Endometrial Cancer

Endometrial Cancer

Endometrial cancer is cancer that attacks the lining on the inside of the uterus. This condition generally occurs in women who have entered menopause, which is around the age of 60-70 years.

The endometrial lining acts as a place for the fertilized egg to attach. Therefore, the endometrial wall will thicken before menstruation. If the egg is not fertilized, the endometrium will slough off, resulting in menstruation .

Endometrial cancer is one of the most common types of cancer in the female reproductive organs. Based on WHO data in 2020, there are more than 7,000 cases of endometrial cancer in Indonesia, with 2,000 of them dying.

Endometrial cancer can be detected early, which is characterized by abnormal bleeding in the vagina. If detected early, the doctor can perform a hysterectomy or surgical removal of the uterus to treat this condition.

Types of Endometrial Cancer

Endometrial cancer is divided into two main types, namely:

  • Type 1 endometrial cancer
    This type is the most common. The development of cancer cells in type 1 occurs slowly (non-aggressive) and can be detected early.
    Type 1 forms of endometrial cancer are endometrioid adenocarcinomas .
  • Type 2 endometrial cancer
    This type has a more aggressive nature. Cancer cells in this type grow and spread more quickly, and recur more often.
    Type 2 endometrial cancer forms are uterine serous carcinomas and clear cell carcinomas .

Causes of Endometrial Cancer

Endometrial cancer occurs when cells in the endometrium undergo changes (mutations). These changes cause these cells to grow quickly and uncontrollably so that they develop into cancer cells.

It is not known exactly why these cells grow uncontrollably. However, there are several factors that are thought to increase a person's risk of developing endometrial cancer, namely:

  • Imbalance of the hormones progesterone and estrogen in the body
  • Overweight or obesity
  • Age 60–70 years
  • Menopause
  • Menstruation at an early age (<12 years)
  • Menopause at a later age than usual (>50 years)
  • Never been pregnant
  • Tamoxifen hormone therapy , for breast cancer patients
  • Colon cancer
  • Polycystic ovary syndrome ( PCOS )
  • Family history of endometrial cancer
  • Other types of cancer, such as breast cancer or uterine cancer

Symptoms of Endometrial Cancer

The most common symptom of endometrial cancer is vaginal bleeding . These symptoms usually have appeared since the early stages of cancer. However, the characteristics of this bleeding can be different, depending on whether the patient is menopausal or not.

If the patient is not menopausal, vaginal bleeding is characterized by:

  • More bleeding during menstruation with a longer menstrual period (more than 7 days)
  • Spots of blood appear outside the menstrual period
  • Menstrual cycle occurs every 21 days or sooner
  • Bleeding occurs before or after sexual intercourse

In postmenopausal patients, any vaginal bleeding or spotting that has occurred for at least a year since menopause should be seen by a doctor immediately.

In addition to bleeding, other early symptoms of endometrial cancer are vaginal discharge that is watery or mixed with blood, and pain during sexual intercourse.

If it has progressed and entered an advanced stage, endometrial cancer will cause additional symptoms, such as:

  • Pelvic pain
  • Weight loss
  • Loss of appetite
  • A lump appears in the lower abdomen
  • Fatigue
  • Bloated
  • Changes in urination and defecation patterns
  • Pain in the lower abdomen, back, or legs

When to go to the doctor

Immediately consult a doctor if you experience the following symptoms:

  • Bleeding that occurs after menopause, after sexual intercourse, or outside the menstrual cycle
  • Vaginal bleeding that lasts more than 7 days
  • Menstruation that occurs more than once a month
  • Vaginal discharge that occurs after menopause
  • Pelvic pain or cramps that don't go away

Although the above conditions are not always associated with endometrial cancer, early examination is needed so that the cause can be identified and treated.

Endometrial Cancer Diagnosis

To diagnose endometrial cancer, the doctor will ask questions about the symptoms experienced and the patient's medical history, followed by a physical examination.

Furthermore, the doctor will perform further examinations to establish a diagnosis, including:

Pelvic exam

A pelvic exam is performed by examining the outside of the vagina, then inserting two fingers into the vagina while pressing the patient's abdomen with the other hand. The goal is to detect abnormalities in the uterus and ovaries.

Doctors can also use a speculum to detect abnormalities in the vagina and cervix.

Transvaginal ultrasound

This examination is done by inserting a special device called a transducer into the vagina. This device will transmit high-frequency sound waves into the uterus to be converted into an image on the monitor. That way, the doctor can see the texture and thickness of the endometrium.

Hysteroscopy

Hysteroscopy is done by inserting a special instrument with a small camera and light (hysteroscope) into the uterus through the vagina. This tool helps the doctor to see the endometrium and conditions in the uterus.

Endometrial biopsy

This examination is done by taking a sample of tissue from the lining of the uterus, to be analyzed in the laboratory. The goal is to detect the presence of cancer cells.

Dilation and curettage ( dilation and curettage )

This examination is also called a curette , which is the scraping or scraping of tissue in the uterus using a special tool. This procedure is performed if the sample from the biopsy is not sufficient to detect cancer cells and the results of the analysis cannot be confirmed.

If endometrial cancer is suspected to have entered an advanced stage, the doctor will perform a scan with X-rays, CT scans , PET scans, and MRIs, to detect whether the cancer has spread to other organs.

The doctor may also perform a cystoscopy or colonoscopy , to detect whether the cancer has spread to the bladder or digestive tract.

Endometrial Cancer Stage

After endometrial cancer is diagnosed, the doctor will determine the stage of the endometrial cancer. There are four stages of endometrial cancer, namely:

  • Stage 1: the cancer is still in the uterus
  • Stage 2: the cancer has spread to the cervix (cervix)
  • Stage 3: the cancer has spread beyond the uterus, such as to the lymph nodes in the pelvis, but has not yet reached the colon or bladder
  • Stage 4: the cancer has spread to the bladder, colon, or even to other organs or parts of the body

Endometrial Cancer Treatment

Endometrial cancer treatment can be done by several methods whose determination is based on several factors, namely:

  • Stage or level of spread of cancer cells in the uterus
  • Overall health condition of the patient
  • Types of endometrial cancer and tumor size
  • Location of endometrial cancer

The following are some actions that can be taken to treat endometrial cancer:

Operation

Surgery is one of the most effective treatment measures in treating endometrial cancer. Surgery can be performed in early-stage endometrial cancer.

The operation performed is surgical removal of the uterus ( hysterectomy ). Based on the condition of endometrial cancer, a hysterectomy may also be accompanied by a procedure to remove the ducts and ovaries.

In a hysterectomy, the doctor can also remove the seed lymph nodes in the uterine area, to detect the spread of cancer cells. Please note, this operation causes the patient to be unable to have children in the future.

Chemotherapy

Chemotherapy is the administration of drugs to kill cancer cells and prevent their spread. This therapy is performed on endometrial cancer that has spread to other parts of the body or has recurred.

The chemotherapy drugs used are cisplatin , carboplatin, doxorubicin, or paclitaxel .

Radiotherapy

Radiotherapy is a therapy using high radiation beams to destroy cancer cells. This procedure can be performed after a hysterectomy or in combination with chemotherapy.

Radiotherapy can also be used to inhibit the spread of cancer cells when surgery cannot be performed. There are two types of radiotherapy, namely:

  • External radiotherapy, by directing energy beams to the part of the body affected by cancer
  • Internal radiotherapy ( brachytherapy ), by placing radioactive material in the vagina

Hormone therapy

Hormone therapy is the administration of drugs that affect hormone levels in the body. This therapy is usually done together with chemotherapy in advanced endometrial cancer where the cancer cells have spread beyond the uterus.

Drugs used in hormone therapy include progestins, tamoxifen, or letrozole .

Complications of Endometrial Cancer

If left untreated, endometrial cancer can lead to a number of complications, including:

  • Anemia due to vaginal bleeding
  • A tear in the uterus, which may appear during an endometrial biopsy or curettage
  • Side effects of chemotherapy and radiotherapy, such as nausea and vomiting, loss of appetite, constipation, hair loss, and rash
  • Cancer that spreads to other organs (metastasis)

Endometrial Cancer Prevention

Endometrial cancer is difficult to prevent because the cause is unknown. However, there are several things that can be done to lower a person's risk of developing this condition, namely:

  • Perform periodic obstetrical examinations, such as pelvic examinations, uterine ultrasound, and pap smears , as an early detection if there are disturbances or abnormalities in the reproductive organs
  • Consult your doctor first before using any contraceptive method
  • Maintain ideal body weight
  • Consuming healthy, complete and balanced nutrition
  • Exercise regularly, for 30 minutes every day

Talk to your doctor about the benefits and risks of hormone therapy after menopause

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