Endometrial cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a cancer that develops in the lining of the uterus, also known as the endometrium. The uterus is a pear-shaped organ of the female reproductive system where fetal growth and development occurs.
The uterus is made up of three layers: the endometrium, myometrium, and perimetrium (mucus layer protecting the uterus). The endometrium is the inner lining of the uterus, and is the layer that grows thick and sheds when fertilisation does not occur. This occurs monthly in a process known as menstruation. Cancers that develop in the endometrium are much more common, and are called endometrial cancers.
The myometrium is the muscular, middle layer that makes up most of the uterus. It is responsible for holding the structure of the uterus, expanding to enable fetal growth, and inducing uterine contractions during childbirth. Cancers of the myometrium, also known as uterine sarcomas, are considered to be very rare. For more information on uterine sarcomas, please refer to the Rare Cancers Australia Uterine Sarcoma page.
Endometrial cancers are generally diagnosed in women over 50, however, it can affect almost anyone with a uterus – including women, teenagers, transgender men, non-binary individuals, and intersex people – at any age.
Types of Endometrial Cancer
There are several types of endometrial cancers, which can be classified by their cellular appearance under the microscope, and whether the tumoura tissue mass that forms from groups of unhealthy cells is linked to excess production of the hormonea chemical substance produced by glands in the endocrine system that regulates various functions in the body oestrogen.
Type 1 Endometrial Cancers
Type one endometrial cancers are the most common type, and are linked to excess oestrogen production in the body. Oestrogen is one of the main female sex hormones that is responsible for puberty, menstruation, pregnancy, bone strength, and other functions. Excess oestrogen production can cause a variety of health problems; however, type one endometrial cancers rarely metastasise and are often slow growing.
Most type one endometrial cancers are adenocarcinomas (cancers arising from mucus-producing glands in organs), and are often referred to as endometrial adenocarcinomas.
Endometrioid Adenocarcinomas
Endometrioid adenocarcinomas are the most common subtype of endometrial cancers. These cancers are often diagnosed early, and often have a good prognosisto predict how a disease/condition may progress and what the outcome might be. The different types of endometrioid adenocarcinomacancer arising from mucus-producing glands in organs includes:
- Adenocarcinoma with squamous differentiation.
- Adenoacanthoma.
- Adenosquamous carcinomacancer arising from tissues that line organs (also known as mixed cell endometrioid adenocarcinomas).
- Ciliated carcinomas.
- Secretory carcinoma.
- Villoglandular adenocarcinoma.
Type 2 Endometrial Cancers
Type two endometrial cancers are a rare type that is not linked to oestrogen production. These cancers are more likely to metastasise, and may not have as good of a prognosis as type one endometrial cancers.
There are several subtypes of type two endometrial cancers, including:
- Clear cell carcinoma.
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells III endometrioid cancer.
- Papillary serous carcinoma.
- Undifferentiated carcinoma.
- Uterine carcinosarcomas (also known as malignantcancerous, may grow and spread to other areas of the body mixed Müllerian tumours).
Mesonephric Adenocarcinomas
Mesonephric adenocarcinomas are a very rare subtype of endometrial cancers. These types of tumours have a variety of growth patterns, and are often misdiagnosed as other endometrial cancer subtypes. Because of how rare these tumours are, it is unclear whether they are linked to oestrogen, and therefore whether or not it would be classified as a type one or type two endometrial cancer.
Mesonephric adenocarcinomas are often aggressive, and may not have as good of a prognosis as other types of endometrial cancer.
Treatment
If endometrial cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cellsthe basic structural and functional unit of all living things look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0 – IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and has not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also classified as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade I cancers. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate course of treatment for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for endometrial cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Hysterectomycomplete or partial removal of the uterus.
- Bilateral salpingo-oophorectomyremoval of both ovaries and fallopian tubes.
- Trachelectomycomplete or partial removal of the cervix.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Hormone therapymedication that alters the levels of certain hormones in the body, such as oestrogen and progesterone.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Endometrial Cancer Treatment and Fertility
Treatment for endometrial cancer may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
The biggest riskthe possibility that something bad will happen factor for endometrial cancer is age. Women over 50 and post-menopausal women are the most at risk.
Other risk factors include:
- Being overweight/obese.
- Family history of uterine, ovarian or bowelportion of the digestive system that digests food (small bowel) and absorbs salts and water (large bowel); also called intestines cancers.
- Never having been pregnant.
- Any medical condition that changes the balance of female hormones.
- Longer period of menstruation (having a period before 12 or menstruation after the age of 55).
- Certain types of hormone replacement therapymedication that increase the levels of certain hormones in the body.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
The most common symptom of endometrial cancer is unusual vaginal bleeding. This may include:
- Changes in your period.
- Heavier periods.
- Bleeding in between periods.
- Constant bleeding.
- Bleeding after menopause.
Some less common symptoms include:
- Smelly or watery vaginal discharge.
- Abdominal/pelvic pain.
- Unexplained weight loss.
- Changes in bowel habits.
- Painful sex and urination.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have an endometrial cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Pelvic examinationa physical exam of the external and internal female pelvic organs.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- Pelvic ultrasounda type of medical imaging that uses sound waves to create detailed images of the organs and structures within the pelvis, including the uterus, ovaries, and surrounding tissues.
- Transvaginal ultrasounda type of pelvic ultrasound that involves inserting a device (known as a transducer) into the vagina to produce sound waves and create images of internal female reproductive organs in greater detail.
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Hysteroscopyexamination of the uterus with a small, flexible instrument known as a hysteroscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells, potentially including:
- Endometrial (pipelle) biopsya procedure that involves inserting a long, thin plastic tube (pipelle) into the vagina and through the cervix to gently extract a sample of tissue from the uterus for testing.
- Dilation and curettagea minor surgical procedure that involves dilating the cervix and scraping out uterine tissue with a small, sharp instrument (curette) (D&C).
