Endometrial Cancer Treatment

Endometrial cancer is the most common gynecologic cancer in many countries. It arises from the endometrium, the tissue that lines the inside of the womb and is shed during menstruation.

Symptoms

• Bleeding after menopause, of any amount, including light spotting
• Bleeding between periods, unusually heavy periods or prolonged bleeding before menopause
• Persistent watery or blood stained discharge
• Pelvic pain or pressure, more often at a later stage

Abnormal bleeding has many causes and most of them are not cancer. The point is not to assume the worst but to have it assessed rather than waited out.

Risk Factors

Factors reported to increase risk include oestrogen therapy that is not balanced with progesterone, long term tamoxifen use, obesity, type 2 diabetes and metabolic syndrome, untreated endometrial hyperplasia, and inherited conditions such as Lynch syndrome. Early onset of periods, late menopause and never having been pregnant are also listed.

Factors reported to reduce risk include combined oral contraceptive use, pregnancy and breastfeeding, regular physical activity and weight reduction. None of these is a general recommendation on its own; each is decided with a physician.

Types and Grade

Endometrial cancers are classified by how the cells appear under the microscope. The most common type generally behaves less aggressively, while some less common types tend to progress more quickly and respond differently to treatment. Grade describes how far the cells have departed from normal tissue.

This classification is not a technicality. Together with the stage, it determines whether treatment beyond surgery is recommended and how closely follow up is scheduled, which is why the pathology report is reviewed with the patient rather than simply filed.

Diagnosis

Assessment usually begins with transvaginal ultrasound to measure the thickness and appearance of the endometrium. If the findings or the symptoms warrant it, an endometrial biopsy or hysteroscopy is performed so that tissue can be examined. The pathology result determines the type and grade, and MRI may be used to assess how deeply the disease extends.

Treatment

Surgery is the main treatment in most cases and typically involves removal of the uterus, together with the tubes and ovaries where indicated, and assessment of lymph nodes. Where the disease and the patient’s situation allow, laparoscopic and robotic surgery can be used.

Depending on the stage and the pathology, radiotherapy, chemotherapy or hormone treatment may be added after surgery. In carefully selected younger patients who wish to preserve fertility, hormonal management may be discussed, with close follow up as a condition of that choice.

Follow Up

Follow up after treatment is planned according to the stage and the pathology report. Its purpose is to detect recurrence early and to manage the effects of treatment. Any new bleeding, pain or swelling between appointments should be reported rather than saved for the next visit.

For an assessment, see the contact page. This page is general information and does not replace an examination. Decisions about your own treatment can only be made after assessment.