Endometrial cancer is a type of cancer of the uterus, which is more common in women between 50 and 70 yrs (postmenopausal women), and is rare in women below the age of 40 yrs. It is one of the common cancers in women. Although the cause of endometrial cancer is not known, the role of estrogen in endometrial cancer has been clearly established. Any factor that increases exposure to unopposed estrogen (that is, without progesterone) increases the risk of endometrial cancer.
Signs Of Endometrial Cancer
There are several risk factors for endometrial cancer. Endometrial hyperplasia or increased number of cells in endometrium is a risk factor. Symptoms of endometrial hyperplasia are heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding.
Other risk factors are diabetes, high blood pressure, obesity, no child bearing, use of estrogen without progesterone as in hormone replacement therapy, use of tamoxifen for breast cancer, radiation therapy to pelvis and family history of uterine cancer. However, it is to be noted that many who develop uterine cancer may not have any risk factor present.
Symptoms Of Endometrial Cancer
Less than 5% of women diagnosed with endometrial cancer do not have any symptoms. In such women it is diagnosed incidentally when doing examination or investigation for other reasons. In the majority of women with endometrial cancer, the symptoms are as follows.
Abnormal Bleeding From Vagina
This is the most common symptom in endometrial cancer. Any bleeding from vagina after menopause is abnormal. In premenopausal women, the symptoms are excessive or prolonged menstrual bleeding and intermenstrual bleeding. About 90% of women with endometrial cancer have abnormal vaginal bleeding or discharge as their only presenting symptom.
But, it should be noted that only around 10% of patients with postmenopausal bleeding have endometrial cancer. The other causes of postmenopausal bleeding are endometrial atrophy, estrogen replacement therapy, endometrial polyps and endometrial hyperplasia.
In any case, whenever postmenopausal bleeding is present it should not be neglected and should be investigated further. Abnormal vaginal bleeding in premenopausal women can also have a variety of other causes like systemic disorders, ectopic pregnancy, local infection and trauma.
The discharge could be white or clear. It could be associated with bleeding. Any such discharge is abnormal and needs to be investigated further. In premenopausal women, discharge is fairly common during menstrual cycle. Abnormal vaginal discharge could also indicate infection.
Weakness And Fatigue
Tiredness and fatigue are indicative of anemia due to excessive loss of blood. However, anemia occurs only when you have neglected excessive menstrual blood flow for quite some time.
Additional Symptoms In Advanced Stage Of Cancer
There could be lower abdominal or pelvic pain and pelvic cramping. The pain could be worse during passing of urine or sexual intercourse. You could notice swelling or lump in pelvic region when the tumour has grown to a considerable extent. You could also have unexplained weight loss.
Diagnosis And Treatment
Endometrial aspiration biopsy is a very accurate diagnostic test. A Pap test is unreliable because only about 30-50% of patients with endometrial cancer have abnormal Pap test results.
The other helpful investigations are hysteroscopy and sonohysterography. Hysterectomy (removal of uterus) followed by chemotherapy and radiotherapy is the usual treatment. In some cases, hormonal therapy is an alternative.