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Endometrial cancer

Endometrium refers to the inner part of uterus, where fetus grows. Endometrial cancer is the most common gynecological cancer. Approximately 34, 000 new cases area diagnosed every year. Average age at the time of diagnosis is 60 years. This cancer affects women from the lower socio economic class and those with inadequate access to preventive medicine.

Causes:

Following is a list of factors that increase the risk of this cancer:

• Prolonged use of estrogen treatments

• Diets high in fat

• Obesity

• Hypertension

• Diabetes

• Family history of endometrial cancer

Signs and Symptoms:

With help of routine PAP smears , most cases are diagnosed at early stages. Patients who present with later stages of this cancer, may complain of vaginal bleeding. Vaginal bleeding in post menopausal women, may indicate to this problem.

Diagnosis:

When there is a suspicion for this condition, patients should be seen by an specialist. He will perform a physical examination, including a pelvic examination and a

PAP smear or a biopsy of the endometrium, which is an outpatient procedure. The tissue sample is then sent to the pathologist.

Staging:

• Stage 1, Disease that is limited to the endometrium, may extend to the body of uterus

• Stage 2, Disease that extends to the cervix of uterus

• Stage 3, Disease that extends to the pelvic lymph glands

• Stage 4, Disease spread to other organs, like bladder, rectum, lungs, liver, etc.

Information obtained from the pelvic examination, along with X rays, CT Scan , etc. will determine the best treatment option. Most accurate information is obtained during surgical treatment of this cancer.

Treatment

Most patients are treated with a combination of Surgery and Radiation therapy. Surgery is most appropriate for patients with very early stages of a disease, specially when the location and stage of cancer makes it easy to operate. Chemotherapy for patients with more advanced disease can control a good percentage of patients. Most patients are treated with a combination of Cisplatinum, Carboplatin, Cytoxan, and Adriamycin which are given intravenously. Treatments are repeated every 4 weeks. Patients benefit from having a Port-A-Cath for administration of chemotherapy. Most important Side effects of these regimens are:

• Hair loss

• Nausea, Vomiting

• Low white blood counts

• Anemia

• Soreness of the mouth

• Heart Problems

• Kidney damage

• Hormone treatment with progesterone, female sex hormones, can be effective and indicated in some patients.

Radiation therapy:

Radiation for cancer of endometrium is a treatment that is offered over 6-8 weeks, 5 days a week. Brachy therapy is another form of radiating the cancer and refers to using radioactive needles inside the endometrium . Following is a list of potential acute and immediate radiation complications:

• Burning while urinating

• Tiredness

• Diarrhea

• Pelvic Skin Irritation

• Urinary Problems

Most of these side effects will subside after completion of Radiation, however some may persist for a long period of time.

Prognosis:

Prognosis depends on the extent of the disease at diagnosis as well as the response to treatment. Most patients with early stage cancers can be cured. In others, the disease can be controlled very well with treatment for a period of time that may vary from months to years. If the disease reoccurs, the treatment will most likely be either chemotherapy or possibly surgery.

Special Situations

Patients with advanced endometrial cancer may develop any of the following complications:

• Bone metastasis

• High Calcium level

• Pain

• Vaginal Bleeding, may be profuse and is best treated with radiation therapy. Local measures to control bleeding might be difficult.

Follow up

After completion of treatment, and in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow up shall be scheduled on a regular basis and initially every 1-3 months for 1-2 years. The frequency of follow up will depend on the condition of the patient and their disease. In each follow up visits, patients are examined and normally a Chest X-ray is obtained every few months and CT scan of pelvis, once a year.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy with same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas, where the cancer has spread to. If patients experience pain, different pain medications could be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.