More detailed description about endometrial cancer

Endometrial cancer is one of the most common cancers in women, placing 4th in incidence just after breast cancer, lung cancer and colon cancer. It can affect women of all ages, but it usually appears after menopause, between the ages of 60 and 70. White women are more commonly affected than representatives of other races, but black women show higher mortality from this disease than white women do.

In healthy tissues, cells undergo controlled divisions, meaning that the appearance of new cells exactly matches the dying off of old ones. When the control of cellular division is lost due to a mutation of the cell's genetic material, the cell and its progeny start to undergo uncontrolled divisions and destroy the organized structure of the tissue of their origin. They may make their way to the circulation and get carried to distant organs via blood. Such seeding is called metastasis.

Factors and symptoms

Many factors affecting cancer development are known. In endometrial cancer, the important risk factors include a long period between the first menstruation and menopause, nulliparity (women who never gave birth), irregular menstrual periods, obesity, diabetes mellitus, hormone replacement therapy and ovarian cancer. In addition, age, race, therapy with tamoxifen (breast cancer medication) and the presence of hereditary nonpolyposis colorectal cancer (HNPCC) also influence the development of endometrial cancer.

The initial symptom of endometrial cancer is usually an irregular vaginal bleeding after menopause (cessation of menstrual cycles). In addition, symptoms may include pelvic pain, pain during intercourse and weight loss. Cancer complications usually appear in advanced stage cancer and are characterized by increasing pain intensity, appearing also during urination. Anaemia and chronic fatigue may also develop as cancer complications.

A physician suspecting endometrial cancer based on typical symptoms will refer the patient further to a gyneacologist who shall perform tests to confirm the diagnosis. These include a Pap smear (cervical smear) and a biopsy (removal of a tissue sample) of the endometrial lining. Ultrasound is also a useful examination modality.

Prevention

Although most cases of this cancer cannot be prevented, measures can be taken to reduce the chance of its appearance. The measures are the following:

• Maintenance of a normal body weight, for the adipose tissue also produces the estrogen hormone which stimulates the growth of the endometrial cells, thereby increasing the chance of cancer development. All measures taken by a woman towards body weight normalization are thus of utmost importance. Regular physical activity halves the risk, and a low fat diet, especially low in fat of animal origin, also reduces the danger of endometrial cancer development.
• Usage of the combination hormonal therapy; menopausal women on estrogen as the sole hormonal substitution therapy have an increased chance of developing endometrial cancer. The physician can affect this risk by adding progestins (a form of the female hormone progesterone). However, such a combination therapy carries with it some dangerous side effects as well, such as an increased risk for breast cancer and the risk for blood clots.
• Treatment of certain diseases such as polycystic ovarian disease and diabetes mellitus that may increase the risk for endometrial cancer. In addition, it is important to recognize and treat endometrial hyperplasia (i.e. an increased growth of the endometrial cells) which may lead to cancer in a small percentage of cases.
• The use of contraception pills may reduce the chance for endometrial cancer for up to 10 years after the last pill.

Therapy

The physician is presented with many therapy options and makes a decision depending on the stage of disease, the patient's age and general health as well as a woman's wish for pregnancy in the future.

Surgery is the most common treatment option in endometrial cancer. The uterus alone can be removed (i.e. hysterectomy), or additionally also the ovaries and the Fallopian tubes (i.e. bilateral oophorectomy). Regional lymph nodes are removed as well. As a result of this procedure, the woman may no longer bear children, and menopause ensues as a result of the removal of the ovaries.

Radiotherapy is used in women who carry a high risk of cancer reappearance after surgery, in cases where the cancer is fast-growing or if it grows deeply into the muscular uterine wall or the blood vessels. Two methods of radioactive radiation are used. Irradiation may be carried out using an external source; in this way, larger areas are irradiated and more of the healthy tissue is destroyed. The second option is the vaginal implantation of a radioactive source. This method enables targeted irradiation, and being less radical, it causes less damage to the healthy tissues.

Chemotherapy is used when the chance of metastases is already high. The employed substances travel the body and kill cancer cells outside of the uterus as well. However, this systemic action is the source of side effects that usually disappear upon conclusion of therapy. Usually, a combination therapy of two or more medications is employed in order to increase effectiveness.

Hormonal therapy works by slowing down or even halting the growth of cancer cells. It is used in women with metastases; it also represents an option for women with an early stage of disease who still want to get pregnant before their uterus is surgically removed.

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