the most common type of uterine cancer
Endometrial cancer is the most common type of uterine cancer. Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).
Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to play a role.
Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a 25% of cases may occur before menapause.
There are two types of uterine cancers:
- Type 1 is the most common, referred to as adenocarcinoma, with a connection to estrogen generally found in Stage I and treated with surgery.
- Type 2 is less common, and it is unclear if the risk factors are genetic. This induces serous and clear cell cancer, and generally requires aggressive treatments that frequently combine surgery, chemotherapy, and radiation.
Symptoms of endometrial cancer include:
- Abnormal bleeding from the vagina, including bleeding between periods or spotting/bleeding after menopause
- Extremely long, heavy, or frequent episodes of vaginal bleeding before menapause
- Lower abdominal pain or pelvic cramping
- Thin white or clear vaginal discharge after menopause
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.
Tests that may be done include:
- Endometrial aspiration or biopsy
- Dilation and curettage (D and C)
- Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)
- Transvaginal ultrasound to estimate the thickness of the uterine lining
If cancer is found, other tests may be done to determine if the cancer has spread to other parts of the body. This is called staging.
Stages of Endometrial Cancer:
- The cancer is only in the uterus.
- The cancer is in the uterus and cervix.
- The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
- The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.
Cancer is also graded as 1, 2, or 3, which is a microscopic assessment of how aggressive the cancer is likely to behave. Grade 1 is the least aggressive, and grade 3 is the most aggressive.
Treatment options involve surgery, radiation therapy, and chemotherapy.
Removal of the uterus (hysterectomy) is generally done in all types of uterine cancer. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.
Laporascopic, total robotic, or open abdominal hysterectomy is recommended over vaginal hysterectomy. A vaginal hysterectomy does not allow the surgeon to look inside the abdominal area and adequately remove all atypical tissue or biopsy any other suspicious areas.
Surgery combined with radiation therapy is often used to treat women with disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. It is also used to treat women with more advanced stages of disease.
Chemotherapy or hormonal therapy may be considered in some cases, especially for those with stage 3 and 4 disease or Type 2 uterine cancer.