Endometrial cancer is a cancer of the interior of the uterus, the endometrium being the lining of the lining of the uterus. In women with cancer at this level, the cells of the endometrium are multiplying abnormally. Endometrial cancer usually occurs after menopause, but 10-15% of cases involve premenopausal women, of whom 2-5% is women under 40 years of age.
|Sidebar: what is the endometrium normally used for?
In a premenopausal woman, during the first half of the menstrual cycle, the normal endometrium thickens and sees its cells multiply during the first half of each menstrual cycle. This endometrium has the role of hosting an embryo. In the absence of fertilization, this endometrium is evacuated each cycle in the form of rules. After menopause, this phenomenon stops.
The endometrial cancer is the second most common gynecological cancer in France, after breast cancer. It is in the 5 most common cancer in women in terms of incidence with about 7300 new cases estimated in 2012. In Canada, it is the 4 in incidence in women (after breast, lung and colon), with 4,200 new cases in 2008 in Canada. Mortality steadily decreases for this type of cancer which is better and better cared for.
When endometrial cancer is treated at an early stage (Stage I), the survival rate is 95%, 5 years after treatment.
Causes of Cancer of the endometrium
A significant proportion of endometrial cancer is attributable to an excess of estrogen hormones produced by the ovaries or brought in from outside. The ovaries produce two types of hormones during the female cycle: estrogen and progesterone . These hormones act on the endometrium throughout the cycle, stimulating its growth and expulsion at the time of menstruation. An excess of estrogen hormones would create an imbalance conducive to the poorly controlled growth of endometrial cells.
Several factors can increase estrogen levels, such as obesity or hormone therapy with estrogen alone. This type of hormone therapy is therefore reserved for women who have undergone removal of the uterus or hysterectomy who are no longer at risk for endometrial cancer. For more information, refer to At-Risk and Risk Factor sections .
For some women, however, endometrial cancer does not appear to be caused by a higher rate of estrogen.
Other causes are involved in endometrial cancer, such as advanced age, overweight or obesity, genetics, hypertension …
Sometimes cancer occurs without a risk factor being identified.
Diagnostic of Cancer of the endometrium
There is no screening test for endometrial cancer. The doctor therefore carries out tests to detect this cancer in the presence of signs such as gynecological bleeding occurring after the menopause.
The first examination to be done is a pelvic ultrasound where the probe is placed on the belly and then in the vaginal space to visualize an abnormal thickening of the endometrium, lining of the interior of the uterus.
In case of anomaly on ultrasound, to detect an endometrial cancer, the doctor does what is called “an endometrial biopsy”. It involves taking some mucous from the inside of the uterus. The biopsy of the endometrium can be done in the doctor’s office, without the need for anesthesia. A tubemince and flexible is inserted through the cervix and a small piece of tissue is drawn by suction. This sample is very fast, but it can be a little painful. It is normal to bleed a bit later.
The diagnosis is made in the laboratory by microscopic observation of the area of mucosa removed.
In case of illness or medication, the doctor should be informed if he or she needs to perform this test.
Symptoms of Cancer of the endometrium
- In menstruating women: vaginal bleeding between menstrual periods or abnormally heavy or prolonged menstruation;
- In postmenopausal women: gynecological bleeding. In a postmenopausal woman who is bleeding, tests should always be done to detect possible endometrial cancer.
Warning. As this cancer sometimes occurs at the time of menopause, when menstruation is irregular, abnormal bleeding can be mistaken for normal.
- Abnormal vaginal discharge, white discharge, loss such as water, or even purulent discharge;
- Cramps or pain in the lower abdomen;
- Pain when urinating;
- Pain during sex.
|These symptoms may be related to many gynecological disorders of the female reproductive system and are therefore not specific to endometrial cancer. However, it is important to consult a doctor quickly, particularly in case of gynecological bleeding after menopause.|
People at risk
The main risk factors for endometrial cancer are:
- Previous treatment with Tamoxifen,
- HNPCC / Lynch Syndrome, an inherited disease associated with an increased risk of endometrial cancer. ( Hereditary Non-Polyposis Colorectal Cancer or Hereditary Colorectal Cancer Without Polyposis)
Other people are at risk:
- Women in postmenopause. As progesterone levels decline after menopause, women over 50 are at increased risk for endometrial cancer. Indeed, progesterone seems to have a protective effect on this type of cancer. When the disease occurs before menopause, it occurs mainly in high-risk women;
- Women whose cycles started very young (before 12 years);
- Women having a late menopause. The lining of their uterus has been exposed to estrogen over a longer period of time;
- Women who have not had children are at higher risk of endometrial cancer compared to those who have had it;
- Women with polycystic ovarian syndrome . This syndrome is characterized by hormonal imbalance disrupting menstrual cycles and decreases fertility.
- Women with endometrial hyperplasia are at higher risk;
- Women with a strong family history of colon cancer in its hereditary form (which is rather rare);
- Women with an ovarian tumor that increases the production of estrogen.
- Women taking certain menopausal hormone therapies (HRTs)
- Obesity . It is a major risk factor because fatty tissues produce estrogen, which stimulates the growth of the uterine lining (the endometrium);
- Hormone replacement therapy with estrogen alone . Hormone therapy with estrogen alone, therefore without progesterone, is clearly associated with an increased risk of cancer or endometrial hyperplasia . It is therefore recommended only to women who have undergone removal of the uterus;
- A diet too rich in fat . By contributing to excess weight and obesity, and possibly directly acting on the metabolism of estrogens, dietary fat, consumed in excess, increases the risk of endometrial cancer;
- Tamoxifen treatment . Women taking or having taken tamoxifen to prevent or treat breast cancer are at higher risk. One in 500 women treated with tamoxifen develops endometrial cancer. This risk is generally considered low compared to the benefits it brings.
- The lack of physical activity.
|It is important to respond quickly to abnormal vaginal bleeding , particularly in a postmenopausal woman. It is then necessary to consult quickly his doctor. Also, it is important to consult regularly with a doctor and regularly pass a gynecological examination , during which the doctor practices an examination of the vagina, the uterus, the ovaries and the bladder.
Warning. A Pap smear, commonly called Pap test (Pap smear test), cannot detect the presence of cancer cells inside the uterus. It is only used to detect cancer of the cervix of the uterus (opening of the uterus) and not those of the endometrium (inside the uterus).The Canadian Cancer Society recommends that women with a higher than average risk of having endometrial cancer evaluate with their doctor the possibility of establishing personalized follow-up.
|Basic preventive measures|
|However, women can reduce the risk of developing endometrial cancer by the following measures. It should be noted that many women with risk factors will never have endometrial cancer
Maintain a healthy weight Obesity is one of the major risk factors for endometrial cancer in postmenopausal women. Swedish researchers have analyzed epidemiological data from European Union countries and found that 39% of endometrial cancers in these countries are linked to excess weight.
Regularly practice physical activities. Women who exercise regularly are less at risk. Several studies indicate that this habit reduces the risk of endometrial cancer.
Take appropriate hormone therapy after menopause. For women who choose to take hormone therapy at menopause, this treatment should contain a progestin. And that’s still the case today. Indeed, when hormone therapy contained only estrogen, it increased the risk of endometrial cancer. Estrogens alone are sometimes prescribed but reserved for women who have had the uterus removed (hysterectomy). They are no longer at risk of having endometrial cancer. Exceptionally, some women may require hormone therapy without progestin, due to adverse effects caused by progestin. In this case, the medical authorities recommend that an evaluation of the endometrium be done annually by a doctor, as a preventive measure.
Adopt as much as possible an anti-cancer diet. Based primarily on the results of epidemiological studies, animal studies and in vitro studies , researchers and physicians have made recommendations to encourage the consumption of foods that help the body prevent cancer. It is also thought that the remission of cancer could be promoted, but this remains a hypothesis. See the sheet Custom Diet: Cancer , designed by nutritionist Hélène Baribeau.
Note . Taking combined oral contraceptives (birth control pill, ring, and patch) for several years reduces the risk of endometrial cancer.
Medical treatments of Cancer of the endometrium
Treatment depends on the stage of cancer progression , the type of cancer (hormone-dependent or otherwise) and the risk of recurrence.
The choice of treatment is not made by a single doctor, but decided in a multidisciplinary consultation meeting bringing together several doctors from different specialties (gynecologists, surgeons, radiotherapists, chemotherapists, anesthetists …) These doctors choose according to the protocols provided, according to the type of endometrial cancer involved. The treatment strategy is therefore very scientifically determined to be as effective as possible with the least possible side effects.
Surgery of Cancer of the endometrium
Most women benefit from surgery to remove the uterus (hysterectomy), as well as the ovaries and fallopian tubes (hysterectomy with salpingo-oophorectomy).
This intervention eliminates the natural sources of sex hormones (estrogen, progesterone and testosterone) that can stimulate cancer cells.
This operation can be done by laparoscopy (small openings on the belly), vaginally, or by laparotomy (opening more important at the level of the belly), and the choice of the type of operation is made by the surgeon so as to obtain the best results.
When surgery is performed at an early stage of the disease, this treatment may be sufficient.
Radiotherapy of Cancer of the endometrium
Some women with endometrial cancer also receive radiation therapy, either external radiotherapy or brachytherapy. External radiotherapy is organized in sessions for 5 weeks, with irradiation from the outside of the body, while the curie therapy consists of intravaginal insertion, a radioactive applicator for a few minutes at a rate of one session per week for 2 to 4 weeks .
It can also be part of the treatment of endometrial cancer, according to the protocols adapted to their case. It is most often proposed before or after radiotherapy.
Hormonal treatment of Cancer of the endometrium
Hormone therapy is also one of the treatments sometimes used. It consists of drugs with an anti-estrogen effect, to reduce the stimulation of cancer cells that would be present in the body.
Once the treatment is done, it is advisable to see your doctor or gynecologist for a gynecological examination very regularly, as recommended by the doctor, every 3 or 6 months for 2 years. Subsequently, annual monitoring is usually sufficient.
The disease and its treatments can have significant impacts, such as changing fertility and intercourse, and can cause a lot of stress. Several support organizations offer services to answer questions and provide comfort. See the Support Groups section.