What is endometrial cancer?

It is cancer of the lining of the uterus or womb. This lining is known as the endometrium. Endometrial cancer is the most common cancer of the female reproductive tract, with an estimated 200 women diagnosed each year (about 1 percent of all cases). Fortunately, it has a high cure rate.

Endometrial cancer is not the same as some other less common malignancies involving the uterus. For example, uterine sarcomas are malignancies arising from the wall of the uterus, not the lining. All in all, these other cancers make up less than 10 percent of the malignant tumours arising from the uterus. The remaining 90 percent are the endometrial cancers talked about here.

Who has the greatest risk of developing endometrial cancer?

Women who get endometrial cancer tend to share certain characteristics. Having these risk factors doesn't mean you'll get the cancer, of course, just as being free of risk factors doesn't guarantee safety.

But you're more like to develop this cancer if:

• You're over the age of 50. Less than 5 percent of endometrial cancer cases are diagnosed in women under 40.
• You're on hormone replacement therapy. Both large doses of oestrogen and long-term treatment with it seem to elevate the risk of endometrial cancer. Using both oestrogen and progesterone appears to reduce the risk of taking oestrogen by itself.
• You're overweight. If your weight is somewhat above the acceptable range for your height, you're twice as likely to get endometrial cancer as a woman at a lower weight; if you're obese, your risk is three to 10 times greater than that of those who aren't. Scientists believe this is because the more fat cells a woman has, the more oestrogen she produces.
• You have diabetes or high blood pressure. Studies show these conditions may increase the risk of endometrial cancer, but scientists aren't sure whether this is a direct result of the diseases or because people who have these diseases tend to be overweight.
• You're taking tamoxifen. Using this drug to treat breast cancer raises your risk of developing endometrial cancer, perhaps because it affects the uterus much as oestrogen does.
• You're white. White women are more likely to develop endometrial cancer than women of other races are.
• Other risk factors include having no biological children, going through menopause late in life, suffering from polycystic ovarian syndrome, and having a history of colon, rectal, or breast cancer. One thing that may lower your risk, according to some studies, is having used oral contraceptives containing both oestrogen and progesterone.

What are the symptoms of endometrial cancer?

Bleeding after menopause is usually the first sign. If that happens, the chances are one in three that you have this cancer. For women who haven't gone through menopause, bleeding between periods might signal either endometrial or cervical cancer. Other symptoms of endometrial cancer include pain during intercourse and painful or difficult urination.

When should I see my doctor?

Make an appointment promptly if you have any of the following symptoms:

• Unusual discharge or vaginal bleeding
• Difficult or painful urination
• A chronic ache in the pelvic area
• Pain during intercourse

These symptoms often have other causes, but your doctor can make sure your problem isn't an early sign of endometrial cancer.

How is endometrial cancer diagnosed?

If your doctor suspects you have endometrial cancer, she'll do a pap smear (take a sample of cells from your cervix to be inspected for abnormalities). If this is negative, she'll probably also do a biopsy of your uterine lining, removing a sample of tissue that will be examined for cancerous cells.


If cancer is detected, your doctor will then determine how far it has spread. There are four stages: stage I means the cancer is confined to the uterus. In stage II, it has spread to the cervix. In stage III, it has spread to other reproductive organs. In stage IV, it's spread to elsewhere in the body. Endometrial cancer is usually diagnosed in the first stage.

What are my treatment options?

A hysterectomy -- surgery to remove the uterus or radiology -- are typically the first line options for treatment.


The best approach depends on whether -- and how much -- the cancer has spread. Your doctor will probably suggest a hysterectomy and may want to remove your cervix, fallopian tubes, and ovaries along with your uterus. She may recommend a course of radiation as an adjunct therapy.


Less common treatments for this cancer include hormone therapy and chemotherapy. Discuss the advantages and side effects of the possibilities with your doctor or oncologist, and be sure to get a second opinion if you are not happy.

Will a hysterectomy affect my sex life?

Some studies suggest that this surgery can lessen sexual desire, but others have found that it has no effect on libido or satisfaction. But if feelings of emotional loss detract from your sex life, counselling (either individual or for both you and your partner) may help.

How can I prevent endometrial cancer?

In your reproductive years, try to maintain a normal weight through a healthy diet and regular exercise.

 If you have already gone through menopause and are worried about endometrial cancer, you should ensure that your hormone replacement therapy contains progesterone as well as oestrogen.

It is rare for doctors to prescribe oestrogen-only therapy to women unless they have already had a hysterectomy.


Kerry Nelson
CONSUMER HEALTH INTERACTIVE
Last Editorial Review: 25/1/2010