Endometrial Cancer

Endometrial Cancer

Overview

Endometrial cancer – cancer that develops in the lining of the uterus (endometrium). This is the most common type of uterine cancer.

Most of them are hormone dependant and are adenocarcinomas and a small subset is non endometroid adenocarcinoma

Risk Factors

  • Prolonged unopposed estrogen exposure is the main risk factor for endometrial cancer
  • Being nulliparous - this increases the risk two- or three-fold. This may be by choice or as a result of infertility with anovulatory cycles.
  • Menopause past the age of 52.
  • Obesity - raises oestrogen level
  • Atypical Endometrial hyperplasia is associated with the presence of concomitant endometrial cancer
  • Women who have hereditary nonpolyposis colon cancer (HNPCC) have a lifetime risk of 30-60% of developing endometrial cancer
  • Tamoxifen is associated with an increased risk of endometrial cancer. However, the risk of endometrial cancer is low in those women aged under 50 years who take tamoxifen for breast cancer prevention
  • Unopposed oestrogen increases the risk of endometrial cancer. Progesterone, however, counteracts the adverse effect of oestrogens.

What are the signs and symptoms?

The most common presenting symptoms are:

  • Abnormal uterine bleeding (or)
  • Post- menopausal bleeding

Evaluation

Clinical or per vaginal examination with a transvaginal or transabdominal ultrasonography is the initial evaluation to look for endometrial thickness and endometrial polyp. Hysteroscopy and endometrial biopsy is necessary for diagnosis. Surgical staging is mandatory for staging of endometrial cancer

Treatment options

  • Post exploratory laparotomy, early stage patients may require Total abdominal hysterectomy and Bilateral salpingo oophorectomy and omental biopsy and peritoneal fluid sampling
  • Higher stage or high grade endometrial cancers require radical hysterectomy with pelvic lymphadenectomy and omentectomy
  • Stage 3 and Stage 4 disease requires multi-modality therapy of surgery chemotherapy and radiotherapy
  • Radiotherapy and targeted therapy are useful in advanced cancer patients

What we offer in our centre?

Multimodality therapy including-

  • Laparoscopic staging for endometrial cancer
  • Open staging laparotomy + omentectomy + bilateral pelvic / para aortic lymphadenectomy
  • Laparoscopic/ open pelvic nodal dissection based on cancer stage
  • Chemotherapy based on cancer stage
  • Targeted therapy / molecular therapy for advanced cancer
  • Radiotherapy for advanced cancers

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