What is uterine-endometrial cancer?
Cancer is a disease in which certain cells of the body grow without control. The uterus (or womb), whose function is to allow embryo-fetal growth during pregnancy, is composed of three layers. The inner layer is called the endometrium, and is what is released with each menstrual cycle in the form of bleeding during the woman’s fertile age. The middle layer is called myometrium and is formed by the uterine muscle itself, is the thickest layer and is what gives shape to the organ. Finally, the outer layer is a thin layer that covers the organ (peritoneum).
According with the uterine origin, there are two main types of uterine cancer:
- Those that develop from the endometrium, that are the most frequent
- Those that originate from the myometrium or uterine sarcomas
Can endometrial cancer be detected early? Could it be prevented?
There are no effective methods for prevention or early diagnosis of endometrial cancer. The most important factor is that women are alert of the symptoms that can occur, and consult as soon as possible with a gynecologist to avoid delays in diagnosis and treatment. The main symptom is genital bleeding after menopause. Pelvic pain or other nonspecific symptoms are very rare in this type of tumor. Likewise, it is important to mention that it is very common to make the diagnosis in asymptomatic women.
Endometrial cancer, in rare cases, can be associated with gene mutations that can cause cancer in other organs such as the intestine. This is known as Lynch Syndrome (hereditary nonpolipoid colorectal cancer syndrome). This is why the management of women with endometrial cancer should be studied and treated by professionals with sufficient knowledge and preparation.
It is important to remember that cytology is not useful for early detection of endometrial cancer. Its function is to detect pre-malignant lesions of the uterine cervix or cervical cancer at very early stages.
What are the risk factors for the development of endometrial cancer?
Most uterine tumors are diagnosed in women near menopause, either a few years before or after. This is the most frequent gynecological cancer and is the 3rd most common cause of cancer among women.
While it is difficult to find a specific cause of endometrial cancer. These are some of the main factors that could increase the risk:
- Age: more than 90% of endometrial tumors occur in women over 40 years
- Hormone replacement therapy in menopause (only with estrogen and without progesterone)
- Tamoxifen: is a drug indicated in women with certain types of breast cancer and that can produce continuous growth of the endometrium.
- Have family members with a history of cancer of the uterus, colon or ovary.
The fact of having any of the risk factors mentioned above does not mean that the woman will have endometrial cancer in the future; this only means that it is necessary to discuss this information with her gynecologist.
What do I have to do to prevent uterine-endometrial cancer?
While there are no specific ways to prevent uterine cancer, some of the following measures may help reduce the risk:
- Use of oral contraceptives
- Multiple pregnancies
- Maintain a healthy and active life with a healthy diet, avoiding obesity, diabetes and hypertension.
What are the symptoms of uterine-endometrial cancer?
Almost 80% of women with endometrial cancer are diagnosed at early stages, and usually after the onset of symptoms. That is why it is very important that women know the main symptoms which include:
- Abnormal genital bleeding (the most common symptom): This may occur during menopause, or during childbearing age outside of the menstrual period.
- Abnormal vaginal discharge.
- Pain or sensation of pressure in the region of the pelvis.
- Changes in the rhythm of bowel habits or urination.
Although these symptoms are also produced by other causes, it is important that women who present some of them persistently, go to the gynecologist.
What procedures can help diagnose endometrial cancer?
- Gynecological ultrasound: is done by introducing a vaginal probe to observe the uterus with its characteristics, including its shape and size. In this way, the presence of fibroids, or polyps in the uterine cavity, can be determined and the thickness of the endometrium (inner layer of the uterus) can be measured. The latter is usually of great help to guide the following diagnostic steps.
- Endometrial biopsy: there are different ways to take an endometrial biopsy to be later analyzed by the pathologist:
- In the office: through thin devices that are introduced into the uterine cavity through the uterine cervix.
- In the operating room: by means of a curettage. It is a procedure that requires general anesthesia but the patient can be discharged on the same day as the procedure, which usually lasts no longer than 20 minutes.
- With direct visualization of the uterine cavity in an operating room: this is carried out by a hysteroscopy. It can be done with local or general anesthesia. It is a procedure that does not usually require hospital admission and is the most used method because it is the most reliable approach, allowing to take the biopsy by looking at the most suspicious lesions.
- Computed axial tomography (CT): is performed routinely prior to any oncological treatment to determine the extension of the disease outside the affected organ: lymph nodes, abdominal organs or the thoracic cavity. It is usually done with oral and intravenous contrast.
- Magnetic resonance imaging (MRI): it is a useful complementary study for the diagnosis of the local extension of the disease.
How should uterine-endometrial cancer be treated?
The final decision of the best treatment for each case is based on the following factors:
- The size of the tumor
- The extent of the disease
- Your wishes for future fertility
- The general state of health
- The patient’s preferences
We are committed to the development of innovative surgical techniques for the treatment of gynecological cancer, including tumors of the uterus. In this sense, laparoscopic mini-invasive surgery represents the best example of technological development to ensure the best surgical results, minimizing postoperative complications.
We are currently especially involved in offering patients the most effective and least invasive therapeutic strategies. Surgical treatment usually represents the first therapeutic strategy of uterine-endometrial cancer that may include any of the following procedures:
- Hysterectomy: removal of the uterus including the cervix.
- Bilateral adnexectomy: consists of the removal of both ovaries and tubes (uterine annexes).
- Pelvic and aortic lymphadenectomy: removal of the lymph nodes surrounding the main arteries and veins of the abdomen and pelvis.
- Detection of the sentinel lymph node: consists of the injection with a tracer (Indocianin Green – ICG-) in the region of the tumor that serves to identify the sentinel node in the pelvis where the tumor would migrate, at the time of the surgical act. This lymph node (although they may be 2 or 3 in number) is identified, extracted and analyzed at the same time by a specialized pathologist. If malignant cells are identified, all pelvic lymph nodes are removed
This is a novel technique that we perform routinely in these women.
- Omentectomy: removal of a fatty tissue attached to the large intestine. It is reserved for specific types of endometrial cancer such as serous histology.
We are committed to the development of innovative surgical techniques for the treatment of gynecological cancer, including cervical tumors. In this sense, laparoscopic mini-invasive surgery represents the best example of technological development to ensure the best surgical results with faster and safer patient recovery. We perform these procedures in almost 100% of patients by using a laparoscopic mini-invasive approach.
After surgery, pathologists will carefully review the material sent to obtain a final diagnosis and determine the true extent of the disease. Then, all the best postoperative therapeutic options are taken into consideration based on factors that include:
- The intra-operative findings
- The final histological result
- The general conditions of each patient
- The preferences of the patient and their relatives
The decision can be simply observation and follow-up, or it can include radiotherapy and / or chemotherapy according to each case.
Follow-up and surveillance:
The oncological follow-up period begins after the initial cancer treatment. Its main objective is to detect early possible recurrence of the disease.
Beyond adopting the most effective follow-up rules, we also pay special attention and interest in maintaining and increasing the quality of life of our patients and achieving a rapid and effective re-insertion in everyday life as before the diagnosis of their cancer.