May 18, 2023 Author : João Casanova Endometrial cancer, endometrial carcinoma or uterine cancer is the most common gynecological cancer. The uterus can be divided into two main parts: An upper portion, or body of the uterus , lined internally by the endometrium. This tissue undergoes cyclical changes throughout the fertile age (between the first menstruation and menopause) due to hormonal effects (estrogen and progesterone). The body of the uterus forms a hollow cavity and houses the fetus during pregnancy. The expression uterine cancer refers to cancer of the body of the uterus originating from the endometrium. There are other forms of cancer of the uterine body in addition to endometrial cancer. A lower area, the cervix , which is the transition between the body of the uterus and the vagina. Under normal conditions it remains closed, protecting the uterine body, and in pregnant women it dilates at the time of delivery to allow the expulsion of the fetus. There are also cancers that originate in cervix, in this case called cervical cancer. Types of endometrial cancer Endometrial cancer occurs when there is some cell mutation and altered cells multiply. There are several types of endometrial cancer, which are based on the microscopic appearance of the cells: Adenocarcinoma is the most common , it originates from the cells of the endometrial glands and has several subtypes, the endometrioid being the most frequent. Other types include, for example, uterine carcinosarcoma, squamous cell, small cell, transitional cell, serous, and stem cell carcinomas. In addition to specifying the type of endometrial cancer, microscopic observation also determines the tumor grade (1 to 3), which is related to the proportion of altered cells and the severity of the disease. The higher the degree, the more cells are altered and the more advanced and severe the disease. Causes and risk factors Endometrial cancer appears to be linked to high estrogen levels . Age is a risk factor for this disease, which mainly affects older women, especially after menopause, although it can occur at other ages. Other risk factors may increase the chance of developing endometrial cancer, including: Family history of endometrial cancer, family or personal history of other gynecological cancers or breast cancer; Hereditary genetic mutation responsible for Lynch syndrome; Excess weight, obesity, pronounced and repeated weight gains and losses over the years; Imbalances in the levels of sex hormones with an increase in estrogens, for example in diseases such as ovarian cancer and polycystic ovary syndrome; Estrogen-only hormone replacement therapy; Pelvic radiotherapy and some chemotherapy treatments; Prolonged fertile life (due to early puberty and late menopause); Never having been pregnant; High-calorie, high-fat diets and a sedentary lifestyle, both through their effects on weight and through direct effects. Symptoms and diagnosis There are no specific symptoms of endometrial cancer and any of the following should always prompt medical attention. An abnormal vaginal bleeding: That occurs after menopause; Between normal menstrual bleeding in childbearing age; Or even menstrual bleeding that are much heavier than usual. Pelvic pain and/or during sexual intercourse; An abnormal vaginal discharge; Blood in the urine; Weight loss without explanation that justifies it; Perception of the presence of a pelvic mass. In addition to suggestive symptoms and the reported history, to have A definitive diagnosis, the physician relies on results of: Physical and gynecological examination; Blood and urine tests; Other medical exams, such as example ultrasound, hysteroscopy, endometrial biopsy. In the face of a positive diagnosis of endometrial cancer, it will be necessary to carry out other exams to assess the extent and stage the disease , which is based on: Tumor size and level of uterine invasion; Spread to nearby lymph nodes; Metastases in distant organs and tissues., Endometrial cancer treatment To define the best treatment approach, the following contribute : The results of disease staging; The characteristics of tumor cells; Particularities of each woman, for example, age, general state of health, or even the desire to have children if she is still of childbearing age. In most cases, treatment involves surgery to remove the uterus (hysterectomy). It may or may not include other modalities such as radiotherapy, chemotherapy, hormone therapy or immunotherapy. When the disease is identified at an early stage and properly treated, the 5-year survival rate can exceed 96%. Endometrial cancer prevention There are no vaccines for endometrial cancer. The HPV vaccine prevents cervical cancer, but not endometrial cancer. There are no other specific preventive measures. Controlling risk factors that can be controlled, being aware of suspicious symptoms and maintaining routine gynecological surveillance is the best thing that can be done to prevent this disease . There are no screening tests for early diagnosis of endometrial cancer. References American Cancer Society . Endometrial cancer. Meet the obstetrics-gynecology clinical team from Hospital da Luz network The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
