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Uterine cancer - (endometrial cancer)
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Uterine cancer  - (endometrial cancer)

Diseases & Conditions A-Z

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WOMEN'S HEALTH

Cancer

Causes

Healthy cells grow and divide in an elegant and orderly way to keep your body functioning normally. But sometimes this growth gets out of control — cells continue dividing even when new cells aren't needed.

In endometrial cancer, cancer cells develop in the lining of the uterus. Why these cancer cells develop isn't entirely known. However, scientists believe that the levels of estrogen in a woman's body play a role in the development of endometrial cancer. Factors that can increase the levels of this hormone and other risk factors for the disease have been identified and continue to emerge. In addition, ongoing research is devoted to studying changes in certain genes that may cause the cells in the endometrium to become cancerous.

Risk factors

The female reproductive system consists of two ovaries, two fallopian tubes and a uterus. The ovaries produce two main female hormones — estrogen and progesterone. The balance between these two hormones changes each month, helping the endometrium thicken in case pregnancy occurs or shed tissue if it doesn't.

When the balance of these two hormones shifts toward more estrogen — which stimulates growth of the endometrium — a woman's risk of developing endometrial cancer increases. Factors that increase levels of estrogen in the body include:

  • Many years of menstruation. If you started menstruating at an early age — before age 12 — and continue to have monthly periods into your 50s, you're at greater risk of endometrial cancer than a woman who menstruated for fewer years. The more years you have a monthly period, the more exposure your endometrium has had to estrogen.

  • Never having been pregnant. The body produces more progesterone during a pregnancy, helping protect you from endometrial cancer by lowering levels of estrogen. If you've never been pregnant, you don't get the benefit of this protection.

  • Irregular ovulation. Ovulation, the monthly release of an egg from an ovary in menstruating women, is regulated by estrogen. Irregular ovulation or failure to ovulate can increase your lifetime exposure to estrogen. Ovulation irregularities have many causes, including obesity and a condition known as polycystic ovary syndrome (PCOS). This is a condition in which hormonal imbalances prevent ovulation and menstruation. Treating obesity and PCOS can help restore your monthly ovulation and menstruation cycle, decreasing your risk of endometrial cancer.

  • Obesity. Ovaries aren't the only source of estrogen. Fat tissue can change some hormones into estrogen. Being obese — defined roughly as being 30 pounds or more overweight — can increase levels of estrogen in your body, putting you at risk of endometrial cancer and other cancers. A high-fat diet also can add to your risk by promoting obesity. Some scientists even think that fatty foods may directly affect estrogen metabolism, further increasing a woman's risk of endometrial cancer.

  • Diabetes. This is a risk factor for endometrial cancer mainly because obesity and type 2 diabetes (formerly called adult-onset or noninsulin-dependent diabetes) often go hand in hand. However, some data suggest that women who have diabetes, whether they're obese or not, are at greater risk of endometrial cancer.

  • Estrogen replacement therapy (ERT). Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of endometrial cancer. However, taking synthetic progestin, a form of the hormone progesterone, with estrogen — combination hormone replacement therapy — causes the lining of the uterus to shed and actually lowers your risk.

  • Ovarian tumors. Some tumors of the ovaries may themselves be a source of estrogen, increasing estrogen levels.

Other factors that can increase your risk of endometrial cancer include:

  • Age. Most endometrial cancers develop over many years. Therefore, the older you are, the greater your risk. Endometrial cancer most often occurs in women between the ages of 50 and 70.

  • Family history of endometrial cancer. Endometrial cancer can run in some families, especially those who have an inherited risk of certain types of colon cancer. If colon cancer and endometrial cancer run in your family, you may have an inherited risk of these cancers.

  • Personal history of breast cancer or ovarian cancer. Some of the same risk factors for breast cancer and ovarian cancer also increase your risk of endometrial cancer.

  • Prior pelvic radiation treatment. Radiation of the pelvic region to treat ovarian cancer or another cancer can damage cells, sometimes increasing the risk of developing a second cancer such as endometrial cancer.

  • Tamoxifen treatment. Endometrial cancer has been found in two out of every 1,000 breast cancer patients who have been treated with the hormonal drug tamoxifen. The drug acts like an estrogen, causing the uterine lining to grow. If you're being treated with this hormone, see your doctor for an annual pelvic examination and be sure to report any unusual vaginal bleeding.

  • Hereditary nonpolyposis colorectal cancer (HNPCC). This inherited disease is rare and results in colon cancer at a young age. The cause is an abnormality in a gene important for DNA repair. Women with HNPCC are at high risk of uterine cancer.

Having risk factors for endometrial cancer doesn't mean you'll get the disease. It means that you're at risk and should be alert to possible signs and symptoms of the disease. Conversely, some women who develop endometrial cancer — and often a more aggressive form — appear to have no risk factors for the disease.

When to seek medical advice

Because endometrial cancer is more likely to be curable the earlier it's diagnosed, see your doctor if you experience any signs or symptoms of the disease — including vaginal bleeding or discharge not related to your periods, pelvic pain or pain during intercourse. Some of the symptoms you experience may be associated with noncancerous (benign) conditions, such as vaginal infections, uterine fibroids or uterine polyps. But it's still important to bring them to the attention of your doctor.

Most endometrial cancers develop over many years. Many develop from less serious abnormalities of the endometrium that doctors can detect and treat before they turn cancerous. That's why regular gynecologic examinations are important for all adult women. This is especially true for women at high risk of endometrial cancer. If you've had endometrial cancer, ask your doctor about regular follow-up exams to check that the cancer hasn't returned.

Screening and diagnosis

If your doctor suspects endometrial cancer, you may be referred to a gynecologist — a doctor who specializes in conditions affecting the female reproductive system. The gynecologist or your primary care doctor will conduct a complete medical history and perform a physical and pelvic examination. During the pelvic examination, the doctor feels for any lumps or changes in the shape of the uterus that may indicate a problem.

Diagnosis may or may not involve a Pap smear. A Pap smear is a test in which your doctor takes a sample of cells from the cervix, the bottom and narrower portion of the uterus that opens into your vagina. Doctors use the test to detect another type of cancer — cervical cancer. Because endometrial cancer begins inside your uterus, it's rarely detectable by a Pap test.

To get a sample of cells from inside your uterus, you'll likely undergo an endometrial biopsy. This involves your doctor removing a small piece of tissue from your uterine lining for laboratory analysis. This may be done in your physician's office and usually doesn't require anesthesia. If enough tissue can't be obtained during a biopsy or the biopsy suggests cancer, you'll likely need to undergo a dilation and curettage (D and C). In this procedure, which requires you to be in an operating room under anesthesia, tissue is scraped from the lining of your inner uterus and examined under a microscope for cancer cells.

Your doctor may also recommend a transvaginal ultrasound to help rule out other conditions. In this painless procedure, a wand-like device (transducer) is inserted into your vagina. The transducer uses sound waves to create a video image of your uterus. This test helps your doctor look for abnormalities in your uterine lining.

If cancer of the endometrium is found, you'll likely be referred to a gynecologic oncologist — a doctor who specializes in treating cancers involving the female reproductive system. You'll need more tests to determine if the cancer has spread to other parts of your body (metastasis). These tests may include a blood test to measure cancer antigen 125 (CA 125), a substance that's released in the bloodstream when endometrial and ovarian cancers are present.

Complications

When discovered early, endometrial cancer is usually confined to a small area of the uterus, making it highly treatable. However, in some women endometrial cancer reaches an advanced stage before diagnosis.

Endometrial cancer can cause pelvic pain and painful urination. As the cancer advances, symptoms may worsen. Treating the cancer can help alleviate the pain, but recovery can be slow.

Women with endometrial cancer tend also to lose blood from vaginal bleeding. Over time, chronic loss of blood can result in anemia — a condition in which the blood is low on red blood cells and oxygen. Anemia causes fatigue and shortness of breath. But anemia can be treated along with your cancer, helping you regain energy.

Finally, endometrial cancer can recur in some women who don't have their uterus removed during treatment.

 

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Last Modified : 03/14/08 11:56 PM