Endometrial Cancer

What the Disease Is

Endometrial cancer originates in the lining of the uterus, known as the endometrium. This type of cancer most commonly affects women after menopause, although it can occur in younger women as well. It begins when abnormal cells in the endometrium start to grow uncontrollably, forming a malignant tumor. Symptoms often include abnormal bleeding and pelvic pain, and the disease can range from localized to more advanced stages where it may spread to other parts of the body. Early detection and treatment are critical for improving prognosis and managing the disease effectively.

Causes

• Hormonal Imbalance: Excess estrogen without sufficient progesterone can stimulate abnormal cell growth in the endometrium. Conditions such as polycystic ovary syndrome (PCOS) or estrogen replacement therapy without progesterone can contribute to this imbalance.
• Obesity: Excess body fat increases estrogen levels in the body, which can raise the risk of developing endometrial cancer.
• Unopposed Estrogen Therapy: Long-term use of estrogen-only hormone replacement therapy (HRT) without progesterone increases the risk of endometrial cancer.
• Family History: Genetic predisposition, particularly in families with Lynch syndrome (hereditary non-polyposis colorectal cancer), increases the risk of endometrial cancer.
• Age: Risk of endometrial cancer advances with age, more especially after menopause.
• Infertility: Women who have never been pregnant or who have had difficulty conceiving may have a higher risk.
• Diabetes: Having diabetes, especially type 2, is associated with a higher risk of developing endometrial cancer.

Predisposing Factors

• Early Menstruation: Starting menstruation at a young age can increase exposure to estrogen over a lifetime.
• Late Menopause: Menopause occurring at a later age extends the period of estrogen exposure.
• Tamoxifen Use: Women who use tamoxifen for breast cancer treatment are at increased risk of endometrial cancer, as tamoxifen can have estrogen-like effects on the endometrium.
• Genetic Syndromes: Hereditary conditions such as Lynch syndrome and Cowden syndrome predispose individuals to endometrial cancer.
• Polycystic Ovary Syndrome (PCOS): PCOS can lead to irregular menstrual cycles and increased estrogen levels, raising cancer risk.
• Menstrual Irregularities: Conditions causing irregular menstrual cycles and prolonged estrogen exposure increase risk.

Signs and Symptoms

• Abnormal Vaginal Bleeding: Includes bleeding between periods, heavy or prolonged menstrual bleeding, or bleeding after menopause.
• Pelvic Pain: Persistent or recurrent pain in the pelvic area.
• Pain During Intercourse: An individual feels uncomfortable with a lot of pain during sexual activity.
• Unusual Vaginal Discharge: Watery or blood-stained discharge that is not related to menstruation.
• Frequent Urination: Increased frequency or urgency to urinate due to tumor pressure on the bladder.
• Difficulty Swallowing: In advanced stages where the cancer may have spread to other organs, swallowing difficulties may occur.

Treatment and Management

• Surgery:
• Hysterectomy: Removal of the uterus, and in many cases, the ovaries and fallopian tubes to eliminate the cancerous tissue.
• Lymphadenectomy: The nearby lymph nodes can be removed to check for cancer spread.
• Radiation Therapy:
• External Beam Radiation: Targets cancer cells from outside the body.
• Brachytherapy: Involves placing a radioactive source directly inside the vagina or uterus to target cancer cells more precisely.
• Chemotherapy:
• Systemic Chemotherapy: Uses drugs to kill cancer cells throughout the body, typically used for advanced-stage endometrial cancer.
• Hormonal Therapy:
• Progestins: Hormone therapy with progestins can be used to manage cancer or prevent recurrence in some cases.
• Targeted Therapy:
• Monoclonal Antibodies: Target specific proteins or pathways involved in cancer growth, such as drugs that inhibit angiogenesis (the formation of new blood vessels that feed the tumor).
• Immunotherapy:
• Checkpoint Inhibitors: Help the immune system recognize and attack cancer cells, often used in advanced cases or for specific genetic profiles.

Prevention Strategies

• Healthy Weight: Maintaining a healthy weight through diet and exercise can lower the risk of endometrial cancer.
• Balanced Hormone Therapy: Using combined hormone replacement therapy (estrogen and progesterone) rather than estrogen alone to reduce risk.
• Regular Gynecological Check-ups: Routine exams and consultations with a gynecologist can aid in early detection.
• Early Pregnancy: Having children at a younger age can reduce the risk of endometrial cancer.
• Use of Birth Control Pills: Oral contraceptives can help reduce the risk of endometrial cancer by regulating menstrual cycles and decreasing estrogen levels.

Conclusion

Endometrial cancer, affecting the lining of the uterus, is a significant health concern that requires timely diagnosis and intervention. Its primary causes include hormonal imbalances and genetic factors, with symptoms that often manifest as abnormal bleeding and pelvic discomfort. Effective management involves a combination of surgical, radiological, and pharmacological treatments tailored to the stage and characteristics of the cancer. Preventive measures, including lifestyle modifications and regular screenings, are vital in reducing the risk and ensuring early detection. Understanding and addressing the risk factors and symptoms can lead to better outcomes and improved quality of life for individuals affected by endometrial cancer.