Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination or sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.
In 2012, endometrial cancers occurred in 320,000 women and caused 76,000 deaths. This makes it the third most common cause of death from women's cancers, behind ovarian and cervical cancer. It is more common in the developed world and is the most common cancer of the female reproductive tract in developed countries. This is believed to be due to the increasing number of elderly people and increasing rates of obesity. Endometrial cancer is also associated with excessive estrogen exposure, high blood pressure and diabetes. Whereas taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and progesterone in combination, as in most birth control pills, decreases the risk. Between two and five percent of cases are related to genes inherited from the parents.
There are several types of endometrial cancer, including the most common endometrial carcinomas, which are divided into Type I and Type II subtypes. There are also rarer types including endometrioid adenocarcinoma, uterine papillary serous carcinoma, and uterine clear-cell carcinoma. Endometrial cancer is sometimes loosely referred to as "uterine cancer", although it is distinct from other forms of uterine cancer such as cervical cancer, uterine sarcoma, and trophoblastic disease.
Most endometrial cancers are carcinomas (usually adenocarcinomas), meaning that they originate from the single layer of epithelial cells that line the endometrium and form the endometrial glands. There are many microscopic subtypes of endometrial carcinoma, but they are broadly organized into two categories, type I and type II, based on clinical features and pathogenesis.
The first type, type I endometrial cancers occur most commonly in pre- and peri-menopausal women, are more common in Caucasian women, often with a history of excessive thickening of the inner lining of the uterus (endometrial hyperplasia) and exposure to elevated levels of estrogen that are not counterbalanced by progesterone (unopposed estrogen exposure). Type I endometrial cancers are often low-grade, minimally invasive into the underlying uterine wall (myometrium), and are of the endometrioid type, and carry a good prognosis. In endometrioid cancer, the cancer cells grow in patterns reminiscent of normal endometrium.
In contrast to endometrial carcinomas, the uncommon endometrial stromal sarcomas are cancers that originate in the non-glandular connective tissue of the endometrium. Uterine carcinosarcoma, formerly called malignant mixed Müllerian tumor, is a rare uterine cancer that contains cancerous cells of both glandular and sarcomatous appearance - in this case, the cell of origin is unknown.
Diagnosis of endometrial cancer is made first by a physical examination and dilation and curettage (removal of endometrial tissue; D&C). This tissue is then examined histologically for characteristics of cancer. If cancer is found, medical imaging may be done to see whether the cancer has spread or invaded tissue.
Dilation and curettage or an endometrial biopsy are used to obtain a tissue sample for histological examination. Endometrial biopsy is the less invasive option, but it may not give conclusive results every time. Hysteroscopy only shows the gross anatomy of the endometrium, which is often not indicative of cancer, and is therefore not used, unless in conjunction with a biopsy. Hysteroscopy can be used to confirm a diagnosis of cancer. New evidence shows that D&C has a higher false negative rate than endometrial biopsy.
Before treatment is begun, several other investigations are recommended. These include a chest x-ray, liver function tests, kidney function tests, and a test for levels of CA-125, a tumor marker that can be elevated in endometrial cancer. The leading treatment option for endometrial cancer is abdominal hysterectomy (the total removal by surgery of the uterus), together with removal of the fallopian tubes and ovaries on both sides, called a bilateral salpingo-oophorectomy. In more advanced cases, radiation therapy, chemotherapy or hormone therapy may also be recommended. If the disease is diagnosed at an early stage, the outcome is favorable, and the overall five-year survival rate in the United States is greater than 80%.
These patients face difficulty conceiving secondary to obesity, polycystic ovarian syndrome and chronic anovulation. Secondary to these issues it is recommended an initial consultation with a reproductive endocrinologist in order to assess the patient’s reproductive options and likelihood of conception. This ensures appropriately informed expectations regarding reproductive potential and thus the patient’s desire to proceed with fertility-preserving therapy.
Endometrial cancer cannot be prevented, but there are some things that may lower the risk of developing this disease. The risk of endometrial carcinomas may be reduced significantly by prolonged progestin therapy every month (for 10 days) alone or in combination with estrogen. Since progestins are known to act as cofactors of cancerization in breast and cervical cancer such concepts are better interpreted cautiously. Therefore hormonal preventive concepts need to undergo a general assessment of benefits and risks.
Alternative therapy may be proposed as cancer cures. These treatments have not been proven safe and effective in clinical trials.
Options for women to have children after cancer have increased significantly in recent years. Women should be counselled on established options such as embryo banking in which hormonal stimulation causes the production of multiple eggs, which are removed, fertilized by sperm, and frozen for future use, and egg banking in which hormonal stimulation causes the production of multiple own eggs, which are removed and frozen for storage and future use, and ovarian transposition and shielding in which ovaries can be surgically moved or shielded from the area receiving radiation. This technique does not protect against the effects of chemotherapy. Experimental techniques include ovarian tissue banking in which an ovary is surgically removed and frozen to be transplanted back into the woman when she is ready to have children. Scientists are also working on ways to mature undeveloped eggs from this ovarian tissue.
After sterilizing cancer treatment, a woman can also choose donated eggs or donated embryos directly, to be transferred into the uterus. Another option to be considered is surrogacy, when a woman carries a pregnancy for another woman or couple or adoption. Recent efforts also investigate the implications of a cancer diagnosis during pregnancy.
A disease of excess body fat that can have a negative effect on health, leading to reduced life expectancy and other health problems.
A condition in which a woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cysts in the ovaries, trouble g
Failure of the ovaries to release an oocyte over a period of time generally exceeding 3 months.
The finger like overgrowths attached to the inner wall of the uterus that extend into the uterine cavity which are made of endometrial tissue
Medical condition characterized by the presence of ectopic endometrial tissue within the myometrium.
The time in most women's lives when menstrual periods stop permanently, and the woman is no longer able to have children.
A hydrosalpinx is an abnormal pouch containing liquid in a fallopian tube.
Infection of the upper part of the female reproductive system and a common complication of some sexually transmitted diseases.
Thickening of the lining of the uterus.
A type of cancer in which abnormal cells begin to grow in one or both of a woman's ovaries.
An abnormal growth of fallopian tube tissue.
A cancer that develops from breast tissue.
A surgery performed to remove a woman's uterus.
The narrow inferior portion of the uterus that projects into the vagina.
Two very fine tubes that transport sperm toward the egg, and allow passage of the fertilized egg back to the uterus for implantation.
The uterus is the largest and major organ of the female reproductive tract that is the site of fetal growth and is hormonally responsive
Sex organ that is a part of the female genital tract having two primary functions: sexual intercourse and childbirth.
Cells composing an inner layer of the uterine lining.
The innermost layer of uterus forming the uterine lumen where the implantation of an oocyte happens.
The primary female sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics.
A pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work.
A condition in which the body either does not produce enough, or does not properly respond to insulin, a hormone produced in the pancreas.
A mental disorder defined by abnormal eating habits that negatively affect a person's physical or mental health.
A medical condition characterized by an excessive amount of estrogenic activity in the body.
An elevated blood pressure, clinically defined as at or greater than 140/90 (systolic/diastolic) mmHg.
An inherited bowel cancer syndrome.
A medical condition of excess body fat that can have a negative effect on health, leading to reduced life expectancy and other health problems.
Eating habits are one of the few factors within our control that impact not only our chances of falling pregnant.
Type of lifestyle with no or irregular physical activity.
Abnormal growth of any cells that comprise uterine tissue.
A pain that occurs between the chest and pelvic regions.
The failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
Bleeding that occurs irregulary between the menstrual period.
Irregular menstruation is a menstrual disorder whose manifestations include irregular cycle lengths as well as metrorrhagia
Pain that occurs in low area of abdomen, below the umbilicus.
Body weight that's greater than what is considered healthy for a certain height.
The painful feelings during sexual intercourse.
A burning or stinging sensation during urination.
Irregular intermenstrual bleeding including postcoital bleeding.
The biological fluid secreted from the vagina.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
Surgical removal of a Fallopian tube(s).
The field of reproductive medicine, that focuses on helping reproductive-age men and women to prevent infertility and birth defects.
Surgical removal of the uterus.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
Surgical removal of one or both ovaries.
Chemotherapy and hormonal therapy, which is used as a treatment option for endometrial cancer.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
The embryo is gestated in a third party's (surrogate) uterus.