Endometrial Cancer Diagnosis and Treatment
for laymen and students
Mario Kopljar, MD
WARNING! This information is
for general use only. If you have EC, ask your doctor to explain these
facts and how they apply to you.
Early symptoms
Go to the beginning
Bleeding is usually the first symptom of EC. Since this tumor is found
mostly in elderly women, any bleeding (from vagina) after the menopause
is suspicious for endometrial tumor. But tumor may obstruct cervical
canal so that blood can not be expelled and that results in abdominal
pains that may vary in intensity from mild cramps to labor like pain. If
a woman is still having menstrual cycles, bleeding is irregular, massive
and does not cease after couple of days like normal menstrual bleeding.
Approximately one quarter of all endometrial carcinomas occur in women
who still have menstrual bleedings. More advanced stages present with
intensive pain, weight loss, anemia (decreased red blood cells count).
Diagnostic process
Go to the beginning
Diagnostic procedures are bimanual vaginal and rectal palpation,
curettage, cytology and histology. But only curettage and hystological
examination under the microscope can result in exact diagnosis.
Postmenopausal bleeding is alarming and on examination uterus is
enlarged and softened as if a woman is pennant. Other findings are also
possible. If tubes and ovaries are fixed and hard it indicates that EC
has invaded them (see Staging and grading). With rectal examination one
can determine whether the tumor has invaded paracervical tissue.
Rectoscopy and cystoscopy may help in exploring intestines and urinary
bladder in search for the signs of invasion. Cytology is not very
reliable, about 50%. Microscopical examination of the tissue obtained by
curettage (DC) is definitely the most exact method in diagnosing EC. It
can tell organic bleeding like miomas or adenomas from inflammations
(endometritis, TBC) and functional bleeding. It is obligatory in any
case of suspicious vaginal bleeding. First a sample is taken from the
cervical canal. Then the canal is widened and samples from the uterus
lining are taken. Tubar angles and the fundus as common sites of
occurrence must be carefully explored. Procedure is done under
anesthesia.
Ultrasound can be used to examine both uterus and urinary bladder.
Cystoscopy (visualization of the inside of the urinary bladder through a
thin tube) can be helpful. CT scan or NMR can be used to determine the
spread, and lymphography is the method of radiological examination of
the lymph nodes.
Complications
Go to the beginning
Inflammation of the uterus (piometra) may occur if the cervical canal
gets occluded. The infection ascends and uterus gets enlarged. Patient
has fever and blood tests show signs of infection (elevated count of
white blood cells, increased sedimentation rate etc.). Intracervical
application of radioactive substances, endometrial TBC and some other
infections may also result in piometra. Main treatment is to dilate
cervix and give antibiotics.
Differential diagnosis (or What
else can it be?)
Go to the beginning
Any postmenopausal bleeding is suspicious for cervical or endometrial
carcinoma, especially in peri- and postmenopausal women. The former
often have irregular bleeding which is usually not abnormal. Carcinomas
and sarcomas of the vulva and vagina may also be the cause of bleeding.
Cervical erosions, polyps, miomas and endometritis are some of the
benign diseases of the female genital tract that may, at first sight, be
mistaken for endometrial carcinoma. It is only the combination of
careful examination and microscopical evaluation than can provide
accurate diagnosis. Ovarian tumors may be hormonally active thus
presenting themselves with hyperplasia (growth) of endometrium (uterine
mucosa) and bleeding.
Prevention and treatment
Go to the beginning
Statements under this title are subject to rapid
change, as new methods are introduced. Ask your doctor about most
recent methods.
Since prolonged growth of endometrium often underlies EC, it is the
cessation of that process with synthetic progesterone that stops further
growth and helps maturation that may prevent EC. Contraceptives may be
used as a source of progesterone that makes endometrial cells to mature.
Also it is important to avoid estrogen influence to the endometrium.
Treatment is either surgical or by irradiation. Operation gives
generally better results and is therefore method of choice for localized
EC (Stages 1 and 2) and if there is no clinical contraindication for
surgery.
If cancer is in Stage 1, surgery is required. It can be combined with
irradiation, especially if cells are immature (Grade III) or if the
invasion of muscular wall is deep. During the operation, lymphatic nodes
harvested and are examined.
In Stage 2, surgery (hysterectomy) is usually followed by radiation, and
hormonal therapy needed, especially in Grade I tumors.
If they are affected, Stage increases from 1 to 3. Also, peritoneal
fluid samples are taken to determine if there are tumor cells in the
peritoneum. If they are, Stage also increases from 1 to 3. Before
surgery, urinary bladder and bowels are examined to exclude Stage 4
tumor. Vagina is observed and examined to exclude Stage 3a. If cancer is
so localized, the removal of uterus, tubes and ovaries with or without
irradiation is considered to be enough. If cervix is affected,
hysterectomy combined with the removal of the tubes and ovaries is done.
Also, radiation therapy should be undertaken.
In Stage 3, surgery (hysterectomy) can sometimes be performed as a
radical procedure after the radiation treatment.
If distant metastases occur, hormonal therapy may give good results. If
cancer has high level of progesterone receptors, it should respond well
to hormonal therapy. If not, chemotherapy may do well. Less
differentiated tumors (Grade II or III) respond better to chemotherapy.
Postoperative radiation is very useful to prevent the tumor to re-occur
especially at the upper parts of the vagina. Chemotherapy and especially
hormonal therapy are superior to surgery in the treatment of Stage 4.
Mario Kopljar, MD
Department of Surgery
University Hospital Sestre milosrdnice
Vinogradska 29
10000 Zagreb, Croatia
http://www.mef.unizg.hr
|
|
You are welcome to share this © article with
friends, but do not forget to include the author name and
web
address. Permission needed to use articles on commercial and
non commercial websites. Thank you.
Endometrial Cancer
Index | CancerLinks
Home | Contact
Us | Top
|