Endometrial Cancer Cancer in the Uterus

Cancer in the Uterus: Endometrial Cancer

Cancer in the Uterus: Endometrial Cancer

Introduction

Cancer comes about when some cells within the body grow out of control. Cancer starting in the uterus is referred to as uterine cancer. There are two categories of uterine cancer: endometrial cancer, the most common cancer of the uterus, and uterine sarcoma, a rare kind of uterine cancer found in the muscles of other uterine tissues. Every woman is at risk of uterine, provided they have a uterus. The risk, however, increases with age and is most common among women who have undergone or are going through menopause2.

Endometrial Cancer

It is the most common type, and it starts in the womb. This type of cancer starts forming in the layer of cells forming the uterine lining, also called the endometrium. Sometimes, endometrial cancer is called uterine cancer since it’s the most common. Often, it is detected at its early stages because of the main symptom associated with it. It often produces abnormal bleeding of the vagina, enabling doctors to discover it early before it progresses. Once discovered early, the uterus has to be removed surgically, and this cures cancer. Other symptoms associated with it include pelvic pain, trouble urinating, and pain during intercourse.

Epidemiology

Endometrial cancer is mostly associated with older women, usually above 50 years. Research statistics indicate that about 90 percent of the total number of women diagnosed with endometrial cancer are at least fifty years. Out of this statistic, the median age has been established to be 63 years. In terms of the geographic location or the geographical aspect of epidemiology, this type of cancer is most common among women in the United Kingdom (UK). It is also more common in western countries than in other continents, including Asia, South America, and Africa. However, it is becoming increasingly common in Asia.

Risk Factors

Several risk factors increase the susceptibility of women to endometrial cancer. These include changes in the balance of the female hormones. A change in the balance of hormones produced by the ovaries causes endometrial changes. Taking hormones containing estrogen but not progesterone after menopause is also a risk factor. Another risk factor is age. It is mainly associated with older women, especially those who have gone through or are at their menopause stages. Women who experienced longer periods of menstruation, having started before age twelve, are also at a higher risk3. One is also a higher exposure of endometrial cancer is they have never been pregnant than those who have experienced at least one pregnancy. Other risk factors include diabetes, hypertension, and obesity.

Pathobiology

Endometrial cancer frequently originated in the corpus area or the lower uterine segment. In low-volume cancer, there is frequently no evidence indicating residual disease after currage. Localized cancer manifests itself as “circular polypoid expansile masses” and is often hemorrhagic and friable. Diffuse endometrium involvement may also show an exophytic visible component, and hemorrhaging and necrosis can also be visible. The myometrium invasion foci appear as well-demarcated gray-white areas, which are lighter than the surrounding myometrium.

Molecular Basis of Endometrial Cancer

Recent studies have indicated that mutations take place in microsatellite sequences on some endometrial cancers1. Overexpression of the HER-2/ neu oncogene occurs in 10 percent of the cases of endometrial cancer, and this was found to have a connection with a poor survival rate. Moreover, there was an occurrence of some receptor tyrosine kinases in some cases. Microsatellite instability of the nonpolyposis colon cancer, hereditary, has been established to be caused by mutation or genetic alterations in the DNA repair genes. Therefore, similar researchers are seeking similar mutations in endometrial cancer. Several molecular mutations have been identified, but that of endometrial cancer has not been clearly understood.

Clinical Manifestation

Endometrial cancer is mostly associated with abnormal vaginal bleeding, which is the most common symptom. The bleeding ranges from a watery, blood-streaked flow to one with more blood. This is often a sign, especially if the individual is going through or has already gone through menopause. This bleeding can also take place between menstrual periods. Other symptoms of endometrial cancer are pain during sexual intercourse, pain in the pelvic region, and gynecologic hemorrhage. However, some women fail to exhibit any symptoms, which can be risky since it could lead to a late-stage detection of endometrial cancer when it has affected other organs aside from the uterus.

Biomarkers and Cytogenetic Laboratory Features

Endometrial cancer is generally classified into type 1 and type 2. Type 1 is estrogen-responsive and type 2 is estrogen non-responsive. This classification depends on the mechanism of development. Type 1 is caused by the stimulation of estrogen and is common in middle-aged women who are perimenopausal. Its histology is well differentiated. Type 2 is common in older post-menopause women. Its histology ranges from moderate to poor differentiation with a poor prognosis. The estrogen receptor, K-ras, PTEN, and progesterone receptor are highly mutated in Type 1 cases. In Type 2, there are high levels of p53 and HER-2/neu5.

Metastasis

Metastatic endometrial cancer originates in the endometrium or uterine lining or the uterus wall and spreads to other organs in the body that are not closely located to the uterus. Endometrial cancer can spread or metastasize to the bladder or rectum, and it can further spread to other organs, including fallopian tubes, ovaries, and the vagina. However, this type of uterine cancer is a typically slow-growing cancer but is frequently detected before it spreads to more distant organs of the body, such as the lungs and the bones. Statistically, only a small proportion of women are diagnosed with endometrial cancer that has far spread to such organs.

Staging

There are four stages as classified by the “International Federation of Gynecology and Obstetrics” (IFGB). Stage I of endometrial cancer is only confined to the womb or uterus, and stage II endometrial cancer has progressed to the cervix. Stage III endometrial cancer has progressed to the lymph nodes, ovaries, and the vagina, while stage IV is cancer that has spread to even more organs, including the rectum, the urinary bladder, and other organs found far from the uterus, such as the bones or lungs4. Most women receive a diagnosis at the early stages; only a few are diagnosed with stage IV endometrial cancer.

Screening and Prevention

There is no standard screening test, particularly for women without any signs or symptoms of endometrial cancer. Screening for endometrial cancer is not possible using the Pas test. Researchers are trying to explore ways of detecting cancer before its symptoms show, and this includes studies on possible genetic risk factors that might increase the risk of susceptibility. Since there are no standard screening procedures, women need to be aware of warning signs and learn the necessary precautions to reduce their chances of endometrial cancer. If symptoms show, one should visit their doctor for an endometrial biopsy or ultrasound to rule out or diagnose cancer for necessary treatment measures to begin2.

Cancer Therapy

There are several treatments for endometrial cancer depending on the stages, including surgical removal of the uterus, chemotherapy, hormone therapy, and radiation. Surgical treatments include hysterectomy, which involves the removal of the uterus, laparotomy, lymph node dissection in which the lymph nodes are surgically removed, and retroperitoneal lymph node dissection in which the lymph nodes that are located behind the abdomen are removed to determine if cancer has spread3. Chemotherapy drugs used for treatment include Carboplatin, Cisplatin, and Docetaxel. Finally, it can be treated using radiation therapy. X-rays and some other high-energy potential rays are used to kill the cancerous cells, and brachytherapy involves placing radioactive material in the body to kill the cells.

Prognosis

Women who have been diagnosed at the early stages have a better prognosis than those with late-stage diagnoses. Many recurrences take happen within the first years after treatment. Many women with an early diagnosis are treated by surgically removing the uterus to cure cancer. Generally, the twenty-year survival rate for each form of this type of cancer is approximately 80 percent compared to 53 percent for cases of papillary carcinomas and 62 percent for cases of clear cell. Prognosis is based on the stage and the type of cancerous cells. The five-year survival is between 74 and 91 percent in women with metastatic endometrial cancer. Also, increased all-cause mortality amongst endometrial cancer patients has proved to be significantly associated with increased BMI5.