Dr. M.J. Bazos, MD
Patient Handout
ENDOMETRIAL
CANCER
About Your
Diagnosis
The uterus, or womb, is
located between the bladder and the rectum. The inner layer of the uterus is
called the endometrium. Endometrial cancer is cancer of the cells of this
layer. More than 30,000 new cases of endometrial cancer are diagnosed each year
in the United States. The cause is not known. The cancer usually occurs among
women between 55 and 70 years of age but can occur among younger women before
they go through menopause. Women at risk for endometrial cancer are obese, have
diabetes, and have never been pregnant or given birth. Another risk is taking
estrogen as replacement therapy for the effects of menopause. The only sure way
to diagnose endometrial cancer is to obtain tissue by means of biopsy and
examine it with a microscope. This is usually done because a woman reports
abnormal vaginal bleeding. Endometrial cancer detected early can be
cured.
Living With Your
Diagnosis
Vaginal bleeding after
menopause is the primary symptom for nearly 90% of patients. If you go through
menopause and start bleeding again, this is abnormal and should be evaluated.
For women who have not yet gone through menopause, any abnormal vaginal bleeding
(heavy bleeding, minimal bleeding, bleeding between menstrual cycles) should be
evaluated. Endometrial cancer if left untreated spreads locally to nearby
structures, causing a foul vaginal discharge, pain in the pelvic area, bloating,
bowel symptoms such as constipation and blood in stools, and urinary symptoms
such as frequency, urgency, or pain with urination. If the cancer continues to
spread, it can cause local swollen lymph glands and an abdominal mass and
eventually involve the liver, lung, and
bone.
Treatment
To
confirm the diagnosis of endometrial cancer for a woman with abnormal vaginal
bleeding, a biopsy specimen is obtained from the uterus by means of a procedure
called dilation and curettage (D & C). The cervix is dilated (widened) and a
curette (a small spoon-shaped instrument) is inserted to remove tissue. Once the
diagnosis is confirmed, a physician determines the extent of cancer (staging).
Staging tells whether the cancer has spread. Blood tests, chest radiographs
(x-rays), and computed tomographic (CT) scans of the abdomen and pelvis are
obtained to look for any spread. Treatment can be surgical, radiation, hormonal,
or chemotherapy. The treatment used depends on the stage of the cancer (stage I,
tumor confined to the uterus; stage II, tumor invading the cervix; stage III,
tumor involving the vagina, ovary or abdominal cavity; stage IV, tumor invading
the bladder and intestine). Most endometrial cancers are in the early stages (I
or II), and surgical removal of the uterus, fallopian tubes, and ovaries
(hysterectomy and bilateral salpingo-oophorectomy) generally is recommended.
Radiation may be given after the operation if the cancer extends beyond the
uterus. The patient and physicians must discussed this. Side effects of surgical
treatment include pain and soreness in the pelvic area and difficulty in
emptying the bladder or moving the bowels. Side effects of radiation therapy are
red, dry, itchy skin, fatigue, diarrhea, discomfort with urination, dryness of
the vagina, and pain with intercourse. The hormone called progesterone may be
recommended if the cancer has spread extensively or has returned after
treatment. Chemotherapy also may be recommended in this situation. Side effects
of hormonal therapy include breast tenderness, leg swelling, acne, nausea, and
headaches. Side effects of chemotherapy include nausea, vomiting, hair loss,
easy bruising and bleeding, and infections.
The
DOs
• Remember that sexual
intercourse and desire are not affected by hysterectomy. Sexual intercourse and
normal activity can be resumed 4 to 8 weeks after the
operation.
• Remember you will no
longer have periods (menstrual cycles). If your ovaries are removed or damaged
by irradiation, menopause occurs, and you can experience hot flashes, sweating,
and other symptoms of menopause.
•
Keep all your follow-up visits during and after treatment. It is important to
undergo examinations to look for response to treatment or recurrence of
cancer.
The
DON’Ts
• Do not ignore any
vaginal bleeding after menopause.
•
Do not ignore any abnormal vaginal
bleeding
(excess, between periods) before
menopause.
• Do not forget the risk
of using estrogen replacement, and discuss this with your
physician.
• Do not forget the
importance of exercise and diet both before the diagnosis and after therapy for
endometrial cancer.
• Do not forget
there is evidence that shows the use of birth control pills may decrease risk
for ndometrial cancer, presumably because of the progesterone in the
pill.
When to Call Your
Doctor
• If there is any vaginal
bleeding or abnormal vaginal
bleeding.
• If you have any abnormal
vaginal discharge (smell, quantity,
color).
• If you need emotional
support after treatment.
• If you
have any side effects of treatment (surgical, radiation, hormonal, or
chemotherapy).