Ask our Doctors: What is Endometrial Cancer? Am I at Risk?

What is endometrial cancer?

Endometrial cancer begins in the layer of cells lining the uterus, known as the endometrium. Globally, it's the 6^th most common cancer in women, and locally, it's the 3^rd, with the majority of cases diagnosed in women over 40.

Endometrial cancer is also often referred to as uterine cancer or womb cancer. Cancers of the uterus also include uterine sarcoma, although this form of cancer is rare.

What are the types and stages of endometrial cancer?

There are 2 types of endometrial cancers. Type 1 is less aggressive and accounts for around 80% of cases while Type 2, which accounts for 20% of cases, is more aggressive and likely to spread.

Endometrial cancer has 4 stages and the higher the stage, the more advanced the cancer:

• Stage I: Cancer has not spread beyond the uterus
• Stage II: Cancer has spread to the cervix
• Stage III: Cancer has spread to the vagina, ovaries, and/or lymph nodes
• Stave IV: Cancer has spread to the bladder or other organs that are further away from the uterus

What is the survival rate for patients with endometrial cancer?

Many factors can affect your chances for successful treatment, from the type and stage of cancer, to your own health and how well you respond to treatment.

When endometrial cancer is detected early and has not spread beyond the uterus, a person has a 5-year relative survival rate of 96%. This means they are 96% as likely to live another 5 years as someone without endometrial cancer. If the cancer has spread to nearby areas or the lymph nodes, the survival rate is 71% and this is further reduced to 20% if the cancer has spread to distant parts of the body.

What causes endometrial cancer, and who's at risk?

Endometrial cancer is linked to high levels of the hormone oestrogen, which is more likely to occur among women who fall into these categories:

• Overweight
• Undergoing certain types of hormone replacement therapy (HRT)
• Have polycystic ovary syndrome (PCOS)
• Have never given birth
• Went through menopause after 55

Other risk factors for endometrial cancer include:

• Diabetes
• Family history of bowel, ovarian or womb cancer
• Treatment of the pelvis with radiotherapy
• Certain kinds of cancer treatments for breast cancer
• Presence of rare gene that causes Lynch syndrome

What are the signs and symptoms of endometrial cancer?

As there is no screening test for endometrial cancer, it is important to be alert to common warning signs and to seek medical advice promptly.

Early symptoms involve abnormal uterine bleeding, which can include:

• Irregular or heavier-than-usual menstrual bleeding
• Spotting or bleeding in between menstruation
• Changes in vaginal discharge
• Postmenopausal bleeding

Signs of advanced endometrial cancer include:

• Pain in the lower back, abdomen or pelvic area
• Bloating
• Feeling full quickly after eating
• Changes in bowel or bladder habits
• Lump or swelling in the stomach or pelvic area
• Pain during sexual intercourse
• Blood in urine

How is endometrial cancer diagnosed?

As with most types of cancer, early detection offers the best chance for successful treatment. To check for endometrial cancer, your doctor will first ask about your symptoms and review your medical and family history. This will be followed by a physical examination which includes a pelvic exam.

If your doctor suspects endometrial cancer, a combination of laboratory and imaging tests will help to confirm the diagnosis. These may include:

• Blood tests to check for cancer markers
• Imaging tests such as computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound to look for any abnormalities or signs of cancer
• Hysteroscopy, during which a small camera and light is inserted into the uterus to look for signs of cancer
• Endometrial biopsy to collect a small tissue sample from the uterus walls, which will be examined for the presence of cancer cells
• Dilation and curettage, a procedure to collect tissue samples from the uterus

What are the treatments for endometrial cancer?

There are several treatment options for endometrial cancer. The best option for you will depend on your overall health and how far the cancer has spread. These include:

Surgery

Endometrial cancer is usually treated using surgery, either by completely removing the cervix and uterus in a hysterectomy, or together with the ovaries and fallopian tubes in a salpingo-oophorectomy. It should be noted that this procedure removes the ability to bear children.

Your doctor may also advise for the lymph nodes and other nearby tissues to be removed, to be checked for the presence of cancer cells.

Radiation and/or chemotherapy

Radiation and/or chemotherapy may be recommended after surgery to destroy any cancer cells that may remain after surgery and help keep the cancer from returning. Radiation therapy may also be an alternative therapy for those deemed medically unfit for surgery. However, the response rate for radiation therapy is less ideal compared to that of surgery.

Targeted therapy

Targeted therapy is a form of treatment that blocks the cancer's ability to grow and spread by targeting specific genes or proteins in the cancer.

Hormone therapy

For some women, there may be an option to delay surgery if the cancer is slow-growing and has not spread beyond the uterus. Hormone therapy with progestin may cause the tumour to shrink, allowing an opportunity to bear children before undergoing surgery. However, if the hormone therapy is ineffective, the delay may allow the cancer to spread so it is important to note that hormone therapy does not replace the need for surgery.

How can we improve the chances of successful treatment?

Early detection of endometrial cancer is crucial in increasing your chances of successful treatment and survival.

Diagnosing this condition can be a challenge, however, as many conditions relating to the female reproductive system, such as cysts and fibroids, may produce similar symptoms. Always speak to a specialist to get a proper examination and to confirm your diagnosis.