Endometrial cancer, also known as uterine cancer, most commonly occurs in older women. Fortunately, it is usually caught in its early stages when it is highly curable Figure 01. Endometrial cancer involves abnormal cellular growth of the endometrium, the tissue that lines a woman’s uterus and is normally shed each month during menstruation. Although accounting for only 6% of all cancers among women, it is the fourth most common cancer after breast, colorectal, and lung cancers.
Endometrial cancer is predominantly a disease of postmenopausal women: 95% of cases occur in women 40 years of age or older. Surgical removal of the uterus (hysterectomy), often combined with radiation, usually cures endometrial cancer. Chemotherapy is used in advanced cases.
Figure 01. Female reproductive anatomy
Endometrial cancer can result from excess amounts of the female hormone estrogen. Excess, or “unopposed” estrogen can result from a number of causes. Endometrial cancer can develop over time when estrogen is not counterbalanced by sufficient progesterone, another female hormone. This situation is referred to as “unopposed” estrogen. The cancerous cells grow from glandular cells in the lining of the uterus, and are called adenocarcinomas. Most endometrial cancers are of this “endometrioid” type, otherwise called “type I” endometrial cancer, and tend to arise when there is unopposed estrogen.
Obesity is associated with excess estrogen. This is because the hormones that can become estrogen in the body are converted to active estrogen in the body fat. Therefore, the more body fat, the higher the estrogen levels in the bloodstream and the greater the chance of getting endometrial cancer.
In addition, women with polycystic ovarian syndrome can develop type I endometrial cancers. Polycystic ovary syndrome is a condition that results in very irregular periods and many cycles during which patients do not successfully ovulate.
Another uncommon cause of unopposed estrogen is estrogen-secreting tumors, such as ovarian tumors.
There is another type of endometrial cancer that is not associated with excess or unopposed estrogen. Cancer of other cell types of the endometrium also occur, such as “serous” carcinomas, called “type II” endometrial cancer. This type of cancer tends to have a poorer prognosis than type I adenocarcinomas, and behaves like most ovarian cancers.
Endometrial cancer tends to spread first by invading the muscular wall of the uterus, and then the other pelvic organs before spreading through lymph vessels to lymph nodes. The tumor may invade deep into the muscular wall of the uterus, as well as into surrounding structures such as the vagina, bladder, or rectum. Cancerous cells can also break off from the tumor and travel (metastasize) into the vagina or through the blood or lymphatic systems to the lymph nodes, lungs, liver, bones, or brain.
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