Endometrial cancer is a type of cancer that begins in the lining of the uterus, called the endometrium. It is the most common type of uterine cancer and primarily affects postmenopausal women, although it can occur in younger women as well.

Types of Endometrial Cancer

1. Endometrioid Adenocarcinoma: The most common type, usually related to excess estrogen exposure.

2. Serous Carcinoma: Less common, more aggressive, and not typically linked to estrogen.

3. Clear Cell Carcinoma: Another rare and aggressive form of endometrial cancer.

Risk Factors

• Age: Most common in women over 50.

• Hormone Imbalance: Higher levels of estrogen relative to progesterone.

• Obesity: Excess body fat can alter hormone levels.

• Reproductive History: Nulliparity (never having been pregnant) increases risk.

• Menstrual History: Early menarche or late menopause.

• Hormone Replacement Therapy (HRT): Particularly estrogen-only therapy.

• Tamoxifen: A drug used for breast cancer treatment that can increase endometrial cancer risk.

• Genetic Factors: Lynch syndrome and other hereditary conditions.

Symptoms

• Abnormal Vaginal Bleeding: Especially postmenopausal bleeding.

• Pelvic Pain: Discomfort or pain in the lower abdomen.

• Weight Loss: Unexplained weight loss.

• Abnormal Discharge: Watery or blood-tinged vaginal discharge.

Diagnosis

• Pelvic Examination: Physical examination of the pelvic area.

• Transvaginal Ultrasound: Imaging to view the thickness of the endometrium.

• Endometrial Biopsy: A sample of endometrial tissue is taken for analysis.

• Hysteroscopy: A scope is inserted into the uterus to examine the endometrial lining.

• Dilation and Curettage (D&C): A procedure to scrape and examine the uterine lining.

Staging

Endometrial cancer is staged based on the extent of the disease:

1. Stage I: Cancer is confined to the uterus.

2. Stage II: Cancer has spread to the cervix.

3. Stage III: Cancer has spread to nearby tissues or lymph nodes.

4. Stage IV: Cancer has spread to distant organs, such as the bladder, rectum, or lungs.

Treatment Options

1. Surgery:

   • Hysterectomy: Removal of the uterus.

   • Bilateral Salpingo-Oophorectomy: Removal of both ovaries and fallopian tubes.

   • Lymph Node Dissection: Removal of nearby lymph nodes to check for cancer spread.

2. Radiation Therapy:

   • External Beam Radiation: Targets the pelvic area from outside the body.

   • Brachytherapy: Internal radiation placed directly into the uterus.

3. Hormone Therapy:

   • Progestins: To counteract estrogen.

   • Aromatase Inhibitors: Reduce estrogen production in postmenopausal women.

4. Chemotherapy:

   • Used especially for advanced or recurrent endometrial cancer.

   • Common drugs include carboplatin and paclitaxel.

5. Targeted Therapy:

   • Drugs that specifically target cancer cells, like monoclonal antibodies or kinase inhibitors.

   • May be used in advanced stages or for specific genetic mutations.

Prognosis

The prognosis for endometrial cancer depends on the stage at diagnosis, the type of cancer, and the patient’s overall health. Early-stage endometrial cancer generally has a good prognosis, with high survival rates. Advanced stages have a lower survival rate but can still be treated effectively in many cases.

Prevention and Monitoring

• Regular Gynecological Exams: Important for early detection, especially for women with risk factors.

• Weight Management: Maintaining a healthy weight to balance hormone levels.

• Healthy Diet: High in fruits, vegetables, and whole grains, and low in red and processed meats.

• Hormonal Balance: Monitoring and managing hormone replacement therapy carefully.

• Genetic Counseling and Testing: For women with a family history of endometrial or other cancers.