Endometrial Cancer

ENDOMETRIAL CANCER

Endometrial cancer is the most frequent gynecologic malignancy in the United States and the sixth most frequent malignancy worldwide. 

The highest incidence of endometrial cancer is reported in North America, followed by Central and Eastern Europe. Conversely, the lowest incidence of endometrial cancer is reported in developing countries such as Central and Western Africa

 In the United States, roughly 47,000 new cases of endometrial cancer and 8,000 related deaths are recorded yearly. At diagnosis, more than 70% of women have stage I disease, which has a 5-year survival rate of 90%. Although white women have a slightly higher lifetime risk of being diagnosed with endometrial cancer, black women are more likely than white women to have higher-grade, more advanced disease at diagnosis.

 The incidence of endometrial cancer has dramatically increased by 21% since 2008, and unfortunately, the mortality rate per 100,000 cases has increased by more than 100% over the last two decades, and by 8% since 2008 

Risk factors include:

  • unopposed postmenopausal estrogen replacement
  • obesity, which increases the risk by 3 to 10 times
  • hypertension
  • high fat diet as found in industrialized nations
  • nulliparity
  • late menopause (after 52)
  • anovulation
  • oligo-ovulation
  • polycystic ovarian syndrome
  • diabetes
  • estrogen-producing tumors
  • h/o of colon cancer, breast cancer, or ovarian cancer
  • h/o of cervical carcinoma in situ is not a risk factor

 

Symptoms of Endometrial Cancer

Medical experts rate this one of the most common sign behind endometrial cancer is pelvic pain and abnormal vaginal bleeding.

endometrial ca symptoms

 

Types of endometrial cancer

  • Adenocarcinoma accounts for > 80% of cases of endometrial cancer
  • Sarcomas account for about 5% of all uterine malignancies and include
  • mixed mesodermal tumors
  • leiomyosarcomas
  • endometrial stromal sarcomas

 

At the time of clinical diagnosis, it has been estimated that approximately 75% of endometrial cancer patients have early-stage disease (FIGO stage I and II) with a 5-year overall survival of 80% to 90%. However, nearly 10% to 15% of patients with the early-stage disease develop recurrences after the primary surgical treatment. Conversely, a very small group of patients are unlucky and present with advanced stage disease with unfortunate prognoses. 

FIGO staging

As soon as the cancer is diagnosed by the professional then he will make efforts to check stage of cancer. Some of the most commonly recommended tests for finding an occurrence of endometrial cancer is CT scan, X-ray tomography, blood test, and positron emission tomography.

Stages of Endometrial cancer:

Stage one: In this stage, the cancer can be noticed only in the uterus area.

Stage two: Little higher than stage one where cancer can be observed in the uterus and cervix directly.

 

Stage three: At this stage, you will find the cancer symptoms spread beyond the range of the uterus. Still, it has not reached bladder and rectum.

Endometrial Staging

Stage four: When cancer gets spread over the pelvic region and also causes damage to the rectum, bladder and other essential parts of the body then the person is believed to face 4th stage of cancer.

 

The 5-year survival rates for regional disease (FIGO stage III) and distant disease (FIGO stage IV) are 57% and 19%, respectively.

Treatment for Endometrial cancer

It is essential to address the following issues in the medical treatment decisions process:

diagnosis; metastatic evaluation in new diagnoses; the role of the gynecologic oncologist in initial management; comprehensive staging; initial surgical management; adjuvant therapy; cytoreduction, chemotherapy, and hormone therapy in advanced-stage or recurrent disease; fertility-sparing treatment and ovarian preservation; management of incidentally diagnosed endometrial cancer after hysterectomy for another indication; follow-up; and estrogen therapy for the management of menopausal symptoms in survivors.

Type 1 endometrial cancer, or endometrioid adenocarcinoma, causes about three-quarters of cases. At diagnosis, most are low-grade and limited to the uterus. With conservative treatment, the precursor lesion (endometrial intraepithelial neoplasia) has a 19-year cumulative risk for progression of 27.5% (95% confidence interval, 8.6% – 42.5%). The precursor lesion coexists with undiagnosed endometrioid carcinoma in 30% to 50% of cases.

Type 2 has clear cell and papillary serous histologies. It carries a worse prognosis than type 1, with high-grade lesions and significant risk for the extrauterine disease. Although uterine papillary carcinoma causes about 10% of uterine cancer cases, it accounts for 40% of deaths resulting from the disease. Endometrial intraepithelial carcinoma usually precedes type 2 uterine cancer.

Risk factors include prolonged exposure to unopposed estrogen, obesity, type 2 diabetes, hypertension, older age, nulliparity, infertility, tamoxifen use, early age at menarche, late age at menopause, smoking (increased risk for type 2, decreased risk for type 1), and genetic predisposition with Lynch syndrome and Cowden disease.

Management of endometrial cancer can be very challenging, even for early-stage disease.

Simple or complex hyperplasia.

progesterone to reverse hyperplastic process (e.g., Provera X 10 days)

Atypical hyperplasia

hysterectomy because of the likelihood of invasion

progestin-only therapy if patient seeking to become pregnant 

Stage I, grade 1 endometrial cancer without deep myometrial invasion

The probability of lymph node metastasis is < 2%.

TAH / BSO, and peritoneal cytologic examination 

Accurate surgical staging enables 50-75% of patients with stage I disease to forego postoperative radiation therapy

For grades 2 and 3 and for grade 1 with a deep myometrial invasion

TAH / BSO with pelvic and para-aortic lymphadenectomy

Extended-field radiation for extrapelvic cancer, depending on the site and extent

Stage IV disease is best treated with systemic chemotherapy

Valium to prevent spasms

Treatment for recurrence is high-dose progestins (Depo-Provera)

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center

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