Endometrial cancer refers to several types of malignancy which arise from the endometrium, or lining of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year in the U. S. The most common subtype, endometrioid adenocarcinoma, typically occurs within a few decades of menopause, is associated with excessive estrogen exposure, often develops in the setting of endometrial hyperplasia, and presents most often with vaginal bleeding.
Endometrial carcinoma is the third most common cause of gynecologic cancer death (behind ovarian and cervical cancer). A total abdominal hysterectomy (surgical removal of the uterus) with bilateral salpingo-oophorectomy is the most common therapeutic approach. Endometrial cancer may sometimes be referred to as uterine cancer. However, different cancers may develop not only from the endometrium itself but also from other tissues of the uterus, including cervical cancer, sarcoma of the myometrium, and trophoblastic disease.
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Classification Most endometrial cancers are carcinomas (usually adenocarcinomas), meaning that they originate from the single layer of epithelial cells which line the endometrium and form the endometrial glands. There are many microscopic subtypes of endometrial carcinoma, including the common endometrioid type, in which the cancer cells grow in patterns reminiscent of normal endometrium, and the far more aggressive uterine papillary serous carcinoma|papillary serous carcinoma and clear cell endometrial carcinomas.
Some authorities have proposed that endometrial carcinomas be classified into two pathogenetic groups: • Type I: These cancers occur most commonly in pre- and peri-menopausal women, often with a history of unopposed estrogen exposure and/or endometrial hyperplasia. They are often minimally invasive into the underlying uterine wall, are of the low-grade endometrioid type, and carry a good prognosis. • Type II: These cancers occur in older, post-menopausal women, are more common in African-Americans, are not associated with increased exposure to estrogen, and carry a poorer prognosis.
They include: • the high-grade endometrioid cancer, • the uterine papillary serous carcinoma, • the uterine clear cell carcinoma. In contrast to endometrial carcinomas, the uncommon endometrial stromal sarcomas are cancers which originate in the non-glandular connective tissue of the endometrium. Uterine carcinosarcoma, formerly called Malignant mixed mullerian tumor, is a rare uterine cancer which contains cancerous cells of both glandular and sarcomatous appearance – in this case, the cell of origin is unknown.
Signs & Symptoms Vaginal bleeding and/or spotting in postmenopausal women • Abnormal uterine bleeding, abnormal menstrual periods • Bleeding between normal periods in premenopausal women in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes)
Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with radiation therapy. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease. hormonal therapy with progestins and antiestrogens has been used for the treatment of endometrial stromal sarcomas. The antibody Herceptin, which is used to treat breast cancers that overexpress the HER2/neu protein, has been tried with some success in a phase II trial in women with uterine papillary serous carcinomas that overexpress HER2/neu.
Radiation therapy for endometrial cancer Radiation therapy is the use of high-dose X-rays to destroy cancer cells. Radiation therapy may be used to treat endometrial cancer after hysterectomy or as the primary therapy, particularly for women who cannot have surgery. The two types of radiation therapy that may be used to treat endometrial cancer are: • Internal radiation therapy (brachytherapy), in which radioactive materials (radioisotopes) are placed into the uterus or other areas where the cancer cells are found. External beam radiation therapy, in which radiation comes from a machine outside the body. In brachytherapy, tiny tubes of radioactive material are inserted through the vagina and left in the uterus for 2 to 3 days.
Brachytherapy may be done in the hospital or as on an outpatient basis. External beam radiation therapy is usually done in an outpatient treatment center. A typical therapy course is radiation treatments 5 days a week for 4 to 6 weeks. Radiation therapy may cause side effects, including: • Fatigue. • Dryness, itching, tightening, and burning in the vagina. Red, dry, tender, itchy skin. • Moist, weepy skin (later in the treatment). • Hair loss in the treated area. • Loss of appetite. • Diarrhea. • Frequent and uncomfortable urination.
If surgery is not recommended, radiation therapy alone may be used. Radiation therapy may also be used if more extensive cancer is discovered during surgery. • Stage IV: Radiation therapy may be used if the cancer is contained in the pelvic region but is usually not recommended if the cancer has spread (metastasized) to other parts of the body. Endometrial cancer may recur. Radiation therapy may be used to control symptoms and increase comfort. Radiation therapy may cure your cancer if the cancer is confined to your vagina and radiation therapy has not been used before.