Causes and risk factors
The cells undergo an abnormal and uncontrolled proliferation, eventually these clusters of cells can lead to formation of a tumor or mass. What causes this abnormal growth is still a mystery. However, tedious research and study of various cases have laid down certain risk factors which can predispose a person to cancer. Genetic factors head the list. A strong family history is one of the major contributing factors. Endometrial cancers are more commonly seen in women after the age of menopause. Hormonal imbalance leading to increase in estrogen levels increases the risk factor for endometrial cancer. Use of estrogen therapy for treating menopausal complaints can pose a possible risk for developing cancer. Infertility and more menstrual cycles too increase the risk. Certain diseases of the uterus like polycystic ovarian disease, ovarian tumor, and use of intrauterine device are other predisposing factors. Certain other factors can predispose a person to cancer, these are: Smoking and chewing tobacco, excessive use of alcohol and poor nutrition; human papilloma virus which causes a benign growth has also been a precursor towards development of cancer. Immuncompromised females are also at high risk of developing cervical cancers. Endometrial cancer can also occur as a result of metastasis of cancer present somewhere else in the body.
Clinical presentation
There are different types of endometrial cancers – squamous cell carcinoma, adenocarcinoma, small cell carcinoma, undifferentiated carcinoma, and carcinosarcoma and transitional cell carcinoma. Indolent growths of the abnormal cells in its initial stage do not pose any noticeable signs and symptoms in the body, hence the patient remains asymptomatic for a long period. Over a period of time, the patient may come up with other health issues. On most of the occasions, the patient usually comes up with vague symptoms like body ache, fatigue, and tenderness all over the body. A noticeable change in weight is complained by the patient or is brought into notice by the known ones. In the early stages of formation of a tumor, no signs and symptoms are evident. As the tumor increases in size, following symptoms can be seen – vaginal bleeding other than menstruation is seen. Irregularities in menses occur. The bleeding is either profuse or prolonged. Dull aching pain and discomfort in the pelvic region is felt. The pain may radiate to the back. The patient can come with complaints of pain during intercourse. Abnormal vaginal discharges can also be seen. If the cancer has spread to other parts of the body, certain other complaints pertaining to other systems of the body is also seen.
Investigations
Diagnosis is done on the basis of the symptoms narrated by the patient and the rectovaginal examination carried out by the gynecologist. Hysteroscopy for internal visualization of the uterus and Pap smear are done. Biopsy is the diagnostic investigation. Transvaginal or abdominal sonography, cystoscopy, proctoscopy, and CT scan can be done. In addition to these, routine blood, CA-125 blood test, ultrasonography, and MRI scans are advised for metastasis.
Treatment
Depending upon the extent and stages of cancer, the treatment is planned. Various surgical approaches can be adopted. Hysterectomy is found to be effective in cases where metastasis has not occurred. Along with this, salpingo-oophorectomy is also done. Radiation therapy is used. Targeted chemotherapy and immunotherapeutic agents are administered. Along with the above-mentioned treatment, certain preventive measures need to be implemented. All sexually active women should get vaccinated against human papilloma virus and use barrier contraceptive devices during sexual intercourse, e.g., condoms. Regular Pap smears should be done. In women between the ages of 21 and 29, it should be done after every 2 years and in women after the age of 30, it should be done after every 3 years.
Recent update:
As per the American Cancer Society, researchers are examining new drugs, combination of various drugs and targeted therapies for treatment of advance endometrial cancers.
