If you are a newly diagnosed patient, first, know that you are not alone and you are in the right place! Endometrial cancer may sound daunting, and if you are recently diagnosed or going through your first year of diagnosis, surgery, and treatment, you may wish you never had to learn more about it. We understand the initial fear all too well, so be reassured that endometrial cancer is a potentially curable disease, especially when diagnosed early and properly managed. You may have heard the phrase, “If you’re going to have a cancer, this is at least a good one to have!” As founder of the ECF, I can thankfully say I was given these words of hope by my oncologist during my first tearful visit, which helped ease me into the process. We believe that phrase applies here to provide a little hope, that if caught early, you could be on your way to a potential cure. Knowing what procedures are involved in diagnosing the type, stage and grade of this cancer and having an idea about the treatment, will empower you as a patient, loved one or caregiver. 

In developed nations, endometrial cancer is the most frequent gynecological malignancy, and the disease burden is anticipated to rise over time.1  In the US alone in 2022, there is expected to be almost 66,000 cases diagnosed this year, and at the Endometrial Cancer Foundation we predict that number to be as high as 68,000 in the US and more than 420,000 based on initial data analysis we have conducted in comparison with previously reported numbers from 2020 from the World Cancer Research Fund. And yet, even though cases are going up, chances are you may not have ever even heard of it until now. 

Endometrial cancer can’t be self-diagnosed. If you have a set of signs and symptoms, like the ones listed below, and have done proper diagnostic tests, your doctor (gynecologist – OBGYN) may be able to determine if you have endometrial cancer, but only pathology (a study of your cells) can make a proper diagnosis. But many times, the disease is misdiagnosed or overlooked for up to two years, because many times there is very little pain involved. We are so good, especially in Western cultures, to ignore warning signs. And in slow moving or socialized medical systems, it can take months to get an appointment with primary care physicians or OBGYNs when symptoms do occur. We have many stones to uncover here at the ECF…

For now, here’s a bit more insight into what kind of disease endometrial cancer is:

What is Endometrial Cancer?

Endometrial cancer is a type of cancer in which the cells lining the endometrium (uterus) start to grow and increase without control.2 This abnormal growth may stay confined to the uterus or spread (metastasize) to other body parts. Keep in mind the uterus (womb, child-bearing organ) has three layers – perimetrium, myometrium, and endometrium. The endometrium is the innermost layer of the three and comprises epithelial cells.

2 Types of Endometrial Cancers

Endometrial cancer or carcinomas can be divided into various types depending on the appearance of the cells under the microscope.3 The various histological types are as follows:

  • Adenocarcinoma
  • Uterine carcinosarcoma
  • Squamous cell carcinoma
  • Transitional carcinoma
  • Serous carcinoma

Signs and Symptoms

Patients with endometrial cancer normally start to notice the following signs and symptoms4:

  • Bleeding from your vagina after menopause
  • Strange pain in the pelvic region
  • Pain during sexual intercourse
  • Vaginal bleeding that is not related to the menstrual cycle
  • Vaginal discharge that is not related to the menstrual cycle
  • Painful urination/micturition (painful reflex when you are voiding your bladder)
  • Other potential associated risk factors:
    • Overweight
    • Prior gynecological surgeries
    • HRT replacement use
    • Prior history of thecoma type tumor
    • Prior history of infertility
    • Women over 60 (average age of diagnosis)
    • Incidence rates, according to the American Cancer Society, are on the rise for American Indian, Alaska Native and non-Hispanic black women, followed by non-Hispanic white women, Hispanic women, and Asian women

If you notice any of these signs and symptoms, don’t assume you have endometrial cancer unless you have consulted a gynecologist. But don’t delay, a gynecologist will thoroughly examine you to check for any abnormality, such as a polyp, and may suggest that the polyp be removed from your uterus and sent for testing in an easy outpatient procedure. If he/she suspects any abnormal growth, then he/she may refer you to a gynecologic oncologist (GYN/ONC). The oncologist will do further sampling to determine if you have endometrial cancer.

Stages of Diagnosis

After you tell the doctor your signs and symptoms, the doctor will take a detailed history regarding the disease from you. This includes medical and surgical history, medication use, and details regarding the onset and progression of the signs and symptoms.

After the history, the doctor will examine you under the following means5:

Ultrasound
This is the first test done to look at all the reproductive organs. The probe sends sound waves and picks up the echoes to make an image of the internal framework of the endometrium. Ultrasound can be used to make an image of the endometrium, measure its size and determine what area they are going to take for biopsy. Ultrasound may be pelvic or transvaginal. For pelvic ultrasound, the transducer is kept on the lower belly; for transvaginal, a probe is introduced into the vagina. Any abnormal thickening of the endometrium or polyps indicates endometrial cancer.

Endometrial Biopsy
In this procedure, a small amount of endometrium is excised through a suction tube inserted into the uterus. It is an accurate test for postmenopausal women. Your doctor may use a small needle to numb an area before taking the sample. The pain after the biopsy is much like cramps.

Hysteroscopy
This involves using a tiny microscope to view the inside of the uterus. The doctor examines the lining and looks for any abnormality.

Dilation and curettage (D&C)
This outpatient procedure is done under general anesthesia, in which a uterus scraping is taken after dilating the cervix.

Testing the Samples

The endometrial sample procured from the above procedures is examined under a microscope. If present, cancer is graded according to the degree of resemblance with normal uterine cells. The less the resemblance, the higher the grade of cancer is and the more likely for cancer to spread to other body parts. 

Endometrial cancer may be grouped as follows:

Low-risk endometrial cancer
Grades 1 and 2 tumors which usually do not spread to other body parts are called low-risk.

High-risk endometrial cancer
Grade 3 tumors that often spread to other body parts are called high risk. This grade includes uterine papillary serous, clear cell, and carcinosarcoma.

You should also know that endometrial cancer may recur in some cases after treatment. It may come back in the uterus, the pelvis, abdominal lymph nodes, or other body parts.

The degree of spreading of cancer to other body parts is represented by staging. Stage 1 is the lowest, and Stage 4 is the highest (meaning the widest spread). Chest-Ray, CT scan, and MRI are common tests performed to check for the spread of cancer.

Other Tests

The doctor may perform blood tests to detect anemia and CA-125 cancer marker. A very high blood level of CA-125 in an endometrial cancer patient suggests that the cancer is beyond the uterus.6 If a woman has endometrial cancer, a very high blood CA-125 level suggests that cancer has likely spread beyond the uterus.

Survival Rates

Once diagnosed early, endometrial cancer can have a good prognosis and treatment outcomes. This can be justified by looking at the 5-year relative survival rates, which show that women with regional to localized endometrial cancer had 70-95% survival rates from 2011-2017.7 However, as treatment strategies improve, endometrial cancer is better managed and treated.

Treatment

Every stage, grade, and the patient has a different treatment procedure according to specifications. Broadly the treatment involves five different options, including8:

Surgery
Surgery involves the removal of the complete uterus (Total Hysterectomy) or the removal of uterus along with ovaries and fallopian tubes (Total Hysterectomy with Bilateral Salpingo-oophorectomy) or along with the removal of lymph nodes (Radical Hysterectomy).

Radiation Therapy
Radiotherapy involves using high-energy X-rays from the outside or from radioactive substances placed inside or near the uterus to kill the cancer cells.

Chemotherapy
Chemotherapy is the use of drugs to kill or stop the growth of cancer cells. The drugs may be given orally or through veins, the methods depending on the stage and type of cancer being eliminated.

Hormone Therapy
In this therapy, tests are performed to determine if cancer cells have receptors where hormones can attach. If so, drugs or radiation are used to block the production of hormones and their attachment so the growth of cancer cells can be stopped.

Targeted Therapy
As the name indicates, this therapy targets a specific cancer cell type minimizing the damage to other normal cells compared to chemotherapy or radiotherapy.

It is essential to get follow-ups done after successful treatment of endometrial cancer because there are some chances that it may recur. But overall, if diagnosed early, treatment options do a good job curtailing the disease and improving the quality of life. With more advanced research being conducted and with new technology, the prognosis of endometrial cancer is improving by the day.
This broad overview was meant for you, as a newly diagnosed patient or your spouse or caregiver. We will go more into depth about treatment options in other blog posts coming soon.

References:

  1. Morice P, Leary A, Creutzberg C, et al. Endometrial cancer. Lancet 2016;387:1094–108. https://pubmed.ncbi.nlm.nih.gov/26354523/
  2. Faizan U, Muppidi V. Uterine Cancer. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562313/
  3. Murali, Rajmohan et al. “High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations.” International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists vol. 38 Suppl 1,Iss 1 Suppl 1 (2019): S40-S63. doi:10.1097/PGP.0000000000000491 https://pubmed.ncbi.nlm.nih.gov/30550483/
  4. Mahdy H, Casey MJ, Crotzer D. Endometrial Cancer. [Updated 2022 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525981/
  5. Braun, Michael M et al. “Diagnosis and Management of Endometrial Cancer.” American family physician vol. 93,6 (2016): 468-74. https://pubmed.ncbi.nlm.nih.gov/26977831/
  6. Ginath, S et al. “Tissue and serum CA125 expression in endometrial cancer.” International journal of gynecological cancer : official journal of the International Gynecological Cancer Society vol. 12,4 (2002): 372-5. doi:10.1046/j.1525-1438.2002.01007.x https://pubmed.ncbi.nlm.nih.gov/12144685/
  7. https://www.cancer.org/cancer/endometrial-cancer/about/what-is-endometrial-cancer.html
  8. Santin, Alessandro D et al. “Current treatment options for endometrial cancer.” Expert review of anticancer therapy vol. 4,4 (2004): 679-89. doi:10.1586/14737140.4.4.679 https://pubmed.ncbi.nlm.nih.gov/15270671/