Endometrial Cancer

What is endometrial cancer?
Endometrial cancer, or cancer of the endometrium, is a cancer that develops from the inner lining of the uterus (womb). This lining is called the endometrium. Cancer is the uncontrollable growth of cells that invade and cause damage to surrounding tissue.

The exact cause of endometrial cancer is not known, but certain risk factors are linked to the disease. Most of the known risk factors are linked to the balance between the hormones estrogen and progesterone. Some risk factors include:

• Early menstruation—If a female begins monthly periods before age 12, the risk for this cancer may increase as the uterus may be exposed to estrogen for more years.
• Late menopause—If a female undergoes menopause after age 50, the risk for this cancer may increase as the uterus may be exposed to estrogen for more years.
• Total length of menstruation span—The span of menstruation may be a more important factor than the age at which periods started or ended.
• History of not being able to become pregnant or having never given birth—During pregnancy, the hormonal balance moves toward more progesterone. For this reason, pregnancies can reduce endometrial cancer risk. Women who have not been pregnant have a higher risk.
• Use of Tamoxifen—This drug, which is used to treat women with breast cancer, acts like estrogen in the uterus and can increase the risk of endometrial cancer.
• Estrogen replacement therapy (ERT)—This therapy, involving the use of female hormone estrogen to offset the effects of menopause, can increase endometrial cancer risk.
• Ovarian diseases—Women who have certain ovarian tumors have higher than normal estrogen levels and lower levels of progestins. The increase in estrogen compared to progestins can increase a woman’s chance of getting endometrial cancer.
• Obesity (being very overweight)— Fat tissue in the body can change some other hormones into estrogens. Having more fat tissue can increase a woman's estrogen levels and her risk for developing endometrial cancer.
• A diet high in animal fat—A high-fat diet can increase the risk of several cancers, including endometrial cancer. Because fatty foods are also high-calorie foods, a high fat diet can lead to obesity—a confirmed endometrial cancer risk factor.
• Diabetes—Diabetes has been linked to weight, but some studies suggest that diabetes by itself could be a risk factor for endometrial cancer.
• Age—As females get older, the likelihood of endometrial cancer goes up. Most endometrial cancers occur in women age 40 or older.
• Family history—Endometrial cancer appears to run in some families who also tend to get a certain type of colon cancer.
• Breast or ovarian cancer—Women who have had breast cancer or ovarian cancer may have an increased risk of getting endometrial cancer.
• Earlier pelvic radiation therapy— Radiation used to treat some other cancers can damage the DNA of cells, increasing the risk of a second type of cancer.

What are the symptoms of endometrial cancer?
The following symptoms may occur with endometrial cancer or other conditions:

• Vaginal bleeding between normal periods in premenopausal women
• Vaginal bleeding or spotting in postmenopausal women
• Lower abdominal pain or pelvic cramping
• Thin white or clear discharge in postmenopausal women
• Extremly long, heavy or frequent vaginal bleeding episodes in women over 40

How is endometrial cancer diagnosed?
If a woman has any of the symptoms of endometrial cancer described above, she should visit her doctor. The doctor will ask her about her symptoms, risk factors, and family medical history. The doctor will also perform a general physical examination and an examination of the pelvis. The following are some of the procedures that may be used in diagnosing endometrial cancer:

• Endometrial biopsy—In this procedure, a sample of endometrial tissue is obtained through a very thin flexible tube inserted into the uterus through the cervix. The tube removes a small amount of endometrium using suction.
• Dilation and Curettage (D & C)— In this procedure, a special surgical instrument is used to scrape tissue from inside the uterus.
• Testing of endometrial tissue–Endometrial tissue samples removed by biopsy or D & C are examined under the microscope to determine whether cancer is present.
• Transvaginal ultrasound or sonography—A transvaginal sonogram uses sound waves to create images of the uterus.
• CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography)—A scan that involves taking series of detailed pictures of areas inside the body. The images are created by a computer linked to an x-ray machine.
• MRI (also called magnetic resonance imaging)— A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body.
• CA-125 assay—This blood test can measure the level of CA-125, a substance that sometimes is found in an increased amount in the blood, other body fluids, or tissues. A particular level of CA-125 may suggest the presence of some types of cancer.

How is endometrial cancer treated?
There are four basic types of treatment for women with endometrial cancer:

Surgery is the main treatment for most women with endometrial cancer. In certain situations, a combination of these treatments may also be used. The choice of treatment or treatments will depend on the type and stage of the cancer and the overall medical condition of the patient.

Can endometrial cancer be prevented?
Most cases of endometrial cancer cannot be prevented, but females can take some measures to reduce their risk of developing endometrial cancer. Risks may be reduced with:

• Using oral contraceptives
• Controlling obesity
• Controlling diabetes

In addition, women who are considering estrogen replacement therapy should talk to their doctors to assess their risk of endometrial cancer.

The American Cancer Society encourages women to discuss any unexpected bleeding or spotting to their doctors. Women who have or are at high risk for hereditary nonpolyposis colon cancer (HNPCC) should receive annual screenings for endometrial cancer with endometrial biopsy starting at age 35.