Endometrial (Uterine) Cancer
Uterine cancer is the cancer of the lining of the uterus, called the endometrium. The uterus consists of the cervix (neck of the uterus) extending to the vagina below and uterine body above it. The body also has two parts; its interior is called the endometrium. Changes in the endometrium occur in a woman’s menstrual cycle. At the end of the cycle, the endometrium is shed and menstruation occurs. This cycle continues until the menopause in women’s life. Almost all endometrium cancers consist of secretory cells of the endometrium, which is called endometrial adenocarcinoma.
We do not know exactly what causes endometrial cancer, but there are some risk factors associated with this disease. Many endometrial cancers are hormone-dependent. Hormonal imbalance in a woman can cause endometrial cancer. Women have hormones called estrogen and progesterone, which are secreted by the ovaries and regulate the menstrual cycle. Regular release of these hormones continues every month. Some known risk factors in endometrial cancer include conditions that increase the amount of estrogen in women, such as menstruation, delayed menopause, infertility and obesity.
Risk Factors for Endometrial Cancer
Total number of menstruations: Having menstruation that starts at a young age age and that continues through late in life, infertility and not giving birth (progesterone hormone that protects the endometrium increases during pregnancy).
Obesity: Obesity increases the risk of endometrial cancer by increasing the amount of estrogen.
Tamoxifen: Tamoxifen is a drug used in the treatment of breast cancer and increases the risk of endometrial cancer.
Ovarian Diseases: It can act by increasing the amount of estrogen.
Diet rich in animal fat: A diet rich in animal fat increases the risk of endometrial cancer like many cancers. Excessive energy causes obesity, and it also has an effect on increasing estrogen levels.
Family Story: A small group of cases of endometrial cancer show familial hereditary characteristics (genetic transition). Women with a family history of bowel and endometrial cancer need counseling with regard to genetic predisposition. Genetic studies may show risk. In these women, screening should be done with endometrial sampling.
Birth control pills have a risk-reducing effect. This protection continues for 10 years after the use of drugs. Diabetes that is under control and maintaining ideal body weight reduce the risk of endometrial cancer. If you have menopausal symptoms and are considering taking estrogen replacement therapy, ask your doctor about the risk of endometrial cancer. Many endometrial cancers develop as a continuation of problems, many of which are more harmless over the years. Hyperplasia is a less serious condition caused by increased growth of the endometrium. Simple hyperplasia, the most common type, can be treated with medication and very rarely cause endometrial cancer. However, the risk of developing cancer is higher in other types of hyperplasia. Progesterone therapy and hysterectomy can be considered in treatment of hyperplasia.
Abnormal bleeding, spotting: The most common finding is abnormal bleeding. Careful attention should be paid to vaginal bleeding especially in menopausal women. 9 out of 10 women with endometrial cancer have abnormal bleeding in varying types.
Uterine Cancer Test
If a woman has complaints such as irregular vaginal bleeding, excessive bleeding and bleeding in menopause, she should consult her doctor. The doctor takes the risk factors, complaints and family history into account. A pelvic examination is performed. If cancer is suspected, an endometrial tissue sample should be taken to reveal the underlying diagnosis and a pathological examination should be done under a microscope.
Endometrial Biopsy: The biopsy can be taken at the doctor’s office. With the help of a thin flexible plastic tube, tissue is sampled by entering the uterus and creating a vacuum.
Hysteroscopy: This method allows the doctor to look inside the uterus. The doctor tries to understand what causes abnormal bleeding by entering the uterus with a thin telescope and filling the uterus with saline (salt water). If necessary, a biopsy can also be taken. It is a procedure is performed under anesthesia and takes about 10-20 minutes.
Dilation and Curettage (D&C): If the biopsy material is too little to clearly show the doctor whether there is cancer, D&C should be performed. In this method, the cervix is widened and a sample is taken by scraping the intrauterine tissue with special tools. It is performed under anesthesia.
Examination of the tissues: Tissue samples taken by biopsy are examined under a microscope to look for cancer cells.
Staging is done according to the extent of endometrial cancer spread. The right treatment option is offered based on the stage of the disease. Besides the stage, the patient’s age, additional medical problems also play a role in the choice of treatment.
After diagnosing endometrial cancer, there are four main treatment options. Surgery, radiotherapy, hormonal therapy and chemotherapy. Surgical treatment is the main treatment method in many endometrial cancers. However, sometimes a combination of these treatment methods can be used. The choice of treatment depends on the stage of the cancer.
Surgical treatment There are different surgical methods in the treatment of endometrial cancer. The main surgical approach involves removing the cervix, uterus, ovaries, and tubes, which is called hysterectomy and bilateral salpingooforectomy. Sentinel lymph node surgery, pelvic and paraaortic lymph node dissection are also performed to investigate the spread to lymph nodes. All surgical procedures can be performed by laparoscopic, robotic or open method.
Radiotherapy: Radiotherapy is the killing of cancer cells thanks to high-energy rays. It can be applied outside the body (external radiotherapy), as well as right next to the tumor tissue (brachytherapy).
Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is recommended for patients with tumors detected in the lymph nodes or outside the uterus in the postoperative (after surgery) pathological examination.
Hormonal Treatment: In hormonal therapy, progesterone-like drugs are used.
Follow-Up After Treatment
Follow-Up after treatment is very important. Follow-ups are made every 3 months in the first 2 years, every 6 months between 2nd and 5th year and annually after 5th year.