14 Jul 2011

Endometrial cancer

Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma -endometrium; Adenocarcinoma - uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus cancer

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).
Causes, occurrence, and risk factors
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 play a role. Estrogen helps stimulate the buildup of the lining of the uterus. Studies have shown that high levels of estrogen in animals result in excessive endometrial growth and cancer.
Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.
The following increase your risk of endometrial cancer:
    Estrogen replacement therapy without the use of progesterone
    History of endometrial polyps or other benign growths of the uterine lining
    Infertility (inability to become pregnant)
    Infrequent periods
    Tamoxifen, a drug for breast cancer treatment
    Never being pregnant
    Polycystic ovarian syndrome (PCOS)
    Starting menstruation at an early age (before age 12)
    Starting menopause after age 50
Associated conditions include the following:
    Colon or breast cancer
    Gallbladder disease
    High blood pressure
    Polycystic ovarian disease
    Abnormal uterine bleeding, abnormal menstrual periods
        Bleeding between normal periods before menopause
        Vaginal bleeding or spotting after menopause
    Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
    Lower abdominal pain or pelvic cramping
    Thin white or clear vaginal discharge after menopause
Cipher and tests
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.
Tests that may be done include:
    Endometrial aspiration or biopsy
    Dilation and curettage (D and C)
    Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)
If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.
Stages of endometrial cancer:
    The cancer is only in the uterus.
    The cancer is in the uterus and cervix.
    The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
    The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.
Cancer is also described as Grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive.
Action - Treatment
Treatment options involve surgery, radiation therapy, and chemotherapy.
A hysterectomy may be performed in women with the early stage 1 disease. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.
Abdominal hysterectomy is recommended over vaginal hysterectomy. This type of hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for a biopsy.
Surgery combined with radiation therapy is often used to treat women with stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. It is also used to treat women with stage 2 disease.
Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.
    American Cancer Society. Cancer Facts and Figures 2009. Atlanta, Ga: American Cancer Society; 2009. [PubMed]
    Park CK, Apte S, Acs G, Harris EER. Cancer of the endometrium. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:Chap 92.
    Lu K, Slomovitz BM. Neoplastic diseases of the uterus: Endometrial hyperplasia, endometrial carcinoma, sarcoma: Diagnosis and management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:Chap 32.
    Hernandez E, American College of Obstericians and Gynecologists. ACOG practice bulletin number 65: Management of endometrial cancer. Obstet Gynecol. 2006;107(4):952. [PubMed]

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