Uterine Cancer (Endometrial Cancer) – Symptoms, Stages & Treatment

Uterine cancer is a medical condition where cancer tumors form on the inner lining of the uterus. The inner lining of the uterus is called Endometrium, hence the name Endometrial cancer. The outer layer of the uterus is made of muscles and it is called Myometrium. Endometrial cancer is different from the cancer that occurs in the muscles of the uterus. It is called Sarcoma of the uterus.

Symptoms of Uterine / Endometrial Cancer

1. Unusual vaginal bleeding or bleeding during non menstrual period
2. Vaginal bleeding after menopause
3. Painful urination and/or sex
4. Pain in the pelvis region

Diagnosing Uterine Cancer

A part of the endometrial tissue is removed from the uterus and checked under a microscope for the presence of cancer cells. Different methods are employed to extract the tissue from the uterus such as:

1. Endometrial Biopsy – a thin, flexible tube is inserted through the vagina, through the cervix and into the uterus. Small amount of tissue is scraped with the tube and removed for testing.
2. Dilatation & Curettage – In this procedure, cervix is dilated and a spoon shaped instrument called Curettage is used to remove the tissue from the uterus.
3. Hysteroscopy – This is a little advanced device which provides the gynaecologist with the ability to view inside the uterus. It is a thin tube like instrument with a light, camera and even a tool to scrape and remove sample tissue from inner parts of the body. This instrument is used to extract sample from the uterus.

Your gynaecologist may also perform a physical examination of the reproductive organs to check for the presence of lumps or for any unusual findings. Medical history may be examined or asked.  A transvaginal ultrasound exam may also be performed to examine the vagina, uterus, fallopian tubes and the bladder. Tumors inside these parts can be seen through this exam.

Is Uterine Cancer curable?

If diagnosed in the early stages, uterine cancer is curable. However, the prognosis (chances of recovery) depends on certain factors including:

1. The stage of the cancer. There are 4 main stages of the cancer depending on the areas affected.
2. How the cancer cells look under the microscope.
3. Whether they are affected by progesterone.

How does Uterine cancer spread from uterus to other parts of the body?

Any cancer (not just uterine cancer) can spread mainly in 3 ways – through tissues, through the lymph system and through the blood.

1. Spreading through tissues – Starting from the place where the cancer cells started growing, they start spreading to nearby tissues.
2. Through Lymph system – If the cancer cells can get into the lymph system that is closer to the area of origin, they travel to other parts of the body through the lymph vessels.
3. Through blood – The cancer cells travel through the blood vessels and get settled on different organs in the body.

When cancer spreads from it’s place of origin to other parts, it is called ‘Metastatis’. If the uterine cancer cells travel through the blood or lymph system and get deposited in the lung, it is not called lung cancer but ‘metastatic endometrial cancer of the lungs’.

Staging Uterine cancer after diagnosis

Once the gynaecologist confirms the tumors as malignant, the next step would be to see how far the cancer has spread. This process is called staging and this requires certain tests to be done before the commencement of appropriate treatment.

1. Pelvic Exam – The gynaecologist wears a surgical glove, lubricates it and inserts his/her finger in to the vagina to examine the size and shape of the vagina, uterus and other parts of the reproductive system. He/she may also look for any lumps by inserting his/her finger into the rectum and by feeling the cervix, uterus etc.
2. X-ray of the chest – An x-ray of the organs and bones in the chest region will be taken to see if the cancer has metastasized to the lungs or other parts of the body.
3. CT Scan – Detailed pictures of the internal organs of the body from different angles will be taken to look for organs that are affected because of the cancer.
4. MRI – Instead of a CT/CAT scan, MRI may be preferred to check the internal organs.
5. PET Scan (Positron Emission Tomography Scan) – A small amount of radioactive glucose is injected into a vein. The PET Scanner rotates around the body and takes pictures. In these pictures, the absorption of glucose by the body parts can be seen. As cancer cells take up more glucose than the normal parts, the areas show up more active on the pictures taken by the PET scanner.
6. Dissection of the lymph nodes – Lymph nodes are surgically removed from the pelvis region and are checked under the microscope.

Stages of Uterine (endometrial) cancer

As said earlier, there are mainly 4 stages of uterine cancer.

Stage 1 – Cancer is found only in the uterus and has not spread to the myometrium (Stage 1A). If the cancer has spread halfway or more into the myometrium, this is classified as Stage 1B.

Stage 2 – If the cancer has spread into the connecting tissue of the cervix but not outside the uterus.

Stage 3 – When the cancer has spread beyond uterus and cervix but not to the pelvis region. This further divided into Stage 3A, 3B and 3C giving a more detailed understanding of the spread of the cancer.

Stage 4 – Cancer has metastasized beyond the pelvis region.

Treatment for Uterine cancer

The treatment options are best left to the expert. Treatment option chosen by your expert gynaecologist depends on the stage of the cancer, the patient’s age, his/her previous medical history and radiation history.

Surgical methods

1. Total hysterectomy – If the uterus and the cervix are removed through the vagina, this is called ‘Vaginal hysterectomy’. If an incision is made in the abdominal area and the uterus and cervix are removed, this is called ‘Abdominal hysterectomy’. If the same operation is performed by making a small keyhole sized incision and by using a laparoscope, this is called ‘Laparoscopic hysterectomy’.
2. Bilateral Salpingo-oophorectomy – In this surgery, uterus, cervix, ovaries and the fallopian tubes are removed.
3. Radical hysterectomy – This is a surgery where uterus, cervix, fallopian tubes, ovaries and lymph nodes are removed.
4. Lymph node dissection – Lymph nodes are removed from the pelvis region.

Along with removal of these organs, some patients may have to undergo radiation therapy to make sure that there are no remnants of cancer cells left in the pelvis region.  Hormone therapy may also be advised to make sure that the cancer doesn’t return.

Radiation therapy

Radiation therapy to treat uterine cancer uses high energy x-rays or other energy beams to kill cancer cells.  This radiation therapy can be done using a machine that operates from outside the body or by using radioactive substances that work from inside the body to kill the cancer cells.

Chemotherapy

The patient will be put on medication that can kill the cancer cells or stop them from multiplying.  The medication can be oral or through an injection. Drugs consumed orally will spread across the body. But, drugs injected through an injection will target a particular area of the body where the cancer is present such as into the cerebrospinal fluid, abdomen etc.

Hormone therapy

Hormone therapy involves administering hormones (through various ways) that can stop cancer cells from growing.

Targeted Therapy

In this type of treatment, drugs  or other substances are used to target specific cancer cells without harming healthy cells. Monoclonal antibodies, mTOR inhibitors and signal transduction inhibitors are three types of targeted therapies that are used to treat uterine cancer.

Will uterine cancer reoccur after successful treatment?

Yes, even after successful treatment, uterine cancer can come back in some patients. If the uterus is not removed, it can start again in the uterus or it may come back in lymph nodes or abdomen or other parts of the body.