Endometrial Cancer

Background
Endometrial cancer is a malignancy of the lining of the inside of the uterus. It is the most common cancer of the female reproductive tract and affects about 3 % of all women during their life-times.

Risk Factors
There are two main types of endometrial cancer: one found in women in their 40 to 50's associated with excess circulating estrogen and a second found in older women not associated with estrogen. Therefore, risk factors for the first type of endometrial cancer include those conditions which increase a woman's amount of estrogen: i.e. women who have late menopause, infrequent periods, polycystic ovarian syndrome, obesity, and those women who have taken estrogen-based medications. Importantly, patients who have taken progesterone with their estrogen do not have an increased risk for endometrial cancer.

The major risk factor for the second type of endometrial cancer is a person's genetic makeup. Women of African-American descent and certain families in which cancers are prevalent, especially those with a history of nonpolyposis colon cancers, have an increased risk of endometrial cancer.

Symptoms and Diagnosis
Fortuitously, endometrial cancer often causes abnormal uterine bleeding early in its development. The bleeding leads patients to seek medical care quickly, resulting in early diagnosis of an endometrial cancer and a near 90% cure rate. However, not all uterine bleeding is caused by cancer. Noncancerous thickening of the lining, polyps, myomas or fibroids, thyroid abnormalities, and thinning tissues can all cause irregular bleeding.

Unfortunately, we do not have a good universal screening test for endometrial cancer. The Pap or Thin Prep is a test for cervical cancer, not for endometrial cancer. Pelvic sonograms and biopsies are used to evaluate patients with increased risk of endometrial. Postmenopausal women who experience bleeding usually require further evaluation. This evaluation may entail ultrasound, office biopsy of the endometrium or biopsy of the endometrium in the operating room (dilation and curettage).

Treatment Methods
The primary treatment for endometrial cancer is surgical removal of the uterus. At the time the uterus is removed, the ovaries and lymph nodes in the pelvis are also removed to determine if the cancer has spread beyond the uterus. In many cases a simple hysterectomy will cure the patient of cancer.

However, based on the extent of the cancer some women will require further treatment after surgery. This further treatment may consist of radiation, chemotherapy or a combination of chemotherapy and radiation. In some patients who cannot withstand an operation, radiation provides excellent treatment. Chemotherapy and hormonal therapy provide additional and alternative therapies for some patients. MRI and CT scans are used to determine the spread of the disease. Finally, a patient's prognosis depends upon the patient's general medical condition, the type and extent of her cancer, and the sensitivity of the cancer to estrogen and progesterone.

Research and Vision
Clinical trials are the only way new drugs and treatments can be evaluated in a systematic manner to prove or disprove improved efficacy. These trials often offer the opportunity to receive the most advanced treatment for her cancer. Patients should discuss with their doctor what clinical trials are available for them and if they might benefit from participating in one.

For more detailed explanations about the staging and treatment of endometrial cancer, please go to the National Cancer Institute website at www.nci.nih.gov/cancertopics then click on women's cancers, next click on endometrial.