Endometrial Carcinoma pertains to a type of malignant cancer of the endometrium or the uterus lining. In the United States, Endometrial Cancer is among the most prevalent of gynecologic carcinomas, affecting nearly 38,000 women annually, an equivalent of 6% of all malignant cancers that occur among women. This disease is also known as uterine cancer.
ENDOMETRIAL CARCINOMA SYMPTOMS
Endometrial Carcinoma has been placed as the third most prevalent reason behind deaths due to ovarian and cervical cancer. The condition is often present when there are cases of Endometrial Hyperplasia that is been associated with heavy vaginal bleeding.
An Endometrial Carcinoma usually begins in the layer of cells that make up the endometrial glands. These cells are composed of a single layer and form a cover over the endometrium itself.
While five percent of patients will not exhibit any symptoms, most women who suffer from Endometrial Carcinoma will experience vaginal bleeding or spotting, particularly among women who have reached the post-menopausal stage. These abnormal bleeding closely resembles menstrual periods. In pre-menopausal women above the age of 40, vaginal bleeding will likewise occur even between menstrual periods. The bleeding is characterized by its length, frequency, and heaviness of flow, which points towards pre-malignant changes arising in the endometrium.
Due to the bleeding, patients will often exhibit anemia due to loss of blood, cramping in the lower abdomen or pelvic regions, back and leg pain, pressure in the bladder or rectal area, and in post-menopausal women, a whitish or clear discharge. There will be a general loss of weight, and a feeling of considerable weakness that signals the spread of the disease.
This type of cancer is composed of several types. Type I Endometrial Carcinoma usually occurs among women who are pre-menopausal or peri-menopausal. In these cases, while the cancer attacks the uterine wall, it is often low-grade and minimally invasive, and thus carries a better prognosis.
Type II usually afflicts women who have passed the menopausal stage. For this type, the prognosis is poorer with the occurrence of either Uterine Clear Cell Carcinoma, Uterine Papillary Serous Carcinoma, or High-Grade Endometrioid Cancer. They are commonly seen in women of African-American descent.
There are many subtypes of this cancer, as well, and the most common is known as Endometrioid Adenocarcinoma, a disease that is widely diagnosed among women who have reached their menopausal stage, particularly if they have had excessive exposure to estrogen.
ENDOMETRIAL CARCINOMA CAUSES
Scientists and researchers have discovered that Endometrial carcinoma develops when the genes within a person’s cells start to mutate. This points toward the disease as being genetic in nature. People who are susceptible to cancer have two types of genes. One, the oncogenes, are responsible for the division of cells as well as influencing embryonic growth, the other are tumor suppressor genes that impede cell division.
Image: Endometrial carcinoma
While these genes are found in all normal human cells, inherited genetic defects may cause them to undergo a genetic mutation. On the other hand, if a person is exposed to carcinogenic substances, this may also lead to an acquired mutation. Based on the current evidence, the incidence of carcinogenesis is a result of a combination of carcinogen exposure and accumulated gene mutations.
Other causes have been pinpointed as caused by a patient’s tissue type and hormones, as well as sensitivity to carcinogen exposure. There are many substances that can damage a person’s DNA and result in carcinogenesis. A number of these common culprits include aklylating agents, which cause leukemia, asbestos, which causes masothelioma of the lung, tobacco, which results in lung cancer, and vinyl chloride, which leads to angiosarcoma of the liver.
A diet high in animal fat is also held responsible, particularly if food intake is rich in additives like nitrates, or is subject to certain kinds of food preparation, such as charbroiling.
ENDOMETRIAL CARCINOMA DIAGNOSIS
Clinical diagnosis of Endometrial Carcinoma is more difficult compared to determining cervical cancer since a woman’s uterus is located above and beyond the cervix. While a pap smear can indicate abnormal changes in the cell make up, pap smears may be ineffective because a smear sample can only be obtained from the inner cervix, which is the lowest portion of the uterus. A biopsy using a special suction instrument made for the purpose is required.
Another method of diagnosing the disease is to take a pelvic sonogram to measure whether the endometrial lining has gained in thickness characteristic of Endometrial Carcinoma. In this manner, a patient will not have to undergo an uncomfortable biopsy if the lining measures 4.0mm or less.
A new development in testing is now available. Known as the TruTest, it uses a bendable Tao Brush to make a thorough sweep of the uterus lining. This method can secure enough tissue for biopsy, and is less invasive and painful compared to having a pipelle biopsy.
Apart from taking down the patient’s complete medical history, the doctor may also conduct a thorough physical examination, pelvic and rectal exam, as well as put the patient through a stool guaiac test, complete blood count and blood chemistry tests, a chest x-ray, and a liver function test. If the stool guaiac test turns out positive, a colonoscopy is also recommended to check for colon cancer.
ENDOMETRIAL CARCINOMA TREATMENT
Endometrial Carcinoma in its early stages is considered highly curable. The first treatment undertaken is a surgical procedure, particularly if the tumors that have grown exhibit the high-risk features of clear-cell tumors, or pathologic grade 3 serous tumors. This is also true if the cancer has taken up nearly half of cervix extension known as the myometrium. In such cases, omentum removal is also undertaken during surgery.
In some cases, the surgeon may perform abdominal hysterectomy, the surgical removal of the uterus. This surgical method will enable the surgeon to check for any evidence that the cancer has spread to other neighboring tissues.
In both the stage 1 and stage 2 forms of the disease where there is a risk for recurrence, radiation therapy is recommended in conjunction with surgery. In stage 3 and stage 4 cases, chemotherapy is one of the viable options.
ENDOMETRIAL CARCINOMA PROGNOSIS
Endometrial Carcinoma that is diagnosed in its early stages has a better prognosis compared to most cervical and ovarian cancers. Women who undergo post-operative radiation have a 90% probability of recovery, provided none of the cancer has spread to the rest of the abdominal tissues. Detection in its early stages followed by immediate treatment can effect a 98% cure rate in patients without the need for radiation therapy.
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