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 where a fetus grows.
Types
TYPE 1 TUMOURS
- They comprise 80% of cases. They are estrogen dependent with good prognosis. Histologically they are Endometroid with well differentiated morphology.
- These include KRAS/ PTEN mutation.
TYPE 2 TUMOURS
- They comprise of 10% of cases. They are non-estrogen dependent and have worst prognosis. Histologically they are often serous papillary.
- They are often aneuploid with alteration in CDK2A, p53 and ERBB2.
Histologically endometrial cancer can be
- Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid cancer — see below).
- Uterine carcinosarcoma or CS (covered below in the grading section).
- Squamous cell carcinoma.
- Small cell carcinoma.
- Transitional carcinoma.
- Serous carcinoma.
- Clear-cell carcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and serous adenocarcinoma are less common types of endometrial adenocarcinomas. They tend to grow and spread faster than most types of endometrial cancer. They often have spread outside the uterus by the time they’re diagnosed.
Etiology
CAUSES
- Changes in balance of female hormones with excess estrogen hormone is a primary cause.
- Obesity.
- Type 2 diabtetes.
- Hypertension.
- Polycystic ovarian disease.
- Early menses.
- Never giving birth.
- Use of contraceptive pills more than 5 years.
- Hormone therapy (Tamoxifen) in breast cancer.
- Old age have risk factors.
- Inherited Colon Cancer (Lynch Syndrome) is familial cause.
SYMPTOMS
- Post-menopausal bleeding is most common symptom-that is bleeding post stoppage of periods.
- Bleeding in between period.
- Pelvic pain, pain during sex can also be a symptom.
Diagnosis
Pelvic examination is important to see cervix
Transvaginal Ultrasound- usually reveals thickened irregular endometrium with vascularity.
Hysteroscopy and Biopsy
- Using scope we can examine inside of the uterus with sos biopsy. This involves removing tissue from your uterine lining for laboratory analysis.
- Endometrial biopsy may be done in your doctor’s office and usually doesn’t require anesthesia.
D&C with Endometrial biopsy
- During D&C, tissue is scraped from the lining of your uterus and examined under a microscope for cancer cells.
- It is a daycare procedure under short general anaesthesia.
CT or MRI scan of pelvis and abdomen to assess spread of disease.
Treatment
Removal of uterus with fallopian tubes and ovary with pelvic and retroperitoneal lymph nodes is main treatment.
- This can be done by laparoscopy with advantage of very minute scar, no healing problem, early discharge (less hospital stay), minimal bleeding.
Radiotherapy
- Radiation is used either presurgery to decrease burden of tumor or after surgery to decrease chances of recurrence.
Chemotherapy
- Fortunately 60-70% do not require it, as most present in early stage.
- It is required only for node positive cancer or if tumor is spread in body.
Hormonal therapy
- It is another good option if spread beyond uterus.
Targeted Therapy and Immunotherapy
- These are also used in advanced stage.