Cancer Results

Overview

The uterus consists of 2 main layers: the endometrium (inner layer) and the myometrium (outer layer).

Most cancers of the uterus are from cells that form glands in the endometrium layer and are called endometrial carcinomas. The focus of this document is on the most common type of endometrial carcinoma, known as endometrioid adenocarcinoma. More aggressive forms include clear-cell, serous and poorly differentiated carcinoma.

Endometrial cancer is often mistaken for but is not the same as cervical cancer, which starts in the cervix and may spread to the body of the uterus

Signs and Symptoms^4,5,6

Unusual vaginal bleeding, spotting and/or abnormal discharge; difficulty or pain when urinating; pain during sexual intercourse; abdominal fullness/pressure; pelvic pain; pelvic mass; weight loss.

Diagnosis and work-up

Screening Options^4,5,6

There are no regular screening test recommendations for endometrial cancer at this time. In most cases, endometrial cancers are found by noticing related signs and symptoms, which is followed up by examination. For those at elevated or high risk, screening may include endometrial biopsies and/or transvaginal ultrasounds at regular intervals.

Treatment Options^4,5,6

Early-advanced stage cancer

The primary treatment for early stage endometrial cancer is surgery which may entail removal of the uterus (hysterectomy) or removal of the uterus along with the fallopian tubes and ovaries (total abdominal hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes from the pelvis and along the aorta may also be removed and analyzed. Other therapies, including vaginal brachytherapy (VB), pelvic radiation, or both may be recommended either before or after surgery. If the endometrial cancer is aggressive and/or of high grade, the surgery may be more extensive including removal of the omentum. Chemotherapy is often given along with radiation therapy.

Metastatic stage cancer

Surgery may be appropriate to alleviate symptoms. Disseminated metastatic endometrial is typically treated with chemotherapy and radiation therapy and/or hormonal therapy.

Risk Factors^3,4,5

Demographics: Older age; female gender

Lifestyle: High fat diet; obesity

Medical History: Estrogen-only hormone replacement therapy; Tamoxifen use; other causes of excess exposure to estrogen unopposed by progesterone; polycystic ovarian syndrome (PCOS); diabetes; endometrial hyperplasia; prior radiation exposure; nulliparity; early menarche and late menopause; infertility; prior pelvic radiation therapy

Risk reduction options: Birth control pills; hysterectomy and bilateral salpingo-oophorectomy; pregnancy; physical activity

Inherited: Family history of disease; inherited genetic syndromes

Associated Myriad MyRisk™ Genes: MLH1, MSH2, MSH6, PMS2, EPCAM, TP53, PTEN, STK11

References

1. Surveillance, Epidemiology and End Results Program, National Cancer Institute (seer.cancer.gov) Dec 10, 2013.
2. Lucenteforte E, Talamini R, Montella M, Dal Maso L, Pelucchi C, Franceschi S, La Vecchia C, Negri E. Family history of cancer and the risk of endometrial cancer. Eur J Cancer Prev. 2009 Apr;18(2):95-9. doi: 10.1097/CEJ.0b013e328305a0c9. PubMed PMID: 19337055
3. Gruber SB, Thompson WD. A population-based study of endometrial cancer and familial risk in younger women. Cancer and Steroid Hormone Study Group. Cancer Epidemiol Biomarkers Prev. 1996 Jun;5(6):411-7. PubMed PMID: 8781735.
4. American Society of Clinical Oncology: Uterine Cancer (http://www.cancer.net/cancer-types/uterine-cancer) Dec 10, 2013.
5. American Cancer Society: Endometrial Cancer (http://www.cancer.org/cancer/endometrialcancer/index) Dec 10, 2013.
6. National Cancer Institute: Endometrial Cancer treatment (http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/patient) Dec 10, 2013.