Endometrial cancer

Cancer of the endometrium has increased in incidence, partly because people are living longer than before and reporting such cases more accurately. The word endometrium generally means the uterine endometrium which is the fundus or the corpus of the uterus. About 32,000 cases are reported every year with 5900 deaths. After breast, colorectal, and lung cancer, endometrial cancer is the fourth most common cancer in women and the most common pelvic neoplasm. Awareness about endometrial cancer is very less which is the reason for endometrial cancer to be in the fourth place. Hence, all women should be encouraged to have annual check ups, including the gynecological examination.

History plays an important role in diagnosing endometrial cancer. One third of the women with post menopausal bleeding have cancer of the uterus, mainly endometrial. Obese women have slightly higher risk of endometrial cancer because of the increased levels of estrone related to excess weight. To explain in detail, there is conversion of androstenedione to estrone in body fat, which exposes the uterus to unopposed estrogen. Obese women should be taken extra care by the medical professionals to evaluate the risk of having cancer of the endometrium.

Women who are on hormone replacement therapy (HRT) are at the potential risk of having endometrial cancer. Unopposed estrogen administered in HRT is the reason for putting the women on HRT at risk. Currently, progesterone is added to the HRT regimen to offset this risk. Hence, a good history and a proper physical examination plays a vital role in diagnosing endometrial cancer.

Investigations like endometrial aspiration and biopsy confirms the presence of endometrial cancer. The median age of having cancer of endometrium is 61, and most women are at least 55 when they are diagnosed with endometrial cancer. Women over 50 years with any potential risks (post menopausal bleeding, on HRT, obesity) are encouraged to undergo endometrial biopsy. Women who are on HRT without progesterone should undergo regular endometrial aspiration or biopsy to rule out hyperplasia, which is a precursor of endometrial cancer.Other factors that put the women at risk are nulliparity (those women with no children) and late menopause (who attain menopause after the age of 52).

Ultrasound is a painless way of measuring the thickness of the endometrium that will give an idea about the changes that has occured in the same. However, ultrasonography does not confirm the presence of endometrial cancer. Endometrial smears (aspiration) and biopsy are the direct ways of diagnosis of cancer of the endometrium. A tissue sample from the endometrium is obtained and analysed. It is a common out patient procedure performed during the gynecological pelvic examination.

Treatment is based on the stage of the cancer but its always total abdominal hysterectomy with bilateral salpingo oopherectomy (removal of uterus and the uterine tubes) which is suggested. External radiation and brachy therapy are suggested for those with risk of recurrence. Recurrent cancer usually occurs in the vagina. These lesions are treated with surgery and radiation, and in some cases with HRT and chemotherapy.

Early diagnosis with endometrial smears and biopsy once a year helps women to identify the cancer of the endometrium and treat them effectively without leaving any complications. Hence, an annual gynecological examination is a must for every woman.