Endometrial Cancer

Cancer of the Uterus or Endometrial Cancer is the most common gynaecologic malignancy with a lifetime risk of 3%. Cancer of the endometrium (lining layer within the uterus) is the most common type of uterine cancer, however cancers of the muscle layer and stromal cells of the uterus can also occur.

Risk factors for this type of cancer include hypertension, diabetes, obesity, unopposed or excess oestrogen (from HRT, PCOS, anovulation) and hereditary conditions.

Symptoms

The most common symptom is post-menopausal bleeding (PMB). All cases of PMB need to be investigated. In peri-menopausal women heavy and irregular bleeding can be a symptom of endometrial cancer. In advanced cases other symptoms such as pain, altered bladder or bowel habit can occur.

Diagnosis and Investigations

The diagnosis is made on endometrial sampling - this is either a curette (D&C) performed in theatre or a pipelle biopsy performed in consultation rooms. Once a diagnosis is made a CT scan of the chest, abdomen and pelvis will be performed as well as blood tests including a CA125 level.

Treatment

Hysterectomy is the standard treatment for Endometrial Cancer. The uterus, tubes and ovaries are removed. In some women the pelvic lymph nodes need to be sampled or removed completely. This decision is usually made intra-operatively. Once the uterus is removed the pathologist will determine the depth of invasion and the grade of the disease - this will determine whether lymph nodes are then removed. In advanced stages the omentum (fatty apron in the abdomen) and/or other deposits will be removed. In most cases the procedure will be via the laparoscopic (keyhole surgery) approach, however this will be determined after a full medical history and examination is performed.

A precursor lesion to cancer is Complex Hyperplasia. It is recommended that this condition is also treated with hysterectomy for definitive management. 15-30% of women with this condition will have an underlying malignancy.

Some women can be treated with progesterone (hormonal) therapy for Complex Hyperplasia or early Endometrial Cancers. It is important to exclude any invasive or metastatic disease before this treatment is offered. Hormonal therapy is offered to women who are unfit for a surgical procedure or who wish to retain fertility.

Follow Up

Once you have completed treatment for Endometrial Cancer you will be monitored regularly over the next several years. Some women will require adjuvant radiation or chemotherapy. You will be referred to the Radiation Oncologist for radiation and the Medical Oncologist for chemotherapy. In some cases your cancer may recur. Further imaging and blood tests will be performed at that time and management options will be discussed. These include further surgery, radiation therapy or chemotherapy.

Staging and Prognosis

The Stage of disease describes how advanced your cancer is and to what organs it has spread to at the time of diagnosis. Your stage is determined after the surgical procedure. Once your disease is staged we have a better idea about prognosis or outlook. This will be discussed with you once we have all the necessary information.

Further information can be obtained from the websites listed in the Links Section or by contacting the Queensland Cancer Council.