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Encyclopedia > Carcinoma of the uterus

Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). It mainly occurs after the menopause, and presents with vaginal bleeding. A hysterectomy (surgical removal of the uterus) is generally performed. When normal cells are damaged or old they undergo apoptosis; cancer cells, however, avoid apoptosis. ... The endometrium is the uterine membrane in mammals which is thickened in preparation for fertilization, and into which a fertilized egg is implanted upon its arrival into the uterus. ... Female internal reproductive anatomy The uterus or womb is the major female reproductive organ of most mammals, including humans. ... Menopause (also known as the Change of life or climacteric) is a stage of the human female reproductive cycle that occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. ... One of the main problems involving the female reproductive organs is vaginal bleeding. ... A hysterectomy is the surgical removal of the uterus, usually done by a gynecologist. ...

Contents

Causes

Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to have a role. One of estrogen's normal functions is to stimulate the buildup of the epithelial lining of the uterus. Excess estrogen administered to laboratory animals produces endometrial hyperplasia and cancer. Estrogens (or oestrogens) are a group of steroid compounds that function as the primary female sex hormone. ... In zootomy, epithelium is a tissue composed of a layer of cells. ... Hyperplasia (or hypergenesis) is a general term for an abnormal increase in the amount of the cells of an organ or tissue causing it to increase in size. ...


The incidence of endometrial cancer in women in the U.S. is 1 percent to 2 percent. The incidence peaks between the ages of 60 and 70 years, but 2 percent to 5 percent of cases may occur before the age of 40 years. Increased risk of developing endometrial cancer has been noted in women with increased levels of natural estrogen. The United States of America — also referred to as the United States, the U.S.A., the U.S., America, the States, or (archaically) Columbia—is a federal republic of 50 states located primarily in central North America (with the exception of two states: Alaska and Hawaii). ...


Associated conditions include the following:

Increased risk is also associated with the following: In medicine, hypertension refers to the problem of abnormally high blood pressure. ... Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. ...

  • nulliparity (never having carried a pregnancy)
  • infertility (inability to become pregnant)
  • early menarche (onset of menstruation)
  • late menopause (cessation of menstruation)

Women who have a history of endometrial polyps or other benign growths of the uterine lining, postmenopausal women who use estrogen-replacement therapy (specifically if not given in conjunction with periodic progestin) and those with diabetes are also at increased risk Infertility is the inability to naturally conceive, carry or deliver a healthy child. ... Menarche refers to the first menstrual period, or first menstrual bleeding, as a girls body progresses through the changes of puberty. ... Menopause (also known as the Change of life or climacteric) is a stage of the human female reproductive cycle that occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. ... In zoology, a polyp is one of two forms of individuals found in many species of cnidarians. ... Progestagens (also spelled progestogens or gestagens) are hormones similar in effect to progesterone, the only natural progestagen. ... This article is about the disease that features high blood sugar. ...


Tamoxifen, a drug used to treat breast cancer, can also increase the risk of developing endometrial cancer. Tamoxifen is an oral selective estrogen receptor modulator which is used in breast cancer, and is currently the worlds largest selling breast cancer treatment. ... Breast cancer is cancer of breast tissue. ...


Symptoms

  • abnormal uterine bleeding, abnormal menstrual periods
  • bleeding between normal periods in premenopausal women
  • vaginal bleeding and/or spotting in postmenopausal women

in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes) One of the main problems involving the female reproductive organs is vaginal bleeding. ...

thin white or clear vaginal discharge in postmenopausal women This article is in need of attention. ...


Diagnosis

Results from a pelvic examination are frequently normal, especially in the early stages of disease. Changes in the size, shape or consistency of the uterus and/or its surrounding, supporting structures may exist when the disease is more advanced.

  • Endometrial curettage is the diagnostic test of choice. Both endometrial and endocervical material should be sampled.
  • If endometrial curettage does not yield sufficient diagnostic material, a dilation and curettage (D and C) is necessary for diagnosing the cancer.
  • Endometrial aspiration or biopsy may assist the diagnosis.
  • A Pap smear may be either normal or show abnormal cellular changes.
  • Transvaginal ultrasound to evaluate the endometrial thickness in women with postmenopausal bleeding is increasingly being used to evaluate for endometrial cancer.
  • Routine screening of asymptomatic women is not indicated since the disease is highly-curable in those patients who are likely to have the disease detected by screening.

In surgery, the use of a curette to remove tissue by scraping or scooping. ... Dilation and curettage is a gynaecological procedure performed on the female reproductive system. ... Dilation and curettage is a gynaecological procedure performed on the female reproductive system. ... See: Aspiration (phonetics) Aspiration (medicine) Aspiration (long-term hope) - see for example, Robert Goddards response to the ridicule by the New York Times, 1920: Every vision is a joke until the first man accomplishes it; once realized, it becomes commonplace. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ... Ultrasound is sound with a frequency greater than the upper limit of human hearing, approximately 20 kilohertz. ...

Pathology

Histopathology is usually a endometrioid adenocarcinoma. It appears on a background of endometrial hyperplasia. Tumor cells are atypical and form irregular glands, with multiple lumens, pluristratification. The stroma is reduced, producing the "back to back" aspect. With evolution of the disease, the myometrium is infiltrated.


Evaluation

Patients with newly-diagnosed endometrial cancer do not routinely undergo imaging studies, such as CT scans to evaluate for extent of disease, since this is of low yield. Preoperative evaluation should include a complete medical history and physical examination, pelvic examination and rectal examination with stool guaiac test, chest X-ray, complete blood count, and blood chemistry tests, including liver function tests. Colonoscopy is recommended if the stool is guaiac positive or the women has symptoms, due to the etiologic factors common to both endometrial cancer and colon cancer. The tumor marker CA-125 is sometimes checked, since this can predict advanced stage disease.1 CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Diagram of the stomach, colon, and rectum Colorectal cancer includes cancerous growths in the colon, rectum and appendix. ... CA-125 is a substance that is produced by cancer cells. ...


Stages of endometrial cancer

Endometrial carcinoma is surgically staged using the FIGO system. Figo and his wife, the Swedish top-model Helen Svedin Luís Filipe Madeira Caeiro, Luís Figo, November 4, 1972 - in Cova da Piedade - Almada, Portugal, is a Portuguese international footballer, who plays as a midfielder. ...

  • Stage IA: tumor is limited to the endometrium
  • Stage IB: invasion of less than half the myometrium
  • Stage IC: invasion of more than half the myometrium
  • Stage IIA: endocervical glandular involvement only
  • Stage IIB: cervical stromal invasion
  • Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
  • Stage IIIB: vaginal metastasis
  • Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
  • Stage IVA: invasion of the bladder or bowel
  • Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes

The myometrium is the middle layer of the uterine wall consisting of smooth muscle cells and supporting stromal and vascular tissue. ...

Treatment

The primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral salpingo-oophorectomy). Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the omentum is also performed. A hysterectomy is the surgical removal of the uterus, usually done by a gynecologist. ... Human female internal reproductive anatomy Ovaries are a part of a female organism that produces eggs. ... In higher vertebrates, the peritoneum is the membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ...


Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.


Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with radiation therapy. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease. Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Chemotherapy is the use of chemical substances to treat disease. ...


Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems.


Expectations

Because endometrial cancer is usually diagnosed in the early stages (70 percent to 75 percent of cases are in stage 1 at diagnosis; 10 percent to 15 percent of cases are in stage 2; 10 percent to 15 percent of cases are in stage 3 or 4), there is a better probable outcome associated with it than with other types of gynecological cancers such as cervical or ovarian cancer. Cervical cancer is malignancy of the cervix; it is one of the more common cancers affecting women of reproductive age. ... Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). ...


Survival rates

The 5-year survival rate for endometrial cancer following appropriate treatment is:

  • 75% to 95% for stage 1
  • 50% for stage 2
  • 30% for stage 3
  • less than 5% for stage 4

Complications

  • Anemia may result, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.)
  • A perforation (hole) of the uterus may occur during a D and C or an endometrial biopsy.

Anemia ( American English) or anaemia ( Commonwealth English), which literally means without blood, is a lack of red blood cells and/or hemoglobin. ...

References

  • Note 1: Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000;182:1328-34. PMID 10871446.

External link


  Results from FactBites:
 
Dr. Koop - Uterine Cancer- Health Encyclopedia and Reference (718 words)
Endometrial carcinomas arise from the glands of the lining of the uterus, the pear-shaped organ in the pelvis.
From where it arises in the lining of the uterus, untreated endometrial carcinoma eventually invades the wall of the uterus and may involve the cervix.
The standard therapy is an abdominal hysterectomy (surgical removal of the uterus) with removal of both fallopian tubes and ovaries, selective removal of pelvic and aortic lymph nodes and washings from the abdominal cavity to look for malignant cells.
  More results at FactBites »

 
 

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