Endometrial cancers
Endometrial cancers are the commonest type of uterine cancers. It mostly occurs in women between the age of 60-70. Endometrial cancers are different from the more common cervical cancers which arise in the lower portion of the uterus.
What actually is the endometrium?
The innermost lining of the uterus (womb) is known as Endometrium. This lining increases in size when the hormone estrogen in the body increases and reduces when the hormone progesterone increases. It plays an important role in the implantation of the embryo after fertilization.
"You can hear Dr Anil Kamath speaking on various aspects of BEndometrial Cancer:"
How does endometrial cancer present?
50 year old Mrs Rao (hypothetical name) was surprised when she noticed bleeding from her vaginal area. Her periods had stopped about 2 years ago. She had mild spotting on two occasions earlier which she had assumed would stop on its own but when this had not happened, she finally decided to visit her gynecologist.
Post menopausal bleeding is a common problem accounting for about 5 % of the OPD attendances to the gynecologist.
Any bleeding twelve months after menopause at a normally expected age is considered abnormal.
Though there are many causes for post-menopausal bleeding it would be safer to assume it is to be due to cancer until it is proven otherwise.
Postmenopausal bleeding is the common way of presentation.
Premenopausal women who have bleeding between the periods cycle or extremely long or heavy periods should be suspected of endometrial cancer.
Some patients may see white or clear vaginal discharge.
The more advanced and severe cases may present with pelvic pain.
What are the risk factors of endometrial cancer?
Risk factors for endometrial cancers are quite similar to that of breast cancer
This includes early menarche, late menopause, use of estrogen replacements, obesity and infertility. Obesity is considered as one of the risk factors for endometrial cancer.
What are the usual tests done for endometrial cancer?
After pelvic examination, most gynecologists would order for an abdominal ultrasound. A thickened irregular endometrium found on ultrasound increases the suspicion of endometrial cancer.
When the level of suspicion is high the next step would be to do a biopsy. This is usually done by either
Dilation `and curettage ( D&C)
Endometrial aspiration and biopsy
Hysteroscopy and biopsy
The material removed is sent to a pathologist who will either confirms or disproves the diagnosis of cancer.
Once the diagnosis is confirmed the next step would be to assess the spread of the disease which is by investigations like CT scan or MRI of the abdomen.. Sometimes a PET scan is also done.
What are the stages of endometrial cancer?
1.Cancer which is confined to the uterus is stage
2.Cancer which has gone on to the lower part of the uterus called the cervix is stage
3.Cancer which has spread outside the uterus but is still within the pelvic area would be stage
4.Cancer which has spread far away from the uterus is stage
How is endometrial cancer treated ?
Treatment should be received preferably in a comprehensive cancer centre where chemotherapy, radiation and surgery facilities are available
Surgery for endometrial cancer involves the removal of the uterus along with the removal of both ovaries. Removal of the uterus from the vagina is not acceptable and should be removed from abdomen. Hysterectomy is combined with the removal of lymph nodes from the drainage areas.
After surgery, the removed parts are examined by the pathologist which determines the final stage of the disease.
In very early cases (stage I) when the tumour is less aggressive only surgery is sufficient but in higher stages (Stage II or III) or when the tumour is of an aggressive variety radiation is recommended.
Radiation is of two types one which is given externally under CT scan guidance, it is known as teletherapy and another other in which radiation is given internally on the residual portion of the vagina by placing wires, is known as brachytherapy.
In some cases when the disease has already spread to the lymph nodes it is necessary to combine radiation with chemotherapy.
A few patients present with an advanced stage of disease which has spread to liver, lungs or elsewhere in the abdomen in such cases the options would be either to give chemotherapy with limited benefit or to just offer the symptomatic treatment without doing anything specific for the disease.
Can endometrial cancer surgery be done by a minimally invasive method?
Definitely yes. More so in early stage cancers. Both laparoscopic and robotic hysterectomy are accepted modalities of treatment. The pain will be lesser and recovery from surgery will be faster. In advanced cases with heavy lymph nodal burden minimally invasive surgery should be done with caution
Risk factors for uterus cancer :