oophorectomy, both ovaries, the fallopian tubes, and the uterus are removed. This may be necessary because endometrial cancer often spreads to the ovaries first.

Radiation therapy uses high-energy radiation from x rays and gamma rays to kill the cancer cells. When the radiation is given from a machine that is outside the body, the process is called external radiation therapy. Sometimes radioactive pellets are placed inside the body near the tumor. This is called brachytherapy or internal radiation therapy. Side effects are common with radiation therapy. The skin in the treated area may become red and dry and may take as long as a year to return to normal. Fatigue, upset stomach, diarrhea, and nausea are also common complaints of women having radiation therapy. Radiation therapy in the pelvic area may cause the vagina to become narrow as scar tissue forms. This phenomenon known as vaginal stenosis makes intercourse painful. In such cases, the use of vaginal dilators may provide some relief. Premature menopause and some problems with urination may also occur. The decision to use radiation therapy depends on the stage of the disease.

Chemotherapy

Chemotherapy uses anticancer drugs to kill the cancer cells. The drugs are given orally (by mouth) or intravenously. They enter the bloodstream and can travel to all parts of the body to kill cancer cells. Generally, a combination of drugs is given since it is more effective than a single drug in treating cancer. Side effects with this treatment include stomach upset, vomiting, appetite loss, hair loss, mouth or vaginal sores, fatigue, menstrual cycle changes, and premature menopause. There is also an increased chance of infections. There are medications available that can reduce the effects of chemotherapy and provide some relief, and women should talk to their doctors about side effects. Chemotherapy is usually reserved for women with advanced (stage IV) or recurrent disease because this therapy is not as effective as surgery or radiation.

Hormonal therapy uses drugs like progesterone that will slow the growth of endometrial cells. These drugs are usually available as pills. This therapy is usually reserved for women with advanced or recurrent disease.

Prognosis

Since it is possible to detect endometrial cancer early, the chances of curing it are excellent. In fact, if the cancer is found in its very earliest stage, approximately 96% of patients survive five years or more. However, the survival rate falls to 66% if the cancer has spread by the time it is initially diagnosed. Although the disease is more frequent in Caucasian women than in African-American women, the survival rates for African-American women are much lower than those for Caucasian women. This may be due to the fact that some African-American women do not seek medical help early enough or lack access to good medical care facilities.

Prevention

Most importantly, women (especially postmenopausal women) should report any abnormal vaginal bleeding to the doctor. Early diagnosis is extremely important in this disease. Since the exact cause for endometrial cancer is unknown, all cases of endometrial cancer cannot be prevented. However, by avoiding certain controllable risk factors, a woman can reduce her chance of developing this disease.

Controlling obesity, blood pressure, and diabetes can help to reduce the risk of this disease. The use of birth control pills over a long period of time has been shown to reduce the risk of this cancer. This is one reason why women who have irregular periods are prescribed birth control pills, to offset an increased risk of developing endometrial cancer. However, endometrial cancer is not the only factor to be considered when choosing a method of birth control. Women should discuss with their doctors the risks and benefits of available birth control methods before deciding on the best choice.

There is evidence that women on estrogen replacement therapy after menopause have a substantially reduced risk of endometrial cancer if progestins are taken along with estrogen. Doctors routinely prescribe estrogen and progesterone together unless there is a reason why a woman cannot take progesterone. Doctors should also pay very close attention to any abnormal vaginal bleeding in women after menopause.

Key Terms

Dilation and curettage (D & C)

A procedure where the doctor dilates the cervix and uses a special instrument to scrape some tissue from the inside of the uterus.

Endometrial biopsy

A medical procedure where a sample of the endometrium is removed and is examined under a microscope.

Endometrium

The mucosal layer lining the inner cavity of the uterus. The endometrium's structure changes with age and with the menstrual cycle.

Estrogen

A female hormone responsible for stimulating the development and maintenance of female secondary sexual characteristics.

Estrogen replacement therapy (ERT)

A treatment where the female hormone estrogen is used as therapy in order to alleviate certain symptoms. Women going through menopause are often given ERT to reduce the hot flashes and other uncomfortable symptoms of menopause. ERT has also been shown to reduce the risk of osteoporosis and heart disease in women.

Progesterone

A female sex hormone that acts on the inner lining of the uterus and prepares it for implantation of the fertilized egg.

Progestins

A female hormone, like progesterone, that acts on the inner lining of the uterus.

Further Reading

For Your Information

Books

• Berkow, Robert, et al., eds. The Merck Manual of Diagnosis and Therapy, 16th ed. Rahway: Merck Research Laboratories, 1992.
• Dollinger, Malin, Ernest Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy: How Cancer is Diagnosed, Treated, and Managed Day to Day. Kansas City: Somerville House Books Limited, 1994.
• Morra, Marion E., and Eve Potts. Choices. New York: Avon Books, 1994.

  Organizations

• American Cancer Society, National Headquarters. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345.
• Cancer Research Institute, National Headquarters. 681 Fifth Ave., New York, NY 10022. (800) 992-2623.
• Gynecologic Cancer Foundation. 401 North Michigan Ave., Chicago, IL 60611. (800) 444-4441.
• National Cancer Institute, National Institutes of Health. 9000 Rockville Pike, Bethesda, MD 20892. (800) 422-6237.

Gale Encyclopedia of Medicine. Gale Research, 1999.