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Endometrial cancer, also known as womb cancer or uterine cancer, is a type of cancer that begins in the uterus (womb), specifically in the layer of cells that form the lining of the uterus, called the endometrium. Endometrial cancer can also be called cancer of the womb or cancer of the uterus.
Nearly all uterine cancers are endometrial cancer. However, there is another much rarer type called uterine sarcoma, in which the malignancy starts in the muscles surrounding the womb. Endometrial cancer and uterine sarcoma are usually treated differently.
According to the National Cancer Institute, in the United States there are approximately 49,560 new cases of endometrial cancer and 8,190 deaths caused by the disease each year.
Most newly-diagnosed patients are over 55 years of age.
The uterus is a small, hollow, pear-shaped organ located in a woman's pelvis. It is part of a woman's reproductive system. The fetus develops in the uterus.
The uterus is divided into three parts:
The uterine wall has two layers of tissue:
The majority of endometrial cancers start off in cells that make and release mucus and other liquids - adenocarcinomas.
A symptom is something the patient feels and describes, such as pain, while a sign can be detected by others as well as, for example a skin rash.
The following are examples of signs and symptoms of endometrial cancer:
The following symptoms are possible in the more advanced stages of the disease:
Some women also experience pain when urinating, while others have difficulties in emptying their bladder.
These signs and symptoms may be caused by endometrial cancer, or some other health problem. Post-menopausal vaginal bleeding does not necessarily mean it is cancer. Irregular bleeding could be caused by fibroids, endometriosis, endometrial hyperplasia or polyps in the womb lining.
According to the National Health Service, UK, "Only 1 in 10 cases of unusual vaginal bleeding after the menopause are caused by womb cancer, so it's unlikely your symptoms will be caused by this condition."
A risk factor is something that increases the likelihood that something will happen, such as a disease. For example, smoking raises the risk of developing lung cancer. Therefore smoking is a risk factor for lung cancer.
The following are risk factors for endometrial cancer:
Scientists at Maastricht University in the Netherlands found that acrylamide is linked to a higher risk of endometrial and ovarian cancer in post-menopausal women. Acrylamide is a carcinogenic compound found in cooked, particularly burned, carbohydrate-rich food.
The doctor will ask questions about the symptoms, the patient's medical history, and whether there is a history of endometrial cancer in the family.
If cancer is detected, the pathologist will need to learn the "grade" of the tumor. This can determine how different the tumor tissue is from normal tissue in the uterus and can help suggest how fast it is likely to grow.
Higher grade tumors grow more rapidly than lower grade ones. A higher grade tumor is more likely to metastasize - to spread to other parts of the body.
The "stage" of the cancer refers to the extend of the disease. Determining the stage, known as "staging", helps the doctor chose the best treatment.
Staging is based on whether the cancer is localized or has spread to nearby tissue, or beyond.
When endometrial cancer spreads from its original site to others parts of the body and a new tumor is formed, that new tumor has the same type of abnormal cells as the original endometrial cancer cells. Endometrial cancer that has spread to a lung is not lung cancer, it is metastasized endometrial cancer.
The doctor will want to find out whether the cancer has spread, and may order one or some of the following tests:
According to the National Cancer Institute, in the majority of cases the uterus is removed so that staging can be done. The pathologist checks to see how deeply the tumor has grown and whether other tissue samples from the uterus have cancer cells.
Treatment options depend on several factors, including the patient's age and general health, the grade of the tumor, whether it has invaded the muscle layer of the uterus, spread to tissues outside the uterus, or reached other parts of the body.
For patients with uterine cancer the current treatment options include surgery, radiation therapy, chemotherapy, and hormone therapy.
A multidisciplinary team - usually there will be a team of specialist health care professionals helping to plan the patient's treatment. The doctor may refer the patient to a specialist, who may be a gynecologist, gynecologic oncologist, medical oncologist and radiation oncologist. The team may also include a registered dietitian and oncology nurse.
The patient will be told what treatment choices there are, and the expected results for each one, plus their possible side effects. Although the aim of cancer therapy is to destroy cancer cells, often healthy cells and tissues are also damaged.
It is important to ask your health care team about any possible side effects and how treatment may impact on your normal everyday activities. It is important that the team and patient work together to make sure the treatment plan takes into account the patient's needs.
Most doctors will recommend that women with endometrial cancer have their uterus surgically removed (hysterectomy). The fallopian tubes and ovaries will usually be removed as well (salpingo-oophorectomy).
Jason D. Wright, MD, wrote in the Journal of Clinical Oncology wrote that women aged 45 years or younger with endometrial cancer can safely keep their ovaries and avoid early menopause.
During the surgical procedure, the surgeon will look carefully around the uterus for signs of cancer. Lymph nodes may also be removed and sent to the laboratory for testing. Removing lymph nodes helps in the staging of the cancer.
Most women spend a couple of days in hospital after a hysterectomy before going home, but some may go home on the day of the operation. It takes from 4 to 8 weeks to be able to return to normal activities.
The doctor and patient should ideally discuss a plan for pain relief before the operation. Medicine can help control pain and discomfort, which is usually present for a few days.
It is not uncommon to feel weak and tired for a few days, and also to experience nausea and vomiting. Temporary loss of bladder control and constipation is also possible.
If the patient is premenopausal, she will stop having periods after the operation and will not be able to get pregnant. There may be symptoms of menopause, such as hot flashes, night sweats and vaginal dryness.
Lymphedema, swelling in one of both legs, is possible after lymph nodes have been removed.
Radiation therapy (UK: radiotherapy) works by damaging the cancer cell's DNA, thus destroying their ability to multiply. Radiation therapy also kills cancer cells. This type of therapy uses powerful energy beams, such as x-rays.
Two types of radiation therapy are used in the treatment of endometrial cancer:
Neo-adjuvant radiotherapy (before surgery) - the doctor may recommend radiation to shrink the tumor, making it easier to remove.
Adjuvant radiotherapy (after surgery) - the aim is to eliminate any cancer cells that may have remained.
For some patients who may not be healthy enough for surgery, radiation therapy only is an option.
In more advanced endometrial cancer, radiation therapy may be used to alleviate symptoms of pain.
Side effects - the skin in the treated area can become sore and red, there may be hair loss. The bowel may be affected, causing sickness and diarrhea. During the radiation therapy course the patient may feel progressively tired. When the treatment is finished these side-effects will usually go away. According to the National Health Service, approximately 5% of patients carry on with long-term treatment effects, including rectal bleeding and diarrhea.
Chemotherapy involves the use of medication to destroy cancer cells.
In overall cancer treatment, chemotherapy can be used for the following goals:
Chemotherapy used for endometrial cancer is usually administered intravenously and in cycles. Each treatment cycle is followed by a rest period.
Side effects - chemotherapy, while killing fast-growing cancer cells, also harms some rapidly dividing healthy cells. The following side effects are possible:
Less commonly, some patients may experience swollen legs and feet, joint pain, balance problems, hearing difficulties, numbness and tingling in the hands and feet, and skin rash.
Hormone therapy is the use of hormones in medical treatment. Hormone therapy may be recommended for patients with advanced endometrial cancer that has metastasized.
Some women in the early stages of cancer who wish to get pregnant may opt for hormone therapy rather than surgery.
There are two main types of hormone therapy for people with endometrial cancer:
Side effects may include weight gain, mild muscle cramps, and mild nausea.
If the endometrial cancer is not detected early or is left untreated it can metastasize - spread to other parts of the body, most commonly to the lungs.
The 5-year survival rate, when all endometrial cancer cases are looked at together, is approximately 69%, according to the American Cancer Society.
For patients whose endometrial cancer is diagnosed at an early stage, the 5-year survival rate is more than 91%.
The earlier the cancer is detected and treated, the better the survival rate.The American Cancer Society emphasizes "These numbers give you an overall picture, but keep in mind that every woman's situation is unique and the statistics can't predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your personal chances of a cure, or how long you might survive your cancer. They know your situation best."
Removing both lymph nodes improves survival - Professor Noriaki Sakuragi and Dr Yukiharu Todo, at the Hokkaido University Graduate School of Medicine in Japan reported that the complete removal of both pelvic lymph nodes and the para-aortic lymph nodes results in better survival rates compared to just removing the pelvic lymph nodes.
Diet, exercise and coffee - a study carried out by the American Cancer Society found that endometrial cancer risk can be reduced with physical exercise, following a healthy and balanced diet, and drinking coffee.
The researchers said that doing 30 minutes of exercise each day and maintaining a healthy body weight can reduce the risk of developing endometrial cancer by almost 60%.According to co-researcher, Elisa V. Bandera, drinking coffee regularly is linked to "an estimated 7% reduction in risk for every cup of coffee consumed, based on eight studies." Bandera added that this applies to both caffeinated and decaffeinated coffee.
In another study, a team at the Harvard School of Public Health also found that coffee protects from endometrial cancer.
Hannah Arem, a doctoral student at Yale School of Public Health, reported that regardless of bodyweight, women who exercised for at least 150 minutes a week had a reduced risk of endometrial cancer.
Contraception - long-term use of the combined contraceptive pill has been associated with a lower risk of developing endometrial cancer, as have contraceptive implants and the IUD (intrauterine device).
This video talks about two types of uterine cancer: 1. Endometrial cancer. 2. Uterine sarcoma.
Written by Christian Nordqvist
Copyright: Medical News Today
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