What is endometrial cancer?

Endometrial cancer is one of the most common types of cancer in women. The uterus is composed of cells called endometrial cells, which thicken and are shed as menstruation when needed. Sometimes, these cells undergo changes and can proliferate abnormally. This condition is referred to as endometrial cancer.

What are the causes and risk factors of endometrial cancer?

The exact cause of endometrial cancer is not known. However, changes in the levels of estrogen and progesterone in the body can contribute to the development of endometrial cancer. Changes in estrogen and progesterone levels can affect the endometrium, which may create a favorable environment for endometrial cancer. While the exact causes of endometrial cancer are not fully understood, there are known risk factors associated with it.

Risk factors for endometrial cancer include:

1. Age: The risk of endometrial cancer increases with age, but it can also occur in younger women.

2. Early onset of menstruation: Starting menstruation at a young age may increase the risk of endometrial cancer because it results in more years of exposure to estrogen.

3. Late menopause: endometrial cancer typically occurs after menopause. Delayed menopause leads to prolonged exposure to estrogen, which can increase the risk.

4. Obesity: Excess body fat can lead to increased estrogen production, raising the risk of endometrial cancer.

5. Diabetes: Type 2 diabetes has been associated with an almost two-fold increased risk of endometrial cancer compared to those without diabetes.

6. Nulliparity: Never having been pregnant can increase the risk of endometrial cancer. Pregnancy shifts the hormonal balance towards progesterone, which may have a protective effect.

7. Polycystic ovary syndrome (PCOS): PCOS is characterized by high estrogen levels and low progesterone levels, which can raise the risk of endometrial cancer.

8. Hormone therapy for breast cancer: Some hormone-suppressing medications used in breast cancer treatment can increase the risk of endometrial cancer.

9. Family history of colorectal cancer: Individuals with a family history of colorectal cancer are at a higher risk of endometrial cancer.

10. Radiation therapy for other cancers: Previous radiation therapy for other cancers may predispose individuals to endometrial cancer.

11. Hormone replacement therapy (HRT) after menopause: HRT can increase the risk of endometrial cancer, particularly if estrogen is taken without progesterone.

It's important to note that having one or more of these risk factors doesn't guarantee the development of endometrial cancer, but it may increase the likelihood, and regular check-ups and screenings are advisable for individuals with these risk factors.

Who gets endometrial cancer?

Endometrial cancer is typically associated with the postmenopausal period and is more commonly diagnosed in individuals aged 55 and older. However, it can also occur in younger women.

What are the symptoms of endometrial cancer?

The initial symptoms of endometrial cancer are vaginal bleeding. Especially during menopause, if vaginal bleeding occurs, it should be considered as endometrial cancer until proven otherwise. In menstruating women, irregular intermenstrual bleeding and excessive bleeding can be the first signs of endometrial cancer.

In addition to vaginal bleeding and discharge, in advanced stages of endometrial cancer, different symptoms can also occur.

• Pelvic pain

• Abdominal pain

• Bloating

• Frequent urination

• Pain during urination

• Postmenopausal bleeding

These symptoms can also result from different issues. However, for early diagnosis, it is important for those experiencing one or more of these endometrial cancer symptoms to consult a gynecologist.

What are the stages of endometrial cancer?

To properly plan the treatment for endometrial cancer, it's crucial to determine the stage of the cancer. The staging of endometrial cancer is based on the extent of the tumor, whether cancer has spread to the lymph nodes, and whether there are metastases. Endometrial cancer is generally categorized into four stages.

Endometrial Cancer Stage 1: Cancer is confined to the uterus. There is no spread to surrounding tissues or distant parts of the body. Stage 1 can be further divided into two subcategories based on whether cancer cells have spread into the uterine muscle tissues (myometrium).

Endometrial Cancer Stage 2: Cancer is present in both the uterus and cervix. In other words, cancer has spread from the body of the uterus to the supporting connective tissues of the cervix. There is no involvement of lymph nodes or distant regions.

Endometrial Cancer Stage 3: Cancer has extended beyond the uterus but has not reached the rectum or bladder. Depending on the spread to fallopian tubes, ovaries, or nearby lymph nodes, Stage 3 endometrial cancer can have subcategories.

Endometrial Cancer Stage 4: This is the advanced stage of endometrial cancer. Cancer has spread to the rectum, bladder, or distant organs in the body. Stage 4 is further divided into two subcategories: Stage 4A, where cancer involves the mucosa of the rectum or bladder, and Stage 4B, where cancer has spread to distant organs such as lymph nodes in the groin, bones, or lungs.

In determining the stages of endometrial cancer, the microscopic appearance of cancer cells is also important. If cancer cells closely resemble healthy tissue and have various cell groups, they are considered "well-differentiated" or "low-grade tumors." If cancerous tissue appears significantly different from healthy tissue, it is termed "poorly differentiated" or "high-grade tumors." The tumor grade can provide insight into how rapidly the endometrial cancer may spread.

How is endometrial cancer diagnosed?

The question "How is endometrial cancer detected?" is one of the commonly asked questions. Women who experience one or more symptoms of endometrial cancer should promptly consult a gynecologist or an obstetrician. After a pelvic examination, further tests may be necessary to confirm the diagnosis.

Vaginal Ultrasound: Vaginal ultrasound imaging is used to visualize tumors and the structure within the endometrium. An ultrasound probe is inserted into the vagina to determine the thickness of the endometrial lining or other abnormalities.

Hysteroscopy: Hysteroscopy, an imaging method, can be used to diagnose endometrial cancer. An thin, flexible tube with a fiber-optic camera is inserted into the uterus. This allows for examination of the inside of the uterus and the endometrial lining.

Pathological Evaluation: To make an accurate diagnosis of endometrial cancer, a tissue sample taken from the endometrial lining through a procedure called curettage needs to be evaluated pathologically. Biopsy can be done with hysteroscopy and may involve anesthesia.

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): CT or MRI imaging techniques can be used to determine the size and abnormalities within the endometrium. Contrast agents may be used during CT or MRI for clearer images. MRI can be helpful for obtaining detailed images if the treatment plan involves hormone management. It can also be used to assess how much the cancer has grown into the endometrial wall and to determine whether fertility can be preserved.

What are the treatment methods of endometrial cancer?

In the treatment of endometrial cancer, various factors are taken into consideration, including the type and stage of cancer, potential side effects of the proposed treatment, the patient's overall health, age, and the impact of treatment on fertility.

Surgical methods are the primary approach in the treatment of endometrial cancer, but chemotherapy, radiotherapy, hormone therapy, targeted therapy, and immunotherapy can also be applied. In the treatment of endometrial cancer, sometimes these methods are used individually, while in other cases, they are combined in a combination.

Surgery for Endometrial Cancer: The most commonly performed method in the treatment of endometrial cancer is surgery. Removing the uterus (hysterectomy) along with pathological examination of the uterus during surgery is the fundamental treatment. Depending on the frozen section results during surgery, the removal of lymph nodes around blood vessels may also be necessary.

Chemotherapy for Endometrial Cancer: Chemotherapy can be administered before or after surgery for endometrial cancer. It may be given after surgery to reduce the risk of recurrence or before surgery to shrink the tumor and make it easier to remove. It can be used alone or in combination with radiotherapy.

Radiotherapy for Endometrial Cancer: Radiation therapy is often used after surgery to eliminate any remaining cancer cells. In some cases, it may be used before surgery to shrink the tumor entirely. Radiotherapy may be preferred for patients whose overall health is not suitable for surgery.

Hormone Therapy for Endometrial Cancer: Hormone therapy involves the use of hormones or hormone-blocking drugs to alter hormone levels. Hormone therapy can slow down the growth of endometrial cancer cells. It may be used in cases of recurrent endometrial cancer and metastatic endometrial cancers. Hormone therapy is often combined with chemotherapy.

How to reduce the risk of endometrial cancer?

To reduce the risk of endometrial cancer, here are some precautions to consider:

1. Regular Gynecological Examinations: Every woman should undergo regular gynecological check-ups. Early detection is crucial in endometrial cancer.

2. Consider Birth Control Pills: Taking oral contraceptives for one year can reduce the risk of endometrial cancer. However, it's important to be aware of the potential side effects of these contraceptives. The decision should be made after discussing the risks and benefits with a doctor.

3. Maintain a Healthy Weight: Controlling your weight is essential as obesity can increase the risk of endometrial cancer.

4. Individualized Risk Assessment: Different factors contribute to different types of cancer. While there is no proven way to completely prevent endometrial cancer, you can reduce your risk. Talk to your healthcare team for more information about your personal cancer risk.

5. Consider an Intrauterine Device (IUD): An intrauterine device that releases progestin can be used as a form of birth control, which may also have a protective effect against endometrial cancer.

Remember that while these measures can reduce the risk, there is no foolproof way to prevent endometrial cancer, so regular check-ups and discussions with your healthcare provider are essential.

FREQUENTLY ASKED QUESTIONS ABOUT ENDOMETRIAL CANCER