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Endometrial Cancer is a serious and life-threatening condition that is the fourth most common cancer among American women. Because of its prevalence, it is extremely important for women to understand this type of cancer and the risks involved with it. This disease affects women of any age past the start of puberty but is far more common among women who have already undergone menopause. Endometrial Cancer is cancer that affects the inside lining of the uterus, but it can spread rapidly to other organs if not promptly treated.
The technical term for this lining is the endometrium. It is the part of the uterus which gets shed during menstruation, so it goes through several different changes in the course of a woman’s 28-day cycle.
First, this lining grows thicker as a result of increased estrogen levels that occur during the cycle’s beginning. This thickening is meant to prepare the uterus for conception. If conception occurs after this point in the cycle, then the thick endometrium provides a healthy place for the embryo to attach and begin growing. If, however, conception does not occur, the endometrium must prepare to shed and be replaced for the next menstruation cycle. As hormone levels drop back down to a normal level at the cycle’s end, the inside layer of the endometrium tissues begins to leave the body.
This process is typically predictable and continues in a cycle until menopause. However, there are some instances in which the tissue cells of the endometrium begin to grow beyond the amount expected early in the cycle. Eventually, the unregulated cells can grow to such extremes that a tumor begins to form along the inside of the uterus.
This overgrowth of cells is what we refer to as Endometrial Cancer. It is important to note that not every tumor will lead to Endometrial Cancer. In many cases, the overgrowth of cells is tested and is found to be benign. The tumor will have to be removed but has no risk of spreading or negatively impacting health in a severe way. In cases of Endometrial Cancer, the tested tumor shows malignant results. This means that the multiplying and unregulated cells are cancerous and pose the risk of spreading throughout the body. Endometrial Cancer can either develop on secretion-producing tissues or on the muscles of the uterus itself.
Tumors on secretion-producing tissues are referred to as Endometrial Adenocarcinomas, and they are far more common than tumors on the muscle or connective uterine tissues. This second form of tumor is referred to as Uterine Sarcomas.
Uterine cancer is the fourth most common cancer type among women in the United States, and rates are similar in almost any other developed country. Endometrial Cancer, specifically Endometrial Adenocarcinomas, accounts for almost all of these cases with the exception of 5% which are diagnosed as Uterine Sarcomas or other cancerous uterine conditions.
Because symptoms, which are explained in detail later on in this article, are easily noticed by most women, Endometrial Cancer is typically caught early on. It is common that women get diagnosed with the condition before it advances past stage I. Thanks to the easily noticed symptoms that lead to early diagnosis of this cancer, survival rates are quite high for affected women.
Specific screenings for Endometrial Cancer have not historically been performed on women that present no symptoms of the disease. That is to say, the symptoms themselves have proved to be a sufficient means of first discovering uterine tumors, both malignant and benign. Preemptive measures have not been considered necessary or useful.
In past cases where screenings were tested, they proved to be ineffective at detecting the disease earlier than when symptoms would typically appear. In these tests, women were having samples from their uterine lining routinely tested to see if any early signs of cancer could be found. This yielded no significant results.
Women who have or experience any of the following risk factors are more likely to develop Endometrial Cancer than women who have or experience none of them.
That being said, having or experiencing a risk factor on this list is not a guarantee that you will ever develop the disease or that the disease will be more aggressive if you do end up developing it. There are no screenings for Endometrial Cancer, so women who have or experience any risk factors should become aware of this condition’s symptoms and look out for them.
The risk factors are as follows:
- Family History of Uterine Cancer
Women who have relatives that have or had Endometrial Cancer or other cancers of the uterine lining are more likely to develop the disease than women with no family history. This is especially true if the relatives affected are a mother, sister, or grandmother. Women with cancer in their family of any kind should always be aware that this raises their risk of developing a similar condition.
There is no screening procedure, but women should be keeping track of menstruation and noting any bleeding outside of this cycle.
- Personal History of Cancer
Women who currently have or have ever had other types of cancer throughout their lives are more likely to develop Endometrial Cancer as well. A woman who has a history of Ovarian Cancer has the greatest increased risk for developing a uterine tumor, but Breast Cancer and Colon Cancer both raise the likelihood of this happening as well. Any cancer survivor or woman currently living with cancer should be aware of the symptoms of related diseases, such as Endometrial Cancer.
Furthermore, if a woman was prescribed the drug Tamoxifen as a treatment method for her Breast Cancer, she is at a much greater risk of developing Endometrial Cancer than women given other drug options.
- Beginning Puberty Early
The beginning of puberty is considered early if a woman gets her period for the first time before the age of twelve.
While early puberty typically comes with no adverse effects or complications, it does expose the uterine lining to hormones, such as estrogen, for a longer duration of time.
This puts women who get their first period early in life at a higher risk for developing Endometrial Cancer at some point in their lives than women who started their periods after age 12. Most women who began puberty early will not ever develop this cancer.
- Beginning Menopause Late
Most women will begin experiencing menopause before the age of 52. Women who don’t go through Menopause until after age 52 are at a higher risk for developing Endometrial Cancer than other women.
This happens for the same reason that early puberty can increase the risk of this condition – it leaves the uterine lining, or endometrium, exposed to estrogen for a longer duration of time. This estrogen exposure can create the overgrowth of cells which can become abnormal and develop into a malignant tumor.
Because most women are diagnosed with Endometrial Cancer after menopause, women of this age should be well aware of the symptoms of this disease regardless of when menopause began.
- Lack of Pregnancies
Women who have never become pregnant have a significantly greater risk of developing Endometrial Cancer than women who have become pregnant or had children. In fact, a lack of pregnancies makes a woman up to three times as likely to develop the disease than other women.
However, a woman who has never been pregnant doesn’t experience the same high-risk factor as other women if she has been taking an oral contraceptive to prevent pregnancy.
Women who choose this means of birth control and have been using it for a period of time longer than one year cut their risk of developing Endometrial Cancer in half.
Obesity is one of the most significant risk factors for developing Endometrial Cancer. Women who are overweight are ten times more likely than women of a healthy weight to be diagnosed with this disease. The uterine lining’s exposure to higher levels of estrogen is what’s responsible for the onset of uterine cancers.
In overweight women, enzymes in the excess fat cells are able to convert the body’s other hormones into estrogen, thus raising levels and exposing the uterine wall, or endometrium, to higher than average amounts of the hormone. Typically, a woman who is at least 50 lbs. over the ideal weight for her body type and height is at the greatest risk.
- High Estrogen Levels for Other Reasons
Any woman, even a woman of ideal weight, is at an increased risk of developing Endometrial Cancer if she has a higher than average level of estrogen in her body. This can occur if a woman has prescribed a form of estrogen therapy but is not also given progesterone to combat the effects of high estrogen levels.
This is referred to as unopposed estrogen, and it significantly raises the risk of uterine cancer by exposing the endometrium to unhealthy amounts of the hormone. This can also occur naturally, without estrogen therapy, in women who have conditions that affect their other reproductive organs.
For example, the risk would be heightened for a woman with ovarian cysts or other conditions of the ovaries.
Medical professionals typically do not screen for Endometrial Cancer.
This is because the two ways in which screening has been tested in the past, transvaginal ultrasound and endometrial biopsy, have both been deemed ineffective at producing an early diagnosis or any benefits at all to the patient.
Symptoms of this cancer appear early on after a cell overgrowth has developed, and they are quite noticeable to the women experiencing them. These symptoms would make themselves apparent typically long before any screening was done.
Additionally, both of these screening procedures result in possibly harmful side effects for the patient. With side-effects present and early detection disproved, the evidence out-ruled the effectiveness of Endometrial Cancer Screenings. They are no longer performed or recommended.
This should not be a cause for concern, however, because symptoms typically appear soon enough to catch cancer before it progresses beyond a Stage I diagnosis. Transvaginal ultrasounds, when used on patients as a screening method for uterine cancer, produced false-positives after testing that led to biopsies being done unnecessarily.
Additionally, these test results created high levels of stress and anxiety in patients who did not actually have the disease. No benefits at all came as a result of this screening method. Biopsy of the uterine lining as a form of screening can cause discomfort, pain, bleeding, and even infections in some women. Like transvaginal ultrasound, this screening method has no benefits for the patient.
Symptoms of Endometrial Cancer appear early on in the disease and are usually immediately noticeable to the affected women. When presenting with symptoms for the first time, women are typically diagnosed at stage I. Women experiencing any one or more of the following symptoms should see a medical professional for early diagnosis and to rule out other conditions and complications.
Women with Endometrial Cancer almost always experience bleeding from the vagina as a first symptom of the disease. If a woman is still of reproductive age and experiences a regular menstrual cycle, she should track the dates of her menstruation and be aware of any bleeding that happens outside of this cycle.
Most women with Endometrial Cancer have already undergone menopause, so bleeding from the vagina is easy to determine as a complication of some kind. While this type of bleeding may indicate conditions other than Endometrial Cancer, this symptom’s prominence in the early stage of this disease makes it worth getting a proper diagnosis from a medical professional. When vaginal bleeding is first noticed, uterine cancer is more than likely to still be in the earliest phase.
However, the following symptoms are usually indicative of more advanced and aggressive cancer.
- Pelvic Mass
Some women may begin to feel a mass or lump on their pelvis area. It is uncommon that a mass would become noticeable without the presence of noticeable vaginal bleeding, but this sometimes happens if a woman mistakes her bleeding for menstruation. These masses indicate that a tumor has grown and the woman needs to seek attention from a medical professional immediately.
Pain in the pelvic area can be extremely difficult to self-diagnose, as many different conditions can cause this symptom. However, pelvic pain can be indicative of an aggressive Endometrial tumor, so it is best to see a medical professional rule out the possibility of cancer.
Pelvic pain is not typically present in the early phases of this disease, so women probably won’t experience this when they first present with vaginal bleeding.
- Weight Loss
Women who notice that their weight is dropping while they aren’t actively trying to lose weight may have developed cancer. This symptom only occurs in more advanced stages of Endometrial Cancer, so it is highly unlikely that weight loss will be the first symptom a woman notices.
However, it is important to seek medical advice when weight loss occurs without any change in eating or activity habits.
Diagnosis and Stages
When a woman first seeks medical attention, usually for vaginal bleeding, her medical professional will likely gather information from her that helps him or her better understands the patient’s history.
Before going in for their appointment with a doctor, patients should be prepared to answer questions about their menstrual cycle, puberty, family history with cancer, personal medical history with cancer, and all forms of medication or hormone therapy that she has taken.
After the interview process, the doctor will perform a physical examination of the pelvic area to try and determine the cause of the symptoms.
If Endometrial Cancer is suspected to be the cause of the patient’s presenting symptoms, then the doctor will refer the patient to a cancer specialist for further testing and to receive treatment options.
The first thing that a specialist will do is take a biopsy from the endometrium, or uterine lining. The biopsy is performed by inserting a very thin needle into the cervix to collect a small sample of tissue from the endometrium. This sample can be tested for cancerous cells in order to identify a mass as benign or malignant. This is the easiest way that doctors get a definite answer about whether or not a patient can be diagnosed with Endometrial Cancer.
It is unlikely that the biopsy would provide no definite results, but if this is the case then a doctor will perform what is called dilation and curettage. During dilation and curettage, a patient is typically given general anesthesia or another form of sedative.
Then, the doctor will dilate a patient’s cervix in order to insert a scraping instrument through it. This instrument is then scraped along the lining of the uterus to collect a sample of cells for testing. When the patient wakes up, she will experience only mild discomfort, if any.
In some instances, a procedure called a Hysteroscopy is performed. In these cases, a small endoscope assists in the insertion and guiding of the scraping instrument into the uterus through the cervix. This endoscope has a very small light and camera on the tip of it so that the doctor is able to see directly inside of the uterus as he or she works.
After a formal diagnosis of Endometrial Cancer has been established, a cancer specialist will determine what stage cancer has progressed to. This is determined by figuring out how much the initial tumor and cancer cells have spread and advanced.
The stages are as follows:
In Stage I, the tumor has not yet spread at all. Instead, it remains solitary on the upper area of the uterine wall without affecting any other organ.
Additionally, the cancer cells have not yet spread to the lymph nodes.
In Stage IA, a tumor has started spreading but still remains solely on the uterine lining without yet affecting other organs or lymph nodes.
It may have started spreading into the myometrium, which is the layer in the middle of the uterine wall but has not spread through more than half of it.
In Stage IB, the tumor has definitely spread into the myometrium and is now taking over more than half of this uterine layer.
In Stage II, cancer has started spreading into the cervical stroma. The cervical stroma is the cervix’s firm and connective tissue.
At this stage, the tumor has still not spread further than the uterus.
In Stage III, the tumor has begun to spread into the serosa, which is the outside layer of the uterine wall. At this point, cancer may have spread past the uterus to other organs.
The ovaries, fallopian tubes, or both organs may be affected.
In Stage IIIA, cancer has spread to the point that it has completely taken over either the outside layer of the uterine wall, the fallopian tubes, or the ovaries.
In the same cases, cancer could have taken over all three of these.
In Stage IIIB, cancer has spread to the vagina after taking over the entire uterine wall.
In Stage IIIC1, the lymph nodes in the pelvic region have been affected by spreading cancer. At this point, cancer has not yet made its way to more distant organs.
In Stage IIIC2, cancer has spread to and taken over the paraaortic lymph nodes. This can happen either after the lymph nodes in the pelvic region have been affected or without them being affected at all. The more distant organs are still untouched by cancer at this point.
In Stage IV, cancer has spread to the inside mucosa of the bladder and to the rectum of the large intestine. The lymph nodes have also been affected at this point, and bones and distant organs may show signs of cancer as well.
In Stage IVA, cancer has either completely taken over the bladder in its entirety or the inside mucosa of the bowel. In some cases, both of the areas may be affected by cancer.
In the final stage, Stage IVB, cancer has spread to and begun to take over organs that are further from the uterus, such as the lungs.
Additionally, lymph nodes are severely affected at this point and cancer has completely metastasized.
Treatments and Drugs
The treatment of Endometrial Cancer typically starts with a hysterectomy, regardless of the stage.
During this surgery, the uterus is removed to prevent the spreading of cancer cells to other areas of the body like the patient’s distant organs and even bones.
While the doctor is performing the operation, he or she will likely examine the lymph nodes and the surrounding area to see if any noticeable cancer is present.
After the completion of the surgery, the doctor can determine exactly what stage cancer has progressed to and make a treatment plan for the patient. Moving forward, patients and their doctors decide if they want to pursue a treatment route that relies on hormone therapy, chemotherapy, radiation, or a combination of these. This decision will depend on how far cancer has spread and how aggressive it is.
Chemotherapy is a way to fight the spreading of aggressive cancer. This is because the strong drugs used during chemotherapy are able to find and kill cancer cells regardless of their placement in the body.
Because the drugs are so strong, they typically cause major side effects for the patient. These include loss of hair, nausea, fatigue, and a decrease in overall health and energy levels. Chemotherapy is only used as a treatment option in more advanced stages of Endometrial Cancer.
Radiation may be chosen as a treatment option if the cancer is in one specific area of the body. The doctor will use radiation beams to pinpoint cancer through the body, and this radiation will begin to destroy the cancerous cells. This method of treatment is usually decided upon immediately after a hysterectomy in order to eliminate the remaining cancer cells.
Hormone therapy is used as a method of treatment when the cancer is in more aggressive stages and is commonly used alongside one of the other two treatment options. During treatment, hormones are introduced into the body in hopes that they can fight off cancer before it spreads any further. Medication is necessary if a patient and doctor have decided on chemotherapy to treat Endometrial Cancer. A drug called Carboplatin is typically given to the patient during chemotherapy and is sometimes used alongside other drugs.
However, in most cases, Carboplatin or a similar drug is used alone to fight cancer. Possible other medications include Doxorubicin, Paclitaxel, and Bevacizumab, but these drugs are typically not effective enough on their own to stop the spreading of cancerous cells.
Coping and Support
As with any diagnosis, it can be extremely difficult for patients to learn that they are living with Endometrial Cancer.
Therapy and support groups can help women diagnosed with this disease learn how to cope with their diagnosis and how to stay positive about their treatment.
In addition to this, many support groups can help women adjust to the new way of life that treatment entails. Being in a support group offers women with Endometrial Cancer the chance to open up to and relate to women who have been where they are. They can discuss their worries and fears with women who have also recently been diagnosed with the disease. They can also learn a lot from women who are well into treatment and even women who have made it to remission. This allows women a safe place to open up and be understood.
In some cases, friends and family who want to help do not have the ability to relate to a loved one with cancer. During treatment, support groups focused on a women’s specific treatment option may be a good outlet for her as well. Chemotherapy, especially, can be very difficult to go through, and a support group of women in a similar situation may help a woman feel less alone in her fears.
These groups offer both education and support, and a doctor will likely recommend reputable options. One-on-one therapy may also be a great option for women diagnosed with Endometrial Cancer. Because of the nature of a cancer diagnosis, many women become fearful and depressed. Depression and hopelessness can actually hinder the effectiveness of treatment, so it is a good idea for women to open up to somebody when they are feeling this way.
Any big life change can cause emotional distress that needs to be addressed before it gets out of control. Endometrial Cancer presents a new way of living for the women affected by it. Because of this, home life can change quite drastically.
Family support groups are worth consideration, as they work with the patient as well as her spouse, children, and other relatives to help make sense of this new lifestyle. Cancer can affect more than just the person diagnosed with it, so it is important for families to have a place to voice their concerns and make sense of their fears.
These groups are also worth consideration because they offer family members a better way of relating to their diagnosed loved one. They can learn about the specifics of the disease, and what they can do in their personal lives to be helpful and supportive.
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