Endometrial Cancer (Uterine Cancer)

What is Endometrial Cancer?

The womb or uterus has an inner lining known as the endometrium. When the cells of endometrium multiply uncontrollably, it leads to endometrial cancer. Usually, it begins as endometrial hyperplasia and culminates as cancer.

What are the main signs and symptoms?

The symptoms of endometrial cancer are initially confined to the uterus and may eventually spread or produce generalised symptoms, including

• Abnormal vaginal bleeding, which can be heavy or in between the periods
• Vaginal bleeding even after menopause
• Pelvic pain
• Dyspareunia
• Abnormal vaginal discharge (bloodstained, yellow)
• Weight loss
• Fatigue
• Loss of appetite

What are the main causes?

The endometrium is quite sensitive to ovarian hormones, especially oestrogen; however, the exact cause of endometrial cancer is not known. There exists a set of risk or predisposing factors that can make a woman prone to endometrial cancer. These includes

• Family history (mother or sister having endometrial cancer or uterine fibroids)
• Early menarche
• Infertility
• Obesity
• Prolonged use of hormone replacement therapy (HRT)
• Breast cancer medicines (tamoxifen)

How is it diagnosed and treated?

A thorough medical history with clinical examination usually clinches the diagnosis of endometrial cancer. In addition, investigations are required to check for the extent of the cancer using

• Pelvic Ultrasound – To reveal endometrial thickness
• Transvaginal Ultrasound –To evaluate changes in the endometrium accurately
• Hysteroscopy – To view the endometrium using an endoscope, which hints towards the irregularity of the inner lining of the uterus
• Endometrial Biopsy – Several small tissue samples taken and evaluated under microscope to confirm the type of endometrial cancer
• Pelvic CT Scan – To help in staging endometrial cancer
• Positron emission tomography/CT scan – To evaluate the spread of the endometrial cells

If detected early, it can be cured with adequate treatment. Treatment modalities for endometrial cancer include:

• Surgery – It is the first line of treatment. If detected in the early phase, the uterus along with ovaries and fallopian tubes is removed
• Radiation Therapy – Proton rays are usually used to kill cancer cells. In certain cases of large-sized tumours, radiation is given to shrink the tumour and surgery is subsequently performed
• Hormone Therapy – Oral hormonal preparations are given, which increase progesterone levels or suppress oestrogen levels, shrinking the tumour cells
• Chemotherapy – Oral or intravenous chemotherapeutic agents are used for killing the cancer cells. Chemotherapeutic drugs also help in shrinking the tumour, making surgical removal convenient

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