Related articles: Endometrial cancer
Definition
Endometrial cancer is a common gynecological malignancy in developed countries.
The tumor is usually preceded by an atypical endometrial hyperplasia, which, in most cases, evolves into an adenocarcinoma.
Endometrial cancer occurs more frequently in menopausal women, while it is rare in fertile age (the menstrual cycle involves a monthly renewal of the endometrium, therefore it is protective).
The risk of developing the disease increases in the presence of hormonal imbalances, obesity, diabetes and hypertension. Previous pelvic tumor therapy can also promote the onset of endometrial cancer and tamoxifen therapy in women with breast cancer. Risk factors also include the presence of a family history or positive personal history for breast and ovarian cancer or hereditary colorectal cancer not associated with polyposis (Lynch syndrome).
Most common symptoms and signs *
- Changes in the menstrual cycle
- Abdominal cramps
- Dismennorea
- Dysuria
- Abdominal pain
- Pain during sexual intercourse
- Pelvic pain
- Menorrhagia
- Metrorrhagia
- Blood loss after menopause
- Vaginal discharge
- polymenorrhea
- Vaginal bleeding
Further indications
Endometrial cancer typically occurs with abnormal postmenopausal or peri-menopausal vaginal bleeding (unrelated to the menstrual cycle). In women under the age of 40, a possible manifestation is the recurrent intermenstrual metrorrhagia. Other symptoms include difficulty or pain during urination and intercourse, pelvic pain, more abundant menstrual flow and reduced interval between two periods. Whitish or clear vaginal discharge may occur weeks or months before the actual bleeding. The tumor is often diagnosed early, when the disease is still confined to the uterine body and, generally, this correlates to a good prognosis. Some forms, however, spread from the surface of the uterus to the cervical canal and deeply invade the myometrium. In addition, endometrial cancer, via the bloodstream and lymphatic vessels, can give distant metastases (especially pulmonary and mediastinal). The diagnosis is formulated by endometrial biopsy and surgical staging. The latter involves the cytology of the peritoneal fluid, the exploration of abdomen and pelvis and the biopsy or excision of suspicious extrauterine lesions. Even a routine Pap test can show the presence of atypical endometrial cells. Treatment requires total hysterectomy (removal of the uterus) with bilateral salpingo-oophorectomy by laparotomy, laparoscopy or robotics. Depending on the degree of invasion, the pelvic and para-aortic lymph nodes can also be removed and all potentially involved tissues are excised. Advanced cancers require the combination of surgery, radiation therapy, chemotherapy and progestin-based hormone treatment. Even atypical endometrial hyperplasia benefits from hormone therapy and can be considered for young patients. This approach requires periodic and specific monitoring to intervene promptly in case of malign evolution.
