Endometrial Cancer

Endometrial cancer is the most common gynecologic cancer. Although the lining of the uterus, or endometrium, accounts for about 70% of these cancers, the muscular wall can also develop a type of cancer known as sarcoma.

Endometrial cancer affects primarily postmenopausal women, although 25% of cases are seen in premenopausal women, with 5% of these under age 40.

Risk factors include obesity, late or heavy menopause, taking estrogen without also taking progesterone, hypertension, diabetes and a pre-cancerous overgrowth of the endometrium known as hyperplasia. Most worrisome however, is the  3-10 fold increase in risk for women who are 30 to 50 pounds overweight, making obesity the most significant of all risk factors.

Symptoms often seen with endometrial cancer include postmenopausal or heavy/irregular premenopausal bleeding, pelvic pain and a foul vaginal discharge. As bleeding abnormalities are seen in approximately 90% of patients with this type of cancer, and as it is seen very early in the development of the disease, it is important to report this as soon as possible to your doctor. Your doctor should perform (or refer you to a specialist)  an office endometrial biopsy or a D&C ( dilatation of cervix and curettage of the endometrium). It is very important to have this biopsy performed especially if you have postmenopausal bleeding or you are age 35 or older and are having heavy and or irregular cycles, as endometrial cancer or any other treatable cause of the bleeding must be ruled out.

Once the diagnosis of cancer is made, you should be referred to a gynecologic oncologist, a doctor who has received extensive specialty training in both the surgical and chemotherapeutic the management of endometrial and all other gynecologic cancers. Your gynecologic oncologist will perform surgical staging including removal of the uterus, fallopian tubes, ovaries and cervix, and lymph nodes in the pelvis and abdomen. Surgery not only helps determine the “stage” ( extent of spread of the disease), but by removing the tumor, may also be curative. In simple terms, cancer confined to the uterus is stage I, cervical involvement stage II, local spread outside the uterus stage III and cancer involving the bladder, rectum or further spread is stage IV, although subdivisions exist.

After surgery, the need for additional treatment is dependent on stage and may include vaginal or pelvic radiation, with chemotherapy for advanced stages and or certain high risk cancer types, or a combination of both. Radical hysterectomy is now being performed in patients with cervical involvement, which often will make the post-operative radiation therapy that was traditionally used in these cases unecessary. Most patients present with stage I and II cancers, where survivals are highest.