Endometrial Cancer (Uterine Cancer)

The endometrium is the inner lining of the uterus. Before menopause, the endometrium sheds approximately every 28 days, a process known as a woman's "period."

Endometrial cancer is the most common type of cancer affecting the female reproductive organs. It occurs when endometrial cells begin to grow uncontrollably. The uterine lining may thicken in some areas, forming a mass of tissue known as a tumor.

Risk Factors for Endometrial Cancer

Several factors may increase the risk of developing endometrial cancer, including:

• Age: Most cases of endometrial cancer are diagnosed after menopause, typically in the mid-60s.
• Hormone Levels: The balance between estrogen and progesterone can influence endometrial cancer risk. Excess estrogen without sufficient progesterone can cause endometrial thickening. This can occur due to irregular menstrual cycles, perimenopause, menopause, or conditions like polycystic ovary syndrome (PCOS).
• Hormone Replacement Therapy (HRT): Certain types of hormone therapy used for managing menopause symptoms may increase the risk of endometrial cancer. If you have a uterus, estrogen-only therapy can lead to endometrial thickening and potentially cancer. To counter this, doctors often recommend a combination of estrogen and progestin, which prevents excessive endometrial growth and lowers cancer risk.
• Obesity: A body mass index (BMI) of 25 or higher significantly increases the risk of endometrial cancer. The higher the BMI, the greater the risk.
• Genetic Factors: Lynch syndrome, an inherited condition, increases the risk of colorectal cancer, ovarian cancer, endometrial cancer, and other cancers. It is caused by a genetic mutation passed through families.

Symptoms of Endometrial Cancer

The most common symptom of endometrial cancer is abnormal uterine bleeding:

• Before or during menopause: Irregular menstrual bleeding, spotting, or bleeding between periods.
• After menopause: Any vaginal bleeding or spotting is considered abnormal.

Symptoms of advanced endometrial cancer may include:

• Pelvic or abdominal pain
• Bloating or feeling full quickly after eating
• Changes in bowel or bladder habits

Diagnosis of Endometrial Cancer

There are no routine screening tests for endometrial cancer unless symptoms are present. After menopause, any abnormal bleeding should be evaluated.

Diagnostic Tests

1. Transvaginal Ultrasound (TVUS):

1. • Measures the thickness of the endometrium and the size of the uterus.
   • A thicker endometrial lining may require further testing.

2. Endometrial Biopsy:

1. • A sample of endometrial tissue is taken and examined under a microscope.
   • This may involve dilation and curettage (D&C) or the use of a hysteroscope (a small camera-guided instrument).

3. Imaging Tests:

1. • If cancer is confirmed, additional tests like MRI or CT scans of the chest and abdomen may be performed to determine the extent of the disease and plan the best treatment approach.

Treatment Options for Endometrial Cancer

Treatment should be managed by a specialist in gynecologic oncology to achieve the best outcomes. The type of treatment depends on factors such as age, cancer stage, tumor classification, and reproductive goals.

Treatment Approaches

There are four primary treatments for uterine cancer:

1. Surgery
2. Radiation Therapy
3. Chemotherapy
4. Hormone Therapy

Your treatment plan may involve one or a combination of these therapies, as determined by your doctor.

1. Surgery

Surgery is the primary treatment for endometrial cancer. The surgeon typically removes:

• The uterus and cervix (Total Hysterectomy)
• The fallopian tubes and both ovaries (Bilateral Salpingo-Oophorectomy)
• Lymph nodes near the uterus (Pelvic Lymph Nodes)
• Lymph nodes higher in the abdomen (Para-aortic Lymph Nodes)
• The omentum, a fatty tissue layer covering the abdominal organs, if needed.

Modern gynecologic oncology utilizes minimally invasive techniques, such as sentinel lymph node mapping to reduce complications like lymphedema. Laparoscopic or robotic-assisted surgery is the preferred approach for early-stage endometrial cancer, as it leads to faster recovery and fewer complications when performed by an experienced gynecologic oncologist.

2. Radiation Therapy

Radiation therapy uses high-energy radiation to destroy cancer cells while minimizing damage to healthy tissue. It may be delivered internally (vaginally), externally, or as a combination of both.

Radiation therapy may be recommended:

• After surgery to reduce the risk of recurrence (Adjuvant Radiation Therapy)
• Instead of surgery for patients who cannot undergo an operation due to medical conditions
• For recurrent cancer that has returned after surgery
• For incomplete cancer removal during surgery

Some patients may also receive a combination of radiation and chemotherapy.

3. Chemotherapy

Chemotherapy is used to treat advanced or aggressive endometrial cancer. It involves drugs that destroy cancer cells throughout the body. This is less common for early-stage endometrial cancer.

4. Hormone Therapy

Hormones influence cell growth in the uterine lining. Your doctor may suggest hormone therapy if:

• You have recurrent endometrial cancer after prior treatment.
• You cannot undergo surgery or radiation due to other health issues.

The goal of hormone therapy is to shrink tumors and control symptoms.

In younger women who want to have children in the future, hormone therapy may be considered as an alternative to a hysterectomy. However, after childbirth, a hysterectomy is typically recommended.

Emotional Impact of an Endometrial Cancer Diagnosis

Being diagnosed with cancer can be overwhelming. Patients and their loved ones may experience a range of emotions, including:

• Shock and disbelief
• Fear and anxiety
• Denial
• Anger
• Guilt
• Loneliness

There is no "right" way to feel, and each person copes differently. Talking with loved ones, support groups, or others affected by cancer can be beneficial. Your medical team will support you throughout your treatment journey.

Health & Wellness After Diagnosis

After an endometrial cancer diagnosis, some women may experience physical changes or want to make lifestyle adjustments, such as:

Maintaining a Healthy Weight

Research suggests that maintaining a healthy weight post-menopause may help reduce the risk of cancer recurrence and improve overall health.

Eating a Balanced Diet

• A nutritious diet can boost energy and aid recovery.
• Aim for at least five servings of fruits and vegetables daily.
• Reduce red meat consumption and include lean protein sources like chicken, fish, lentils, and beans.

Staying Physically Active

• Regular exercise may help lower the risk of cancer recurrence and other health issues.
• Physical activity can also reduce bone loss (osteoporosis) in women who experience early menopause.

Quitting Smoking and Reducing Alcohol Consumption

• Quitting smoking significantly improves overall health by reducing the risk of heart disease, lung disease, osteoporosis, and smoking-related cancers.
• If you need help quitting, consult your doctor for guidance.

Follow-Up Care

After treatment, regular follow-ups will be scheduled based on your needs. Follow-ups may be conducted by your gynecologic oncologist or medical oncologist. If you notice any new symptoms between appointments, contact your doctor immediately.

Expert Care at Thely Clinic

At Thely Clinic, our team includes a specialist gynecologic oncologist offering the latest treatments for endometrial cancer. We provide comprehensive oncology care and continuous support to maintain the best possible quality of life during and after treatment.

If you have any questions or would like to schedule a consultation, feel free to reach out to our team.