Endometrial cancer, i.e. cancer of the endometrium, is a malignant tumor of the female reproductive system. The prognosis of endometrial cancer depends on the stage of the tumor at the time of diagnosis. Knowing what the symptoms of this cancer are may allow you to apply for tests early enough and increase the chances of a full recovery. Check what are the causes of the development of endometrial cancer, what symptoms may be its first sign, and the step-by-step process of diagnosis and treatment.

Endometrial cancer , i.e.endometrial cancer(Latin endometrial carcinoma) is most often diagnosed in women in the perimenopausal period, i.e. between 55 and 64 years of age, as well as in women over 70 years of age. In Poland, the frequency of its occurrence is estimated at about 7 percent.

The greatest risk of developing this cancer concerns postmenopausal women. There are several types of factors known to contribute to the development of endometrial cancer. Among them, hormonal and lifestyle factors seem to have the greatest influence. The role of the latter is proven by the fact that as many as 50-70% of patients suffering from endometrial cancer are obese at the same time.

How does endometrial cancer develop?

The endometrium is the mucosa that lines the inside of the uterus. Its structure and functioning are subject to hormonal regulation. Changes in the concentration of sex hormones, accompanying the subsequent phases of the menstrual cycle, cause continuous reconstruction of the endometrium and its monthly exfoliation.

Endometrial cancer is caused by the uncontrolled growth of cancer cells. These cells are resistant to biological control mechanisms. They can multiply quickly and infiltrate the surrounding tissues.

In more advanced stages, endometrial cancer may spread to other organs through the lymphatic vessels. The proliferation of uterine mucosa cells is stimulated by female sex hormones - estrogens. For this reason, endometrial cancer is included in the group of so-called hormone-dependent neoplasms.

Its development is closely related to the estrogen metabolism of a woman's body. The risk of endometrial cancer increases with age, by contrastthe peak incidence is in women around the age of 60.

Endometrial cancer - risk factors

Which women are at increased risk of developing endometrial cancer? Many years of scientific research and the experience of doctors has allowed to identify several groups of factors that contribute to the development of this cancer.

The most important of them seem to be changes in the body's hormonal balance. Its proper functioning is based on maintaining a balance between two groups of sex hormones - estrogens and gestagens (mainly progesterone). Endometrial cancer develops when estrogen activity becomes greater and is not counterbalanced by progesterone.

Estrogens constantly stimulate the growth of the uterine mucosa, which carries the risk of abnormal cell division and changes in cell structure. These phenomena constitute the nucleus of the neoplastic process.

In what situations can estrogens be so advantageous? One of the most common causes of it is obesity. Excess fat is not only unnecessary kilograms, but also active tissue, showing hormonal activity. Fat cells are involved in the metabolism of estrogens, increasing their concentration in the blood.

The diseases coexisting with obesity, which also increase the risk of developing endometrial cancer, include:

  • insulin resistance
  • diabetes
  • hypertension

Excess estrogen can also accompany other hormonal disorders. One such example is polycystic ovary syndrome (PCOS).

It is also worth remembering that estrogens are sometimes used as drugs - including oral contraception or as hormone replacement therapy in postmenopausal women. Currently, most of these preparations also contain gestagen, whose task is to balance the effects of estrogens and reduce the risk of causing endometrial cancer. Two-component contraceptive pills show a protective effect against the development of this cancer.

Other conditions that may be a risk factor for the development of endometrial cancer include the early age of early menstruation and the late age of the onset of menopause. Both of them are associated with the prolongation of estrogen production by the active ovaries. The increased risk also applies to those patients who have never been pregnant.

Finally, it is worth mentioning genetic factors that may also influence the development of endometrial cancer. We are talking mainly about rare genetic diseases associated with an increased risk of developing various typestumors. An example of such a disease is Lynch syndrome. Although this disease is most often associated with colorectal cancer, it is also likely to develop endometrial cancer, ovarian cancer and other cancers of the gastrointestinal tract.

Endometrial cancer prevention

Since we already know the factors associated with the increased risk of developing endometrial cancer, it is also worth mentioning those that may help to avoid it.

A he althy lifestyle is extremely important in the prevention of endometrial cancer - maintaining an appropriate BMI (according to WHO the correct values ​​are in the range of 18.5-24.99), regular physical activity and adherence to the principles of he althy eating.

A reduced risk of developing the disease also applies to patients taking two-component (estrogen-gestagen) contraceptive pills. An additional protective factor is having children.

Another issue related to the prevention of endometrial cancer is preventive examinations. For this cancer, no population-based screening programs (such as Pap smears in cervical cancer) are carried out. Such tests are recommended only for patients from higher risk groups (obesity, PCOS, Lynch syndrome, etc.).

However, it is definitely worth learning about the most common symptoms of endometrial cancer (see below). Regular gynecological check-ups are equally important, allowing the assessment of the condition of the uterine mucosa and the early identification of suspicious changes.

Endometrial cancer - symptoms

An important feature of endometrial cancer is the fact that it becomes symptomatic relatively quickly. The first and most important symptom of endometrial cancer is abnormal vaginal bleeding.

They usually appear in the early stages of the disease development. As it most often affects postmenopausal women, any vaginal bleeding in a woman who has stopped menstruating should be a reason for prompt medical consultation.

In the case of younger patients, intermenstrual bleeding is an alarming symptom. The remaining symptoms of endometrial cancer are non-specific and may accompany many other conditions. These include vaginal discharge, lower abdominal pain and general weakness.

Endometrial cancer stages. FIGO classification

Endometrial cancer staging is very important in choosing a treatment method. Endometrial cancer can originate from so-called precancerous conditions, which include atypical complex endometrial hyperplasia.

It is the state in which the cellendometrium are no longer under the body's control and multiply excessively, while undergoing neoplastic remodeling. At this stage, however, they do not yet have the ability to infiltrate tissues or form metastases.

Compound atypical hyperplasia may or may not be a precursor to endometrial cancer. In many cases, the neoplastic disease develops on the basis of completely he althy tissue. The international FIGO classification is used to describe the staging of endometrial cancer. Increasingly higher stages of the disease in this classification mean a worse prognosis and a lower chance of full recovery.

The FIGO classification takes into account the following endometrial cancer stages:

  • IA - cancer limited to the uterine body only, infiltrating<50% grubości warstwy mięśniowej
  • IB - tumor limited only to the uterine body, infiltrating>50% of the thickness of the muscle layer
  • II - cancer that has spread to the cervix and surrounding connective tissue, but not beyond the uterus
  • III A - neoplasm affecting the serous membrane or appendages (ovaries, fallopian tubes)
  • III B - neoplasm involving the vagina or the parietal tissue
  • III C1 - tumor involving pelvic lymph nodes
  • III C2 - cancer involving the peraortic lymph nodes
  • IV A - cancer infiltrating the rectal or bladder mucosa
  • IV B - cancer affecting the inguinal lymph nodes or forming distant metastases

An additional classification that doctors use to describe the advancement of endometrial cancer is the TNM scale. This classification is a universal tool that is also used for other cancers (for example, lung cancer or colorectal cancer).

Its name is an abbreviation of the three most important parameters that should be taken into account when describing a neoplastic disease:

  • T (tumor) - tumor size
  • N (nodes) - presence of lymph node metastases
  • M (metastases) - presence of metastases - in distant organs.

Endometrial cancer - diagnosis

Endometrial cancer diagnosis is based on several types of tests. It usually begins with a detailed medical history and a gynecological examination. In some cases, a physical examination can detect a cancerous tumor in the lower abdomen. It is also very important to examine the lymph nodes for signs of possible metastasis.

The much more accurate methods of endometrial assessment include ultrasound (USG) performed with the use of a special transvaginal transducer. In this examination, the doctor measures the thickness of the endometrium and also looks for changes in its structure.

The correct thickness of the endometrium in postmenopausal women should not exceed 5 mm. If the uterine mucosa is thickened or there are other abnormalities, a histopathological diagnosis may be necessary. Its purpose is to collect endometrial fragments and microscopic evaluation of them.

Material for histopathological examination can be obtained in two ways. The first is curettage of the uterine cavity, i.e. scrapings with the help of special surgical tools. All obtained tissues are then sent for histopathological evaluation. It is worth emphasizing that the endometrium has a great potential for renewal and heals spontaneously within 5 days after the curettage treatment.

Another way to obtain an endometrial specimen is an endometrial biopsy, i.e. a targeted collection with a special needle. A biopsy is usually performed during a hysteroscopy to obtain a sample from a specific endometrial site.

Hysteroscopy involves the insertion of a speculum with a camera into the uterine cavity. In addition to the control over the site of taking the sample, the webcam allows a more accurate assessment of the appearance of the endometrium compared to the ultrasound examination.

If endometrial cancer is diagnosed, additional imaging tests are performed to assess its stage and the presence of distant metastases (e.g. abdominal and thoracic computed tomography).

Endometrial cancer treatment methods

The treatment of endometrial cancer is selected individually for each patient. The most important method is surgery to remove the tumor, although it is not always possible (for example, in elderly patients who cannot undergo general anesthesia).

If, however, there are no contraindications to the operation, a hysterectomy, i.e. removal of the uterus, is performed. In the vast majority of cases, the appendages (ovaries and fallopian tubes) are also removed.

From the oncological point of view, the most important thing is to excise the tumor with an appropriate margin of he althy tissue - it gives hope that all tumor cells have been removed. If the tumor also affects the surrounding lymph nodes, a lymphadenectomy, i.e. their removal, is performed.

After the surgery, all resected tissues are subjected to a histopathological examination. Its result determines the use of additional treatment methods.

In complementary therapy, chemotherapy and radiotherapy are used, as well as a combination of both of them. Due to the specific location of endometrial cancer, a special type of radiotherapy is used to treat it - brachytherapy.

The essence of brachytherapy is to place the radiation source directly inside the tumor. Thanks to this, it is possible to protect nearby organs (intestine, bladder) against the damaging effects of radiation.

The last of the complementary methods of treatment is hormone therapy, which consists in administering progesterone derivatives. Hormone therapy is also used in young patients with low-advanced endometrial cancer who wish to maintain fertility.

The prognosis of endometrial cancer depends on its stage. In the case of cancer detected early and limited only to the endometrium, the 5-year survival rate is over 90%. The presence of metastases in the lymph nodes and in distant organs worsens the prognosis. For this reason, it is very important to know the early symptoms of endometrial cancer and to contact your doctor quickly if you notice them.

About the authorKrzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.

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Category:

Oncology