Endometrial cancer

Alternative Names:- Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma -endometrium; Adenocarcinoma – uterus; Cancer – uterine; Cancer – endometrial; Uterine corpus cancer

Definition:
The endometrium is the tissue lining the uterus (or womb). The uterus, a hollow organ about the size and shape of a pear, is found in a woman’s pelvic region and is the organ where the fetus grows until birth. The upper part of the uterus is called the corpus; the lower, narrower part of the uterus is called the cervix. The cervix is the opening between the uterus and the vagina. The outer layer of the uterus is called the myometrium. The myometrium is thick and composed of strong muscles. These muscles contract during labor to push out the baby.

The endometrium is soft and spongy. Each month, the endometrium changes as part of the menstrual cycle. Early in the cycle, the ovaries secrete a hormone called estrogen that causes the endometrium to thicken. In the middle of the cycle, the ovaries start secreting another hormone called progesterone. Progesterone prepares the innermost layer of the endometrium to support an embryo should conception (pregnancy) occur. If conception does not occur, the hormone levels decrease dramatically. The innermost layer of the endometrium is then shed as menstrual fluid. This leads to the cyclical nature of the menstrual cycle.

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Endometrial cancer occurs when cells of the endometrium undergo a transformation and begin to grow and multiply without the control mechanisms that normally limit their growth. As the cells grow and multiply, they form a mass called a tumor. Cancer is dangerous because it overwhelms healthy cells by taking their space and the oxygen and nutrients they need to survive and function.


Not all tumors are cancerous; however, cancerous tumors are called malignant, meaning they can spread to other tissues and organs. Cancerous tumors may encroach on and invade neighboring organs or lymph nodes, or they may enter the bloodstream and spread to the bones or distant organs, such as the lungs. This process is called metastasis. Metastatic tumors are the most aggressive and serious of all tumors.

Two main types of endometrial cancers exist. Nearly all endometrial cancers are endometrial adenocarcinomas, meaning they originate from glandular (secreting) tissue. The other type of endometrial cancer, uterine sarcomas, originates in the connective tissue or muscle of the uterus. A subtype of endometrial adenocarcinomas, adenosquamous carcinoma, includes squamous cells (that is, the type of cells found on the surface of the skin and cervix). Other subtypes of endometrial adenocarcinomas are papillary serous adenocarcinomas and clear cell carcinomas.

Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often eliminates all of the cancer.

In developed countries, uterine cancer is the most common cancer of the female genital tract. In the United States, uterine cancer is the fourth most common cancer in women. Uterine cancer was diagnosed in about 42,160 women in the United States in 2009, and about 7,800 women died of the disease. Uterine cancer occurs in women of reproductive age and older. About one-quarter of cases occur before menopause, but the disease is most often diagnosed in women in their 50s or 60s.

Symptoms:
Signs and symptoms of endometrial cancer may include:

*Prolonged periods or bleeding between periods
*An abnormal, watery or blood-tinged discharge from your vagina
*Pain during intercourse
*Abnormal uterine bleeding, abnormal menstrual periods
*Bleeding between normal periods before menopause
*Vaginal bleeding or spotting after menopause
*Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
*Lower abdominal pain or pelvic cramping
*Thin white or clear vaginal discharge after menopause

Causes & Risk Factors:
Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to play a role. Estrogen helps stimulate the buildup of the lining of the uterus. Studies have shown that high levels of estrogen in animals result in excessive endometrial growth and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.

The following increase your risk of endometrial cancer:

•Diabetes
•Estrogen replacement therapy without the use of progesterone
•History of endometrial polyps or other benign growths of the uterine lining
•Infertility (inability to become pregnant)
•Infrequent periods
•Tamoxifen, a drug for breast cancer treatment
•Never being pregnant
•Obesity
•Polycystic ovarian syndrome (PCOS)
•Starting menstruation at an early age (before age 12)
•Starting menopause after age 50

Associated conditions include the following:
•Colon or breast cancer
•Gallbladder disease
•High blood pressure
•Polycystic ovarian disease

Complecations:
Endometrial cancer can spread to other parts of your body, making it more difficult to treat successfully. Endometrial cancer that spreads (metastasizes) most often travels to the lungs.

Diagnosis:
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.

Tests that may be done include:

•Endometrial aspiration or biopsy
•Dilation and curettage (D and C)
•Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)….

If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.

Stages of endometrial cancer:

1.The cancer is only in the uterus...….

2.The cancer is in the uterus and cervix.
3.The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
4.The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.
Cancer is also described as Grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive.

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Treatment:
Treatment options involve surgery, radiation therapy, and chemotherapy.

A hysterectomy may be performed in women with the early stage 1 disease. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.

Abdominal hysterectomy is recommended over vaginal hysterectomy. This type of hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for a biopsy.

Surgery combined with radiation therapy is often used to treat women with stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. It is also used to treat women with stage 2 disease.

Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.

Coping & Support:
After you receive a diagnosis of endometrial cancer, you may have many questions, fears and concerns. How will the diagnosis affect you, your family, your work and your future? You may worry about tests, treatments, hospital stays and medical bills. Even if a full recovery is likely, you may worry about possible recurrence of your cancer.

Fortunately, many resources are available to help answer questions and provide support. The key is to remember that you don’t have to face your questions or fears alone.  Some strategies and resources are given below that may make dealing with endometrial cancer easier:

*Know what to expect. Find out enough about your cancer so that you feel comfortable making decisions about your care. Ask your doctor for information about the stage, your treatment options and their side effects. In addition to talking with your doctor, look for information in your local library and on the Internet. Staff of the National Cancer Institute (NCI) will answer questions from the public. You can reach the NCI at 800-4-CANCER (800-422-6237). Or contact the American Cancer Society at 800-227-2345.

*Be proactive. Although you may feel tired and discouraged, try to take an active role in your treatment. Before starting treatment, you might want a second opinion from a qualified specialist. Many insurance companies will pay for such consultations.

*Maintain a strong support system. Strong relationships may help you cope with treatment. Talk with your close friends and family members about how you’re feeling. Connect with other cancer survivors through support groups in your community or online. Ask your doctor about support groups in your area

Prognosis:
Endometrial cancer is usually diagnosed at an early stage. The 1-year survival rate is about 92%.

The 5-year survival rate for endometrial cancer that has not spread is 95%. If the cancer has spread to distant organs, the 5-year survival rate drops to 23%.

Prevention:
To reduce your risk of endometrial cancer, you may wish to:

*Talk to your doctor about the risks of hormone therapy after menopause. If you’re considering hormone replacement therapy to help control menopause symptoms, talk to your doctor about the risks and benefits. Unless you’ve undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking a combination of estrogen and progestin can reduce this risk. Hormone therapy carries other risks, such as a possible increase in the risk of breast cancer, so weigh the benefits and risks with your doctor.

*Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after you stop taking oral contraceptives. Oral contraceptives have side effects, though, so discuss the benefits and risks with your doctor.

*Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight. If you need to lose weight, increase your physical activity and reduce the number of calories you eat each day.

*Exercise most days of the week. Work physical activity into your daily routine. Try to exercise 30 minutes most days of the week. If you can exercise more, that’s even better.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000910.htm
http://www.mayoclinic.com/health/endometrial-cancer/DS00306
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/womb_cancer.shtml
http://www.emedicinehealth.com/endometrial_cancer/article_em.htm
http://health.allrefer.com/health/endometrial-cancer-endometrial-cancer.html

http://mesotheliomaz.info/endometrial-cancer.html

http://www.medicalook.com/Cancer/Endometrial_carcinoma.html

http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html

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