This cancer arises from the innermost lining (endometrium) of the uterus (womb).
In younger patients, it is associated with increased exposure to oestrogen. Oestrogen is the main female hormone, which causes the endometrium to build up each month and then be shed as a period.
What are the Risk Factors ?
It is thought that factors which lead to prolonged higher than usual levels of oestrogen, or estrogenic actions not being 'balanced' by progesterone, may somehow increase the risk of endometrial cells becoming cancerous. These include:
- If you have never given birth to a baby.
- If you are overweight.
- If you take oestrogen-only HRT (hormone replacement therapy). Most women take 'combined HRT' which includes progestogen to balance the effect of oestrogen to reduce the risk of endometrial cancer.
- If you have certain rare oestrogen producing tumours.
- If you have a late menopause (after the age of 52) or started periods at a young age.
Other Risk Factors
1. Endometrial hyperplasia
This is a benign (non cancerous) condition where the endometrium builds up more than usual. It can cause heavy periods, or irregular bleeding after the menopause. Most women with this condition do not develop cancer, but their risk is slightly increased.
This is a drug, which is used in the treatment of breast cancer. Although taking tamoxifen increases the risk of developing endometrial cancer, the benefits of taking it usually outweigh the risks.
3. Diabetes and High Blood Pressure.
The small increased risk with these two conditions may be related to the fact that many people with these conditions are overweight.
4. Polycystic Ovary Syndrome (PCOS)
This is a condition where women do not ovulate regularly and have infrequent & irregular menstruation. It possibly increases the risk.
A diet high in fat may be a contributing factor.
6. Genetic factors
Most cases are not due to genetic or hereditary factors. In a small number of cases, a 'faulty' gene, which can be inherited, may trigger the disease. Patients would usually have a family history of breast, ovarian, uterine and colonic cancers.
What are the symptoms of endometrial cancer?
In most cases the first symptom to develop is abnormal bleeding from the vagina as follows:
- Vaginal bleeding in women past the menopause. This can range from 'spotting' to more heavy bleeds.
- Bleeding between normal periods (intermenstrual bleeding) in women who have not gone through the menopause.
How is endometrial cancer diagnosed and assessed?
1. Precise and definite diagnosis is first important step. Cancer of the Endometrium is usually diagnosed by performing:
- Endometrial sampling
This is done in the clinic setting. The procedure involves passing a thin tube into the uterus. By using gentle suction, small samples of the endometrium are obtained. The sample (biopsy) is processed and examined under the microscope for cancerous cells.
- Hysteroscopy and Dilatation & Curettage
This is usually done under general anaesthesia. The procedure involves your gynaecologist inserting a thin telescope (hysteroscope) through the cervix into the uterus. The doctor can see the lining of the uterus and take samples (biopsies) of abnormal looking areas.
2. Following diagnosis, the next step is to assess the extent of spread (Stage) of the cancer by:
- CT Scan; MRI Scan or PET-CT Scan
- Chest X-Ray; Blood Test