Endometrial Cancer Facts
The terms, "uterine cancer" and "endometrial cancer," are often used interchangeably. Endometrial cancer is the most common cancer of the female reproductive organs among American women. It can often be cured, especially when diagnosed early. There are an estimated 40,000 new cases of endometrial cancer diagnosed each year in the United States and approximately 7,500 deaths per year from this disease.
Endometrial cancer develops from the endometrium, the inner lining of the uterus. (It is this lining that is shed every month during your menstrual period.)
Most women with endometrial cancer are diagnosed after menopause, although some women develop the disease earlier, around the time menopause begins.
Abnormal vaginal bleeding is the most common symptom. Because bleeding is a symptom, the disease is often caught early. Women who are experiencing menopausal symptoms and are considering estrogen replacement therapy should talk to their doctors to assess their risk of endometrial cancer.
Types of Uterine Cancer
Nearly all endometrial cancers are adenocarcinomas--cancers of the glandular cells.
Three less common uterine cancers that do not come from glandular tissue of the endometrium are classified as uterine sarcomas, but can involve the endometrium. These are:
- stromal sarcomas, which develop in the stroma (supporting connective tissue) of the endometrium;
- malignant mixed mesodermal tumors (that may combine features of endometrial carcinoma and those of sarcomas); and
- leiomyosarcomas, which start in the myometrium (muscular wall of the uterus).
Precancer – Complex Hyperplasia with Atypia
Many women who present with vaginal bleeding after menopause or abnormal menstrual bleeding will have a biopsy that shows precancerous changes of the endometrium, termed complex hyperplasia with atypia. There is a high risk of progession to cancer in 25 to 50 percent of these patients. If a patient is done with childbearing, her physician will ususally recommend a hysterectomy. Otherwise, in younger patients, there are some circumstances where conservative management with hormones (usually progestins) may be appropriate with close follow-up. Many gynecologists will refer patients to have their surgery with a gynecologic oncologist as there is such a high rate of finding true cancer at the time of hysterectomy.
Symptoms
Abnormal vaginal bleeding is the most common symptom of endometrial or uterine cancer. A woman should see her doctor if she has any of the following symptoms: unusual vaginal bleeding or discharge, difficult or painful urination, pain during intercourse, or pain in the pelvic area.
Diagnosis
The most accurate way to diagnose endometrial cancer is with an endometrial biopsy. According to the American Cancer Society, hereditary nonpolyposis colorectal cancer (HNPCC) is the only risk factor with sufficient risk to warrant routine screening.
Stages
The most common cancer grading system used for gynecological cancers, which is used by Seattle Cancer Care Alliance gynecologic oncologists, is the International Federation of Gynecology and Obstetrics (FIGO) system.
Stage I – Cancer is confined to the uterus
Stage II – Cancer has spread to the cervix
Stage III – Cancer has spread to the pelvic organs, vagina or regional lymph nodes
Stage IV – Cancer has spread into the upper abdomen or distant to lungs
Risk Factors
The risk factors for endometrial cancer include obesity, hypertension, diabetes, inappropriate estrogen use, tamoxifen use, never having had children, and late menopause.
Many of these are also risk factors for breast cancer, or are due to breast cancer treatment (taking tamoxifen, for example).
An additional risk factor is hereditary nonpolyposis colorectal cancer (a syndrome where family members have colon cancer).
Most known risk factors for endometrial cancer concern the balance between estrogen and progesterone in the body. The risk is lowest in women who have taken oral contraceptives for symptoms of endometrial cancer. Menopausal women are strongly encouraged to report any unexpected bleeding or spotting to their physicians.