Back To CoursePathophysiology Textbook
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Heather has taught reproductive biology and has researched neuro, repro and endocrinology. She has a PhD in Zoology/Biology.
If you've been following our other lesson on endometrial cancer, then you're all caught up as to what endometrial cancer is. But for those of you who may have missed our other lesson or like to do things out of order, endometrial cancer is a cancer that occurs in the endometrial lining of the uterus. See, the uterus has three layers: outer, middle and inner.
The endometrium is the inner lining, or layer, of the uterine wall, the one that grows and sheds during menstruation. This one here:
And, in case you haven't put two and two together, this is a cancer of the female reproductive tract, meaning that you guys don't have to worry about getting it, although you do have some male-specific cancers of your own to be aware of, but those are covered in other lessons.
So, Step 1: What is endometrial cancer? Check!
Step 2: How is it diagnosed? Well, just like most diseases, endometrial cancer comes with a set of symptoms that doctors look out for. The first one is any type of abnormal bleeding from the vaginal area. What do I mean by abnormal? Well, any bleeding that a patient doesn't normally see during their menstrual period. This could be:
Bleeding is usually the first symptom of endometrial cancer and occurs in the early stages of the disease. The good thing is that the early stages of endometrial cancer are slow-growing and, if caught early, the chances of a cure are good. However, if untreated, other symptoms can occur. Usually the bleeding is painless, but sometimes it can be associated with other symptoms, including:
But how does a doctor confirm that these symptoms are indeed signs of endometrial cancer? Many problems with the female reproductive tract can also include abnormal bleeding or pelvic pain.
To start, doctors can perform a routine pelvic exam just like they do during a woman's annual physical. This type of exam allows doctors to inspect the outer vaginal area and feel the inner cervix and uterus for any changes in size or shape. The next step to confirm endometrial cancer is inserting a small scope like a miniature camera or an ultrasound device into the vaginal canal to get a visual picture of the uterus. This will help the doctor view any abnormalities that may be present.
However, the best test is an endometrial biopsy. A biopsy is the removal of a small piece of tissue. Think of it like this: the word 'bio' means 'life,' and 'opsy' is kind of like the word 'optical.' And what do we think of when we hear 'optical?' Well, probably glasses or optics, all of which are associated with looking at things. So a biopsy is looking at a small piece of life, or in this case, live tissue from the human body.
In an endometrial biopsy, a piece of endometrial tissue is removed from the uterus and screened for cancer. This allows the doctor to examine the tissue directly to see if any cancer cells are present. This procedure identifies almost 80-90% of endometrial cancers.
And that brings us to Step 3: Treatment options. Once a woman is diagnosed with endometrial cancer, the first step is to determine what stage the cancer is at. Like most other cancers, the stages of endometrial cancer are associated with how far along the disease has progressed.
In the early stages (Stages 1 and 2), the cancer is confined to the uterus and/or the cervix, these two areas here:
These are the stages where the chances of recovery are highest because the cancer is localized to one area. But once the cancer spreads out of the reproductive tract (Stages 3 and 4) to other parts of the body, its gets harder to treat. Treatment is similar to other cancers, and the three main pathways are:
These can be used together or separately. The earlier stages of endometrial cancer are better candidates for surgery or localized radiation therapy because the cancer is localized to the reproductive tract. However, radiation is not as effective by itself and is more effective when combined with surgery.
Once the cancer has spread, however, surgery can be combined with chemotherapy or hormone therapy. Both chemo and hormone therapy target the whole body rather than just the reproductive tract. Chemotherapy is when cancer-killing chemicals are put into the bloodstream so they can travel throughout the body. Hormone therapy is similar but uses synthetic hormones to increase progesterone or decrease estrogen in the body.
Hmmm...why would you want to give hormones to someone with cancer? Aren't they used for things like reproduction? And yes, they are, but let's think about it a second. Where is endometrial cancer located? In the female reproductive tract, right? And what does the reproductive system use to function and communicate with the rest of the body? Ah, hormones! You see, cancers of the female reproductive tract are sensitive to the hormones of female reproduction. That's estrogen and progesterone.
Higher levels of estrogen tend to increase hormone-sensitive cancers, while higher levels of progesterone can help decrease them by slowing down cell growth. It's like a balancing act. If both estrogen and progesterone increase, then the scale stays balanced. But if only estrogen increases, the scale is off-balance, so we have to use medication to increase progesterone to help restore the balance!
So before we wrap up, let's take a quick moment to review. Endometrial cancer is a cancer that occurs in the endometrial lining of the uterus. The endometrium is the inner lining, or layer, of the uterine wall, the one that grows and sheds during menstruation.
One of the first and most common symptoms is abnormal bleeding. This can be in the form of bleeding in between periods or excessive bleeding during menstruation, watery, blood-tinted fluid or discharge in between menstrual periods, or bleeding after menopause. Usually the bleeding is painless, but sometimes it can be associated with other symptoms, including pelvic pain or cramping, pain during intercourse, pressure in the abdominal area, or enlarged lymph nodes.
Confirmation of endometrial cancer can be done through a pelvic exam to feel for abnormalities in size or shape of the uterus, a visual exam using a small scope or ultrasound to view the uterus, and a biopsy of the endometrial tissue to confirm the presence of cancer cells inside the uterus. Once confirmed, there's a few options for treatment. These can be used individually or together.
Surgery can be used during the early stages to remove the cancer cells from the uterus. Second, local radiation can be used to treat the cancer cells locally or, third, chemotherapy, to treat cancer that has spread to other parts of the body. And fourth, for those who may not want to undergo surgery or chemo or cannot tolerate it, there is also hormone therapy. This can be used to slow down the growth and progression of the cancer cells. The first two, surgery and local radiation, are usually used during the earlier stages of cancer, while chemo and hormone therapy are more often used during the later stages.
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Back To CoursePathophysiology Textbook
20 chapters | 274 lessons