Download Endometrial Cancer

Endometrial Cancer
Endometrial cancer is a disease in which malignant (cancer) cells form in the tissues of the
endometrium.
The endometrium is the lining of the uterus, a hollow, muscular organ in a woman's pelvis.
The uterus is where a fetus grows. In most nonpregnant women, the uterus is about 3
inches long. The lower, narrow end of the uterus is the cervix, which leads to the vagina.
Cancer of the endometrium is different from cancer of the muscle of the uterus, which is
called sarcoma of the uterus.
Risk Factors
Taking tamoxifen for breast cancer or taking estrogen alone (without progesterone) can
affect the risk of developing endometrial cancer.
Endometrial cancer may develop in breast cancer patients who have been treated with
tamoxifen. A patient taking this drug should have a pelvic exam every year and report any
vaginal bleeding (other than menstrual bleeding) as soon as possible. Women taking
estrogen (a hormone that can affect the growth of some cancers) alone have an increased
risk of developing endometrial cancer. Taking estrogen in combination with progesterone
(another hormone) does not increase a woman's risk of this cancer.
Symptoms
Possible signs of endometrial cancer include unusual vaginal discharge or pain in the pelvis.
These and other symptoms may be caused by endometrial cancer. Other conditions may
cause the same symptoms. A doctor should be consulted if any of the following problems
occur:
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Bleeding or discharge not related to menstruation (periods).
Difficult or painful urination.
Pain during sexual intercourse.
Pain in the pelvic area.
Detection and Diagnosis
Tests that examine the endometrium are used to detect (find) and diagnose endometrial
cancer.
Because endometrial cancer begins inside the uterus, it does not usually show up in the
results of a Pap test. For this reason, a sample of endometrial tissue must be removed and
examined under a microscope to look for cancer cells. One of the following procedures may
be used:
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Endometrial biopsy. The removal of tissue from the endometrium (inner lining of
the uterus) by inserting a thin, flexible tube through the cervix and into the uterus.
The tube is used to gently scrape a small amount of tissue from the endometrium
and then remove the tissue samples. A pathologist views the tissue under a
microscope to look for cancer cells.
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Dilatation and curettage. A surgical procedure to remove samples of tissue or the
inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped
instrument) is inserted into the uterus to remove tissue. Tissue samples may be
taken for biopsy. This procedure also is called a D&C.
Prognosis (Chance of Recovery)
Certain factors affect prognosis and treatment options.
The prognosis and treatment options depend on the following:
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The stage of the cancer (whether it is in the endometrium only, involves the whole
uterus, or has spread to other places in the body).
How the cancer cells look under a microscope.
Whether the cancer cells are affected by progesterone.
Endometrial cancer is highly curable.
Stages of Endometrial Cancer
After endometrial cancer has been diagnosed, tests are done to find out if cancer cells have
spread within the uterus or to other parts of the body.
The process used to find out whether the cancer has spread within the uterus or to other
parts of the body is called staging. The information gathered from the staging process
determines the stage of the disease. It is important to know the stage in order to plan
treatment. Certain tests and procedures are used in the staging process. A hysterectomy
(an operation in which the uterus is removed) will usually be done to help find out how far
the cancer has spread.
The following stages are used for endometrial cancer:
Stage I
In stage I, cancer is found in the uterus only. Stage I is divided into stages IA, IB and IC,
based on how far the cancer has spread.
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Stage IA: Cancer is in the endometrium only.
Stage IB: Cancer has spread into the inner half of the myometrium (muscle layer of
the uterus).
Stage IC: Cancer has spread into the outer half of the myometrium.
Stage II
In stage II, cancer has spread from the uterus to the cervix, but has not spread outside the
uterus. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread
into the cervix.
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Stage IIA: Cancer has spread to the glands where the cervix and uterus meet.
Stage IIB: Cancer has spread into the connective tissue of the cervix.
Stage III
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond
the pelvis. Stage III is divided into stages IIIA, IIIB and IIIC, based on how far the cancer
has spread within the pelvis.
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Stage
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Stage
Stage
IIIA: Cancer has spread to one or more of the following:
The outermost layer of the uterus; or
Tissue just beyond the uterus; or
The peritoneum.
IIIB: Cancer has spread beyond the uterus and cervix, into the vagina.
IIIC: Cancer has spread to lymph nodes near the uterus.
Stage IV
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and
IVB, based on how far the cancer has spread.
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Stage IVA: Cancer has spread to the bladder and/or bowel wall.
Stage IVB: Cancer has spread to other parts of the body beyond the pelvis,
including lymph nodes in the abdomen and/or groin.
Recurrent Endometrial Cancer
Recurrent endometrial cancer is cancer that has recurred (come back) after it has been
treated. The cancer may come back in the pelvis, in lymph nodes in the abdomen or in
other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with endometrial cancer.
Different types of treatment are available for patients with endometrial cancer. Some
treatments are standard (the currently used treatment), and some are being tested in
clinical trials. Before starting treatment, patients may want to think about taking part in a
clinical trial. A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer. When clinical
trials show that a new treatment is better than the standard treatment, the new treatment
may become the standard treatment.
Clinical trials are taking place in many parts of the country. Choosing the most appropriate
cancer treatment is a decision that ideally involves the patient, family and health care team.
Four types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is the most common treatment for
endometrial cancer. The following surgical procedures may be used:
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Total hysterectomy. A surgical procedure to remove the uterus, including the
cervix. If the uterus and cervix are taken out through the vagina, the operation is
called a vaginal hysterectomy. If the uterus and cervix are taken out through a large
incision (cut) in the abdomen, the operation is called a total abdominal
hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in
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the abdomen using a laparoscope, the operation is called a total laparoscopic
hysterectomy.
Bilateral salpingo-oophorectomy. A surgical procedure to remove both ovaries
and both fallopian tubes.
Radical hysterectomy. A surgical procedure to remove the uterus, cervix and part
of the vagina. The ovaries, fallopian tubes or nearby lymph nodes also may be
removed.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some
patients may be given radiation therapy or hormone treatment after surgery to kill any
cancer cells that are left. Treatment given after the surgery, to increase the chances of a
cure, is called adjuvant therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells,
either by killing the cells or by stopping the cells from dividing. When chemotherapy is
taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can
reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is
placed directly into the spinal column, an organ or a body cavity such as the abdomen, the
drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the
chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation Therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of
radiation to kill cancer cells. There are two types of radiation therapy. External radiation
therapy uses a machine outside the body to send radiation toward the cancer. Internal
radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters
that are placed directly into or near the cancer. The way the radiation therapy is given
depends on the type and stage of the cancer being treated.
Hormone Therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and
stops cancer cells from growing. Hormones are substances produced by glands in the body
and circulated in the bloodstream. The presence of some hormones can cause certain
cancers to grow. If tests show that the cancer cells have places where hormones can attach
(receptors), drugs, surgery or radiation therapy are used to reduce the production of
hormones or block them from working.
New types of treatment are being tested in clinical trials.
Treatment Options by Stage
Stage I Endometrial Cancer
Treatment of stage I endometrial cancer may include the following:
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Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy). Lymph
nodes in the pelvis and abdomen may also be removed for examination under a
microscope to check for cancer cells.
Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or
without removal of lymph nodes in the pelvis and abdomen) followed by internal
radiation therapy or external radiation therapy to the pelvis. After surgery, a plastic
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cylinder containing a source of radiation may be placed in the vagina to kill any
remaining cancer cells.
Radiation therapy alone for patients who cannot have surgery.
Clinical trials of radiation therapy and/or chemotherapy.
This article section refers to specific treatments under study in clinical trials, but it may not
mention every new treatment being studied.
Stage II Endometrial Cancer
Treatment of stage IIA endometrial cancer is usually a combination of therapies, including
internal and external radiation therapy and surgery.
Stage IIA
Treatment of stage IIA endometrial cancer may include the following:
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Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy). Lymph
nodes in the pelvis and abdomen may also be removed for examination under a
microscope to check for cancer cells.
Surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or
without removal of lymph nodes in the pelvis and abdomen) followed by internal
radiation therapy or external radiation therapy to the pelvis. After surgery, a plastic
cylinder containing a source of radiation may be placed in the vagina to kill any
remaining cancer cells.
Radiation therapy alone for patients who cannot have surgery.
Clinical trials of radiation therapy and/or chemotherapy.
This article section refers to specific treatments under study in clinical trials, but it may not
mention every new treatment being studied.
Stage IIB
Treatment of stage IIB endometrial cancer may include the following:
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Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy, and
removal of lymph nodes in the pelvis and abdomen for examination under a
microscope to check for cancer cells) followed by radiation therapy.
Internal radiation therapy and external radiation therapy, followed by surgery
(hysterectomy and bilateral salpingo-oophorectomy, and removal of lymph nodes in
the pelvis and abdomen for examination under a microscope to check for cancer
cells).
Surgery (radical hysterectomy with or without removal of lymph nodes in the pelvis
for examination under a microscope to check for cancer cells).
Stage III Endometrial Cancer
Treatment of stage III endometrial cancer may include the following:
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Surgery (radical hysterectomy and removal of lymph nodes in the pelvis for
examination under a microscope to check for cancer cells) followed by internal
radiation therapy and external radiation therapy.
Radiation therapy alone for patients who cannot have surgery.
Hormone therapy for patients who cannot have surgery or radiation therapy.
Clinical trials of chemotherapy.
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Clinical trials of new therapies.
Stage IV Endometrial Cancer
Treatment of stage IV endometrial cancer may include the following:
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Internal radiation therapy and external radiation therapy.
Hormone therapy.
Clinical trials of chemotherapy.
This article section refers to specific treatments under study in clinical trials, but it may not
mention every new treatment being studied.
Treatment Options for Recurrent Endometrial Cancer
Treatment of recurrent endometrial cancer may include the following:
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Radiation therapy as palliative therapy to relieve symptoms and improve the
patient's quality of life.
Hormone therapy.
Clinical trials of chemotherapy.
This article section refers to specific treatments under study in clinical trials, but it may not
mention every new treatment being studied.
Additional Resource
National Cancer Institute Resources
Cancer Information Service
1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
Internet: www.cancer.gov
LiveHelp, NCI's live online assistance:
https://cissecure.nci.nih.gov/livehelp/welcome.asp
Source: National Cancer Institute, National Institutes of Health
Updated: February 21, 2006