Endometrial Cancer Treatment In India

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What is Endometrial cancer?

Endometrial cancer is also known as uterine cancer and it is a type of cancer that begins in the uterus. The uterus is a hollow, pear-shaped pelvic organ where fetal development takes place. Endometrial cancer begins to form in the lining (endometrium) of the uterus. If discovered early, surgically removing the uterus cures it.

What are the symptoms of Endometrial cancer?

The common symptom of endometrial cancer is abnormal vaginal bleeding, this includes:

  • Changes in the length or flow of menstrual periods
  • Vaginal bleeding or spotting during menstrual periods
  • Vaginal bleeding even after menopause
  • Blood-tinged vaginal discharge
  • Pain in the lower abdomen or pelvis
  • Pain during sex

Abnormal vaginal bleeding can also be caused by menopause or other non-cancerous conditions. But in some cases, it is a clear sign of endometrial cancer. Therefore, your physician can help you identify the cause of your symptoms and recommend the appropriate treatment. 

What are the causes of Endometrial cancer?

Below are some factors that increase the risk of endometrial cancer:

  • Changes that may occur in the balance of female hormones in the body – The ovaries produce two main female hormones — estrogen and progesterone. Changes in the balance of these hormones may cause endometrium cancer.
  • More years of menstruation – When menstruation starts at an early age (before 12 years of age) or getting menopause later, increases the risk of endometrial cancer.
  • Infertility / Never become pregnant – If you have never been pregnant, you are at a higher risk of endometrial cancer.
  • Older age – As you get older, your risk of endometrial cancer will increase. Generally, endometrial cancer occurs after menopause.
  • Obesity – Being obese will increase your risk of endometrial cancer. This occurs because of excess body fat, which alters your body’s balance of hormones.
  • Hormone therapy for breast cancer – Taking hormone therapy drugs for breast cancer will increase the risk of developing endometrial cancer.
  • An inherited colon cancer syndrome – Lynch syndrome increases the risk of colon cancer and other cancers, including endometrial cancer. Lynch syndrome is inherited from parents to children.

The following factors may also increase a woman’s risk of developing endometrial cancer:

  • Obesity
  • Family history of endometrial, ovarian cancer or colon cancers
  • Diabetes
  • Personal history of breast cancer
  • Personal history of ovarian cancer
  • Prior radiation therapy for pelvic cancer
  • Personal history of polycystic ovary syndrome

How is endometrial cancer diagnosed?

The tests and procedures used to diagnose endometrial cancer include the following:

  • Physical examination and medical history: An examination of the body to check general signs of health, including lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken into consideration.
  • Transvaginal ultrasound examination: This is a procedure used to examine the vagina, uterus, fallopian tubes, and bladder. To perform a transvaginal ultrasound, your physician will insert an ultrasound probe into your vagina. This probe will transmit images onto a monitor.

If your physician detects abnormalities during the ultrasound examination, they may request one or more of the following tests to collect a sample of the tissue for testing:

  • Endometrial biopsy: In this test, your physician will insert a thin flexible tube through your cervix into your uterus. They will apply suction to remove a small piece of tissue from your endometrium through the tube.
  • Dilation and curettage (D&C): If the results of a biopsy are unclear, your physician may collect another sample of endometrial tissue using D&C. To do this procedure, they will dilate your cervix and use a special tool to scrape tissue from your endometrium.

After collecting a sample of tissue from your endometrium, your physician will send it to a laboratory for testing. A laboratory professional will examine the sample under a microscope to check if it contains cancer cells. If you have endometrial cancer, your doctor will request additional tests to find out if cancer has spread to other organs or not, such as PET Scan etc.

What are the stages of endometrial cancer?

Endometrial cancer gradually spreads from the uterus to other parts of the body. The cancer is classified into four stages, based on the extent of growth:

Stage 1: The cancer is present in the uterus only.

Stage 2: The cancer is present in both, the uterus and cervix.

Stage 3: Cancer has spread beyond the uterus, but not as far as the rectum or bladder. It may be present in the fallopian tubes, ovaries, vagina, or the nearby lymph nodes.

Stage 4: Cancer has spread beyond the pelvic area like the bladder, rectum, or the distant tissues and organs.

Endometrial cancer is easier to treat in the early stages.

What is the treatment for endometrial cancer?

The specific treatment for endometrial cancer will be determined by your physician based on the following:

  • Your overall health and medical history
  • The extent of the disease
  • Your tolerance for medications, procedures or therapies
  • It will also depend on the subtype and stage of cancer.

The choice of treatment will depend on the stage of cancer. Most people will be treated with surgery first and some may need additional options, such as the following: 

Surgery:

  • Hysterectomy – surgical removal of the uterus
  • Salpingo-oophorectomy – surgical removal of the fallopian tubes and ovaries
  • Pelvic lymph node dissection – surgical removal of some of the lymph nodes from the pelvis
  • Para-aortic lymphadenectomy – surgical removal of the lymph nodes that surround the aorta, the main artery of the heart
  • Laparoscopic lymph node sampling – surgical removal of lymph nodes through a narrow viewing tube called a laparoscope, which is inserted through a small incision (cut) in the abdomen (belly). To check if cancer has spread, the surgeon will also remove the nearby lymph nodes for testing. This is known as lymph node dissection or lymphadenectomy and this will help to determine the stage of your cancer.
  • Sentinel lymph node mapping – use of fluorescent imaging to identify cancerous lymph nodes that would otherwise go undetected.

In case, cancer has spread to other areas of the body, the surgeon might recommend additional surgeries. After the surgeon removes all cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or hormone treatment after surgery to kill any cancer cells that are left.

Radiation therapy:

Radiation therapy will use high-energy beams to kill cancer cells. Your physician may recommend one or both types of radiation therapy after the surgery. This will help to kill cancer cells that remain after the surgery. In some cases, radiation therapy is recommended before surgery, which can help to shrink tumors to make them easier to remove. But if you cannot have surgery due to poor health, then your doctor may recommend radiation therapy as the main treatment. There are two main types of radiation therapy which is used to treat endometrial cancer:

  • External beam radiation therapy: An external machine focuses beams of radiation on the uterus from outside the body.
  • Internal radiation therapy: Radioactive materials are placed inside the body, in the vagina or uterus and this is also known as brachytherapy.

Chemotherapy:

Chemotherapy uses chemicals to kill cancer cells and you may receive one or more chemo drugs in combination. Chemotherapy drugs are administered by pills (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body and kill the cancer cells.

Chemotherapy is recommended after surgery if there’s an increased risk that cancer may return. Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer that has spread to the other parts of the body.

Hormone therapy:

Hormone therapy involves the use of hormone-blocking drugs to lower hormone levels in the body. In response, cancer cells that rely on hormones for their growth will die. 

Your physician might recommend hormone therapy for stage III or stage IV endometrial cancer which has spread to the other parts of the body. Hormone therapy is often combined with chemotherapy.

Targeted drug therapy:

Targeted drug treatments focus on the specific weakness present within the cancer cells. By blocking these weaknesses, targeted drug treatments will cause cancer cells to die. Targeted drug therapy is combined with chemotherapy for treating advanced endometrial cancer.

Immunotherapy:

Immunotherapy is a drug treatment which helps your immune system to fight cancer. Your immune system might not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For endometrial cancer, immunotherapy might be considered if the cancer is advanced and other treatments have not helped.

Supportive (palliative) care:

Palliative care is specialized medical care which focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that helps your ongoing care. Palliative care can be used while undergoing other treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used with the other appropriate treatments, then cancer patients may feel better and live longer. Palliative care aims to improve the quality of life for cancer patients.

Frequently Asked Questions:

What is the success rate of uterine cancer?

The survival rate for women with uterine cancer is 81%. 

How long before endometrial hyperplasia turns into cancer?

It takes ten to twelve years from the time it begins to grow to develop into endometrial cancer.

What is the aggressive form of uterine cancer?

The most common type of uterine cancer is adenocarcinoma and other variants of uterine cancer include serous carcinoma and uterine clear cell carcinoma. 

Does uterine cancer bleed all the time?

Around 90% of women with endometrial cancer have experienced abnormal vaginal bleeding. This could be a change in their periods, bleeding between periods, or bleeding after menopause. 

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