Understanding Endometrial Cancer and
How To Manage It

Your guide to understanding all aspects of endometrial cancer

Cancer has shown me what family is. It showed me a love that I never knew really existed.

Michael Douglas

Early detection and diagnosis always increase your chances of receiving successful treatment and beating all forms of cancer – including endometrial cancer. Detecting endometrial cancer early will significantly boost your odds of survival. Hence, it is important to adhere to the recommended screening protocol for your age group so that you and your physician can detect and test any anomalies or changes.

You can read the section that details the various types of cancer before embarking on the journey to understand endometrial cancer better. Read more

Let’s understand
the anatomy first

The uterus is the pear-shaped hollow organ, which is part of the pelvis – the area below your stomach and in between your hip bones. The inner lining of the uterus is called the endometrium. Fetal development occurs in the uterus or the womb during pregnancy. The uterus has two main parts:

  • The upper part of the uterus is called the body or the corpus
  • The cervix is the lower end of the uterus and connects it to the vagina

Uterine cancers refer to cancers that start in the body of the uterus, not the cervix. Cervical cancer is a separate type of cancer. Read more

The body of the uterus has two main parts:

  • The myometrium is the outer layer. It is a thick layer of muscle that helps push the baby out during childbirth.
  • The endometrium is the inner layer. During a normal menstrual cycle, hormones cause the endometrium to change. A hormone called estrogen causes the endometrium to thicken, so it can sustain and nourish an embryo if pregnancy occurs. If pregnancy does not occur, estrogen is produced in lower amounts and the body produces more of a hormone called progesterone. The progesterone causes the endometrial lining to shed from the uterus, causing the menstrual flow (period). This cycle repeats until menopause.

What is endometrial cancer?

Endometrial cancer is a type of cancer which begins in the layer of cells forming the lining of the uterus and is the most common type of uterine cancer. It begins when healthy cells in the endometrium start mutating or changing. Such mutations cause these cells to grow rapidly and prevent cell death. The accumulation of these abnormal cells forms a malignant mass or tumour. Often, the cancer cells invade nearby tissues and may break off from a tumour to spread or metastasize to other parts of the body. Endometrial cancer can often be cured.

Types of Endometrial Cancer
Endometrial cancer types are classified based on the types of cells where the cancer begins and
how they look under a microscope and include the following.

Adenocarcinoma

Most endometrial cancers are adenocarcinomas, and endometrioid cancer is the most common type of adenocarcinoma. Endometrioid cancers start in the glands and generally resemble the normal uterine lining (endometrium). Some of these cancers have flat, thin cells (called squamous cells) in addition to the glandular cells. There are many sub-types of endometrioid cancers including:

  • Adenocarcinoma with squamous differentiation
  • Adenoacanthoma
  • Andenosquamous (or mixed cell)
  • Secretory carcinoma
  • Ciliated carcinoma
  • Villoglandular adenocarcinoma

Uterine carcinosarcoma

This type of cancer starts in the endometrium and has features of both endometrial carcinoma and sarcoma (cancer that starts in the muscle cells of the uterus). The cancer cells are generally poorly differentiated, which means they do not resemble the cells they originally came from.

Squamous cell carcinoma

This is a rare form ofendometrial cancer. Primary endometrial squamous cell carcinoma in situ is even more uncommon; it usually occursin postmenopausal women.

Small cell carcinoma

This is a rare form of carcinoma and resembles small cellcarcinoma of the lung and other organs.

Transitional carcinoma

Transitional cell carcinomas are rarely found in the female genital tract. Although it is most common in the ovary, small series of cases in the cervix have been reported, with isolated cases described in the fallopian tube, adnexa uteri, and endometrium.

Serous carcinoma

This form of endometrial cancer typically arises in postmenopausal women, and bears histological similarity to ovarian serous adenocarcinoma.

Most endometrial cancers are a type of adenocarcinoma called endometrioid cancer. Clear-cell carcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, dedifferentiated carcinoma and serous adenocarcinoma are rare forms of endometrial adenocarcinomas. They tend to grow and spread faster than most types of endometrial cancer.

What causes endometrial cancer?

While the exact causes of endometrial cancer are not known, it is found to be primarily due to changes or mutations in the DNA of the cells of the endometrium – which is the inner lining of the uterus. These mutations give rise to abnormal cells, which grow uncontrollably and accumulate to form a mass or tumour. These cancer cells may also invade the nearby tissue and may spread or metastasize from the initial tumour to other parts of the body.

What are the Risk Factors?

While most cervical cancers are caused by HPV, there are other factors which may increase your risk

Your age – endometrial cancer often occurs after menopause

A family history of uterine, colon, or ovarian cancer

Hormone therapy (especially treatments using estrogen)

Obesity – excess body fat may alter your body’s hormone balance
Using a drug called tamoxifen – this is used during hormone therapy for breast cancer and may increase the risk of endometrial cancer. However, in most cases the benefits of tamoxifen far outweigh the minor risk of developing endometrial cancer.

Starting to menstruate at an early age or starting menopause at a later age

Having other medical conditions:
  • PCOS (polycystic ovary syndrome) – a condition where cysts grow on the ovaries
  • Diabetes – a condition where the natural ability of the body to produce insulin is compromised
  • Lynch syndrome – a hereditary nonpolyposis colon cancer (HNPCC)

What Can be Done to Reduce Your Risk of Endometrial Cancer?

While there are no sure methods to prevent endometrial cancer, research has shown that certain factors may lower your risk

What are the Symptoms?

Usually the first sign of endometrial cancer is unusual vaginal bleeding

This includes:

Bleeding after menopause

Experiencing periods that are longer or heavier than usual

Bleeding or spotting in between periods

A bloody or pink watery vaginal discharge

Other symptoms may include:

Pain, discomfort or pressure in the pelvic area

Pain during sex

Experiencing these symptoms does not always mean that you have endometrial cancer. However, if you have any signs or symptoms which are out of the ordinary, it is recommended that you visit your doctor.

Screening and Diagnosis

Endometrial cancer occurs only in women. If you experience any of the signs and symptoms listed above, make an appointment with your doctor for prompt evaluation. Screening tests may be done when you have no cancer symptoms at all. 

The main objective of endometrial screening is to detect precancerous changes in endometrial cells, which if untreated have a potential to develop into cancer. The secondary objective is to find endometrial cancer at an early stage, when treatment is usually more successful. 

It is important to remember that your physician does not necessarily think you have cancer if he or she suggests a screening test. They could just be following a normal screening protocol for your age group.

Screening tests for endometrial cancer

Tests and procedures used to screen for endometrial cancer may include the following.

The Pelvic Exam

What to expect

A pelvic exam is a part of a woman’s routine medical check-up. Pelvic exams can help diagnose certain types of cancers, as well as reproductive problems. A Pap test can be done during a pelvic exam , but sometimes a pelvic exam is done without a Pap test. A Pap test is needed to find early cervical cancer or pre-cancers so ask your doctor if you need a Pap test along with your pelvic exam.

A pelvic exam is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up. 

During a pelvic exam: 

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will look at your pelvic area and feel your reproductive areas. It is normal for your doctor to insert his/her gloved fingers into your vagina as part of the test.
  • Your doctor may also do routine screening tests for sexually transmitted diseases by taking a swab of cells.
  • The collected samples are then examined in the lab for any abnormalities.
  • The pelvic exam itself should take around 5-10 minutes. If you experience any pain, be sure to inform your doctor.
Transvaginal ultrasound

What to expect

A transvaginal ultrasound is used to examine the thickness and texture of the endometrium or vaginal lining and detect any abnormalities.

The ultrasound is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up.

During this procedure:

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will start by applying a special gel to a small probe, called the transducer. The rounded end of this device is then gently inserted into the vagina.
  • Sound waves are used to create video images of your uterus.

Both these tests are screening tests. They cannot help you tell for certain if you have endometrial cancer. However, an abnormal result may indicate that more testing is required.

Diagnostic tests for endometrial cancer

If the screening protocol detects abnormalities, your doctor may recommend further follow-up diagnostic tests to confirm if cancer is present. Refer to this section for more information about diagnostic tests for endometrial cancer. Read more

Staging Endometrial Cancer

If your physician detects or confirms endometrial cancer, you may be referred to a specialist in female reproductive cancers – called a gynecologic oncologist. A gynecologic oncologist is an obstetrician-gynecologist or OB-GYN, who has additional training in the diagnosis and treatment of endometrial and other gynecologic cancers. Once your cancer is diagnosed, other tests may be used to determine

If the disease has spread beyond the lining of the uterus (i.e. determine the stage of cancer)

How quickly the cancer will grow

How likely it is to spread through the body

What sort of treatments might work

The likelihood of the cancer to recur (come back)The likelihood of the cancer to recur (come back).

The stage of your cancer is a key aspect in determining your treatment. Refer to this section to understand your cancer diagnosis and for more information about how endometrial cancer is staged. Read more

Treatment options for
Endometrial Cancers
Treatment of endometrial or uterine cancer normally involves surgery, chemotherapy, hormone therapy, and if required, radiation as well. You can refer to this section to understand the types of cancer treatments and their side effects better. Read more
Your cancer journey
Everyone deals with a cancer diagnosis and treatment in a different way. Refer to this section, to understand various aspects of your cancer journey and the road to recovery. Read more
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