Endometrial Cancer – Diagnosis and Treatment
Diagnosis
Methods to Identify Endometrial Cancer
Diagnosis of endometrial cancer usually starts when a person reports symptoms like abnormal vaginal bleeding, especially after menopause.
Some cases come to light during routine checkups, but symptoms often lead to further testing.
Test or Procedure | What It Checks |
---|---|
Pelvic Exam | Size and feel of uterus, ovaries, and nearby areas. |
Transvaginal Ultrasound | Thickness and look of the uterine lining. |
Hysteroscopy | Direct view of uterus lining and possible tissue sample. |
Endometrial Biopsy | Presence of cancer cells in uterine lining. |
Dilation & Curettage | More complete tissue sample if biopsy unclear. |
MRI/CT Scan | Tumor size, possible spread to other organs. |
Chest X-ray | Checks if cancer has moved to the lungs. |
Blood Tests | Measures blood cells and tumor marker levels. |
Genetic Testing | Inherited conditions like Lynch syndrome. |
Pelvic Examination
A pelvic exam is often the first step. The healthcare provider checks the reproductive organs.
They look at the external genitals and may use two fingers in the vagina and the other hand on the abdomen to feel the uterus and ovaries.
A speculum opens the vaginal canal, making it easier to see the cervix and spot signs of tumors, polyps, or other issues.
Imaging Procedures
Imaging tests help in diagnosis. Transvaginal ultrasound is common.
A wand, or transducer, goes into the vagina to create detailed pictures of the uterus. This test can show thickening or unusual texture in the endometrial lining, which might suggest cancer or a polyp.
Doctors may order MRI or CT scans when they need more detailed images. These scans show the size, location, or possible spread of the tumor. A chest X-ray checks if cancer has reached the lungs.
Hysteroscopy
Hysteroscopy gives a direct look inside the uterus. The doctor inserts a thin, flexible tube with a light and camera through the vagina and cervix.
This tool provides a clear view of the uterine lining and helps spot growths or tumors. If needed, the doctor collects tissue samples using small tools passed through the hysteroscope.
Endometrial Biopsy and Tissue Sampling
Doctors use an endometrial biopsy to confirm cancer. They take a small tissue sample from the lining of the uterus.
A lab checks the sample under a microscope for cancer cells. Most biopsies are quick and happen in a medical office, with little recovery needed.
If the biopsy does not give a clear answer or has too little tissue, the doctor may perform dilation and curettage (D&C). During D&C, tissue is gently scraped from the uterus for testing.
Blood and Genetic Tests
Doctors may order a complete blood count (CBC) and check for tumor markers like CA 125. These tests can give clues about the cancer.
Testing for inherited syndromes, such as Lynch syndrome, may be recommended if there is a strong family history of cancer.
Risk Factors Considered
When planning tests, healthcare teams look at a person’s background. Obesity, diabetes, and hormone levels can raise the chance of developing cancer.
Family history or genetic traits, like Lynch syndrome, also increase risk.
How Doctors Determine the Spread of Cancer
Once doctors diagnose cancer, they determine how far it has spread. This process is called staging. Staging helps plan treatment.
Testing for Cancer Spread
Doctors use imaging tests like MRI, CT scans, and sometimes PET scans for staging. A chest X-ray checks for spread to the lungs.
Blood tests show overall health and may indicate if cancer has moved to other parts of the body.
Sometimes, doctors perform surgery to check for spread. Tissue samples taken during surgery provide exact information.
Stages Explained
Doctors use numbers 1 through 4 to describe how far endometrial cancer has advanced:
Stage | Where Cancer Is Found |
---|---|
1 | Inside the uterus only |
2 | Uterus and cervix |
3 | Nearby tissues or lymph nodes |
4 | Distant organs, like bladder, bowel, or lungs |
- Stage 1: Cancer is only in the uterus.
- Stage 2: Cancer has moved to the cervix, but not beyond the uterus.
- Stage 3: Cancer has reached nearby tissues or regional lymph nodes.
- Stage 4: Cancer has spread to distant areas, such as the bladder, bowel, or elsewhere in the body.
Treatment
Surgical Procedures
Surgery is usually the first step in treating endometrial cancer. Most patients have their uterus removed in a hysterectomy.
This operation often includes removing the ovaries and fallopian tubes, called a bilateral salpingo-oophorectomy. Removing these organs can cause menopause if it hasn’t happened already and means pregnancy is no longer possible.
During surgery, the doctor may also remove nearby lymph nodes. Testing these lymph nodes shows how far the cancer has spread and helps plan follow-up care.
Sometimes, the doctor checks extra tissues for signs of disease. The main goal is to remove as much cancer as possible.
Key points:
- Total Hysterectomy: Removes the uterus.
- Bilateral Salpingo-Oophorectomy: Removes ovaries and fallopian tubes.
- Lymphadenectomy: Lymph nodes removed for testing.
Use of High-Energy Treatments
Radiation treatment uses beams of energy to destroy cancer cells. Doctors may use radiation before surgery to shrink tumors or after surgery to reduce the risk of cancer returning.
If surgery isn’t possible due to health reasons, radiation may be the main treatment.
Two main types of radiation are used:
Type | How It Works |
---|---|
External beam radiation | A machine outside the body targets the cancer. |
Brachytherapy (internal) | Radioactive material placed inside the vagina. |
Doctors sometimes recommend both types to control tumors. The type and timing depend on the stage and spread of the cancer.
Medicine to Destroy Cancer Cells
Chemotherapy uses strong drugs to destroy cancer cells throughout the body. These drugs may be given through a vein (IV) or by mouth.
Doctors may use different medicines alone or in combination, depending on the case.
Chemotherapy can be used at different times:
- After Surgery: To lower the chance of cancer returning.
- Before Surgery: To shrink tumors and make them easier to remove.
- For Advanced Cancer: To treat disease that has spread beyond the uterus or returned after earlier treatments.
Possible side effects include tiredness, nausea, hair loss, and weakened immunity.
Therapy Affecting Hormones
Hormone treatments lower or block hormones that help some endometrial cancer cells grow. Doctors use medicines like progesterone-like drugs or drugs that block estrogen, especially if the cancer is advanced or has spread.
Hormone therapy can be an option for those who cannot have surgery or want to delay more aggressive treatment. These medicines can slow or stop cancer growth in some patients.
Precise Target Medications
Targeted therapy focuses on chemicals in cancer cells that help them live and grow. These medicines block those processes and cause cancer cells to die while trying to spare healthy cells.
Doctors usually give targeted drugs with chemotherapy for people with advanced cancer.
Examples of targeted approaches:
- Drugs that block proteins cancer needs to survive.
- Medicines aimed at cancer cell signals, not healthy tissue.
Doctors choose these treatments based on cancer features found in lab tests.
Treatments That Help the Immune System
Immunotherapy helps the body’s defense system find and destroy cancer cells. Cancer sometimes hides from the immune system, but these treatments help immune cells attack tumors.
Doctors may use immunotherapy for advanced endometrial cancer when standard therapies have not worked. They often offer it if the cancer has certain features seen in lab studies.
Medicines used may cause side effects, like skin changes or flu-like symptoms, but many patients manage them with support.
Comfort and Symptom Management
Supportive or palliative care helps patients feel better and live as well as possible during cancer care. This care focuses on managing pain, nausea, and other symptoms caused by cancer and its treatment.
A palliative team includes doctors, nurses, and other health professionals. They work with the main cancer team and the patient’s family to give extra support.
Palliative services do not replace regular treatments but are given alongside them.
Benefits of palliative care:
- Improved comfort.
- Better coping with side effects.
- Emotional and practical support for families.
Coping and support
Facing endometrial cancer can bring many emotions, like fear or confusion. It helps to get clear information about the diagnosis and treatment choices.
Patients should talk with their medical team about the type and stage of cancer, available treatments, and possible side effects. Getting a second opinion can also help when making important treatment decisions.
A strong support system can improve quality of life. Family and friends can listen or provide day-to-day help. Joining support groups, either in person or online, connects people to others with similar experiences.
Many people find it useful to continue activities they enjoyed before their diagnosis, when possible. Staying engaged in these routines can give a sense of normalcy.
Some people seek extra support, such as counseling or group therapy. Others try complementary approaches, like acupuncture, to manage side effects or feel more relaxed.
Simple support tips:
Action | Purpose |
---|---|
Learn about the cancer. | Informs decisions and reduces uncertainty. |
Get a second opinion. | Supports confidence in treatment decisions. |
Connect with others. | Reduces isolation and builds relationships. |
Try acupuncture. | May ease some side effects. |
Stay active when able. | Helps keep quality of life. |
Getting Ready for Your Visit
Steps You Can Take Beforehand
Being prepared can help you make the most of your time with your gynecologist, gynecologic oncologist, or other health professionals.
Here are ways to get ready for your appointment:
- Keep a Symptom Log: Write down all symptoms, even small ones or those that seem unrelated.
- Document All Medications: List every medicine you take, including prescriptions, over-the-counter drugs, vitamins, and supplements. If you have used birth control pills, tamoxifen, or hormonal therapies, add those too.
- Bring Support: Invite a family member or friend to your appointment. They can help listen, take notes, and remind you of important points later.
- Prepare Written Questions: List questions in order of importance. This ensures you discuss your main concerns even if time runs short.
Below is a table with example questions to ask your healthcare team:
Possible Questions to Ask |
---|
What might be causing my symptoms? |
Are other causes possible? |
What tests are needed for diagnosis? |
Will I need any further tests? |
What types of treatments are available? |
What side effects could these treatments cause? |
Are there other treatment options? |
How will these affect my daily life? |
Can you refer me to a specialist? |
Will insurance cover my treatments? |
Ask new questions if they come to mind during your visit.
What Health Professionals May Ask You
Your gynecologist or gynecologic oncologist will probably ask about your health, symptoms, and family history.
Common questions include:
- Have you noticed any unusual vaginal bleeding or discharge? If so, how often?
- Are you experiencing pelvic pain?
- When did your symptoms start? Do they come and go, or are they constant?
- Does anything help improve or worsen your symptoms?
- Have you taken any estrogen-only hormone therapy for menopausal symptoms?
- Do you have a history of cancer or other major illnesses?
- Has anyone in your family had cancer? If yes, what kind and at what age?
Health professionals use your answers to better understand your condition and plan the next steps. Try to answer honestly, even if some topics feel personal or difficult.