The Truth About Endometrial Cancer

Endometrial cancer begins in the lining of the uterus and is the most common type of cancer affecting the female reproductive system. One of its earliest warning signs is abnormal vaginal bleeding, which allows for early detection and treatment. 

When diagnosed in its initial stages, surgical removal of the uterus often provides a high chance of cure. Let’s explore endometrial cancer in more detail.

Warning Signs of Endometrial Cancer

• Abnormal vaginal bleeding (especially after menopause)
• Unusually heavy or prolonged menstrual periods
• Bleeding between periods
• Watery or blood-tinged vaginal discharge
• Pelvic pain or discomfort
• Pain during intercourse
• Unexplained weight loss
• Feeling a lump in the lower abdomen
• Difficulty urinating or changes in bowel habits (in advanced cases)

What Causes Endometrial Cancer?

Endometrial cancer occurs when genetic mutations develop in the cells of the uterus lining, causing uncontrolled growth. Over time, these abnormal cells form tumors that can spread to nearby tissues and spread to other body parts. While the exact triggers for these mutations are not always clear, several key factors contribute to the development of endometrial cancer.

Hormonal Imbalance and Its Role

An imbalance between estrogen and progesterone is one of the most high risk factors for endometrial cancer. Estrogen promotes the growth of the endometrial lining, while progesterone helps regulate and shed it. 

When estrogen levels remain high without enough progesterone to counteract its effects, the endometrium can thicken excessively, increasing the likelihood of abnormal cell growth. This imbalance may result from conditions such as polycystic ovary syndrome (PCOS), obesity, or estrogen-only hormone replacement therapy (HRT). 

Women who experience early menstruation (before age 12) or late menopause (after age 55) also have prolonged estrogen exposure, increasing their risk.

Obesity and Insulin Resistance

Excess fat tissue produces estrogen, leading to an overstimulated endometrial lining. This effect is especially significant after menopause, when the ovaries stop producing estrogen, and fat cells become the primary source of the hormone. 

Additionally, insulin resistance—common in obesity and type 2 diabetes—can promote cell growth in the endometrium, raising the risk. The combination of high estrogen levels and metabolic changes explains why postmenopausal women with obesity are at a higher risk of endometrial cancer.

Genetic and Family History Factors

Some cases of endometrial cancer are linked to inherited genetic conditions. Lynch syndrome, a disorder caused by mutations in DNA repair genes, significantly increases the risk of endometrial and colorectal cancer. Women with a family history of endometrial cancer or known genetic mutations should consider genetic counseling and regular screenings.

Hormone-Influencing Medications

Certain medications affect estrogen levels and may contribute to endometrial cancer risk. Estrogen-only HRT, used to treat menopause symptoms, increases risk if not combined with progesterone. Women using these medications should be monitored for any unusual vaginal bleeding or other symptoms.

How Endometrial Cancer is Diagnosed

Medical History and Physical Examination

A doctor will discuss symptoms, including abnormal bleeding, pain, or other concerns. Risk factors such as obesity, hormone therapy, diabetes, and family history of cancer will also be assessed. A pelvic exam is done to check for the abnormalities in the uterus or surrounding tissues.

Transvaginal Ultrasound (TVUS)

A transvaginal ultrasound is often the first imaging test used to examine the uterus. A small probe inserted into the vagina creates detailed images using sound waves, allowing doctors to measure endometrial thickness and detect abnormalities. If the lining appears unusually thick or irregular, further testing is necessary.

Endometrial Biopsy

An endometrial biopsy is a major step in diagnosing endometrial cancer. A slender tube is inserted inside the uterus through the cervix to remove a small sample of tissue. This procedure is done in a doctor's office and helps determine if cancerous cells are present.

Hysteroscopy with Biopsy or Dilation and Curettage (D&C)

If a standard biopsy does not provide enough information, a hysteroscopy may be performed. This procedure involves inserting a thin, lighted camera through the cervix to examine the inside of the uterus and take targeted tissue samples. When a larger sample is needed, a D&C is performed, scraping tissue from the uterus for further examination. This procedure is done under anesthesia in a hospital or outpatient setting.

Imaging Tests for Staging and Spread

• Pelvic and Abdominal CT Scan – Provides a detailed view of the uterus and surrounding organs
• MRI (Magnetic Resonance Imaging) – Assesses the depth of tumor invasion into the uterine wall
• PET Scan (Positron Emission Tomography) – Detects abnormal cell activity in other parts of the body
• Chest X-ray – Checks for potential spread to the lungs
  

Blood Tests

• CA-125 Blood Test – This marker may be elevated in advanced cases
• Complete Blood Count (CBC) – Helps check for anemia caused by prolonged abnormal bleeding

Genetic Testing for High-Risk Individuals

If a strong family history of cancer is present, genetic testing may be recommended. Conditions like Lynch syndrome significantly increase the risk of endometrial and other cancers. Identifying a genetic predisposition allows for earlier screening and prevention strategies.

How Endometrial Cancer is Treated

Surgical Treatment

The standard surgical approach involves a hysterectomy, which is the removal of the uterus. This procedure often includes a bilateral salpingo-oophorectomy, removing both fallopian tubes and ovaries. It's important to note that a hysterectomy eliminates the possibility of future pregnancies and induces menopause if the patient hasn't undergone it already. 

During surgery, the surgeon examines surrounding tissues for signs of cancer spread and may remove pelvic lymph nodes and para-aortic lymph nodes for further analysis to accurately stage the cancer.

Radiation Therapy

Radiation therapy uses high-energy beams to target & kill cancer cells. It can be administered externally or internally, which is called brachytherapy. In some instances, radiation therapy is recommended before surgery to shrink tumors, making them easier to remove. 

For patients who are not candidates for surgery due to health concerns, radiation therapy may serve as the primary treatment.

Chemotherapy

Chemotherapy uses drugs to wreck cancer cells and is typically used when endometrial cancer has spread beyond the uterus or if there's a significant risk of recurrence. This treatment can be done either orally or intravenously & often involves a combination of medications over a set period.

Hormone Therapy

Hormone therapy aims to block hormones that fuel certain types of endometrial cancer. This approach is generally reserved for advanced or recurrent cancers, particularly hormone-receptor-positive ones. 

Medications may be used to lower hormone levels or prevent hormones from acting on cancer cells.

Targeted Therapy

Targeted therapy focuses on particular abnormalities within the cancer cells. By targeting these unique aspects, the therapy can more precisely inhibit cancer growth. This treatment is often considered for advanced cancers or when traditional therapies are ineffective.

How to Lower the Risk of Endometrial Cancer

1. Maintain a Healthy Weight

Excess body fat increases estrogen, which can overstimulate the endometrial lining and raise cancer risk. Maintaining a balanced diet & regular physical activity can help regulate hormone levels & support overall health.

2. Stay Physically Active

Regular exercise helps manage weight, lower estrogen levels, and improve insulin sensitivity. Studies have suggest that physically active individuals have a lower risk of developing endometrial cancer.

3. Manage Hormone Levels

• Use of Combination Hormone Therapy – If undergoing hormone replacement therapy (HRT) for menopause, using a combination of estrogen and progesterone instead of estrogen alone can help protect the uterus.
• Birth Control Pills – Long-term use of oral contraceptives has been linked to reduce the risk of endometrial cancer by regulating hormone levels. However, this option should be discussed with a healthcare provider.

4. Monitor and Treat Underlying Health Conditions

Certain medical conditions, namely polycystic ovary syndrome or PCOS, diabetes, and high blood pressure, are linked to higher endometrial cancer risk. Managing these conditions through lifestyle changes & medications can help reduce the likelihood of developing cancer.

5. Be Aware of Family History and Genetic Risks

A family history of endometrial or colorectal cancer, mainly due to Lynch syndrome, increases the risk of developing the disease. Genetic testing and regular screenings can help detect cancer early or guide preventive measures.

6. Avoid Smoking and Excess Alcohol Consumption

Smoking is linked to various cancers, and while its direct role in endometrial cancer is unclear, avoiding tobacco improves overall health and reduces the risk of other complications. Limiting alcohol intake can also help maintain a balanced hormonal environment.

Sterling Hospital is Your Partner in Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to a healthier and brighter life. We've got you if you are looking for the best oncologist in ​​Ahmedabad (Gurukul) & (Sindhu Bhavan), cancer hospital in Vadodara (Bhayli & Race Course Road), or Rajkot. With considerable years of experience, we have built a team of the best oncologists in these regions to provide you with premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier future.