‘Surgical procedures is the primary treatment modality for endometrial cancer .Mostly hysterectomy is used.’

Emobileclinic Trending Topic:Endometrial Cancer

Endometrial cancer accounts for more than 95% of cancer of the uterine. It is the commonest gynecological cancer in the developed world. Other frequent gynecological cancers are cervical cancer, ovarian cancer, choriocarcinoma, Vulva, Vagina and Leimyosarcoma. Endometrial cancer affects most women in perimenopausal and post-menopausal years. Most often diagnosed in the ages of 50-65 years. Only about 5% cases occur in women under 40 years.

Causes and risk factors

• Obesity: Large weight gain over adult life is a strong indicator

• Diabetes mellitus and hypertension

• Syndromes of increased endogenous estrogen stimulation: These is associated to the production of endogenous estrogens in excess of progestin. This simulative influence is felt more on obese post-menopausal women, women with polycystic ovarian disease, those with infertility and low parity and women with cases of estrogen secreting granulosa cell and theca cell tumors of the ovary.

• Heredity: The majority of familial clustering of endometrial cancer is in association with colorectal cancer as part of hereditary non-polyposis colorectal cancer (HNPCC)

• Socio-economic status: Some studies reported slight higher risk of endometrial cancer in women of higher socio-economic status, but subsequent studies do not report this.

Factors that lower the risk are;

• Progesterone protection: This inhibits the effect of estrogen by decreasing estrogen receptors and increasing the activity of enzymes that metabolise estradiol to less potent metabolites.

• Oral Contraceptives: Low dose combined contraceptive pill reduces the risk of endometrial cancer and long term use further reduces the risk

• Life Style: The effect of smoking on endometrial cancer is unclear. Some researches observes a reduction in circulating estrogens among smokers, but the overall consequences is deadly.

Symptoms are;

• Abnormal uterine bleeding especially during post-menopausal

• Cervical Cancer

• Endometrial polyps

• Endometritis

• Degenerating sub-mucous uterine fibroid

• Vaginal and vulva lesions

• Ovarian tumors (especially granulosa cell tumour)

• Anemia and loss of weight

• Fever

• Offensive Vaginal discharge

• Enlarged uterus

Endometrial cancer’s survival rate is high as the cancer is confined to the uterus. Early detection plays a major role in treatment option. Major diagnostic tools are;

• Endometrial biopsy: During historical examination of the endometrium, if endometrium carcinoma is found, endocervical curettage is performed to rule out invasion of the endocervix

• Hysteroscopy: About 50% of women with abnormal uterine bleeding will have evidence of uterine pathology at hysteroscopy. The increased sensitivity of endometrial biopsy when accompanied by hysteroscopy has made this the gold standard for investigation of women with potential symptoms of endometrial cancer

• Transvaginal ultrasound: A probe is placed in the vagina. This allows measurement of the thickness of the endometrium as well as imaging of focal abnormalities within the endometrial cavity and adnexal pathology. Any woman with recurrent episode of postmenopausal bleeding should be investigated with both transvaginal ultrasound and hysteroscopy to exclude both endometrial and ovarian disease.

Treatments (Stage 0- IV)

Surgical procedures is the primary treatment modality for endometrial cancer .Mostly hysterectomy is used. Sometimes preoperative irradiation is used to increase the likelihood of sterilization of small tumor deposits outside the uterus and reduce the risk of tumor dissemination resulting from surgical manipulation. At the advanced stage, individualization therapy is necessary. The uterus, tubes and ovaries are removed if necessary.