Uterine / Endometrial Cancer – Gynecological Malignancies

About Gynecologic Cancers

In this section, we provide an overview of the signs and symptoms of some of the most common types of gynecologic and urogenital tract cancers that affect women, including:

Breast Cancer
Cervical Cancer
Colon Cancer
Endometrial Cancer (also Uterine Cancer)
Endometriosis and Risk of Certain Cancers
Fibroids and Risk of Certain Cancer
Ovarian Cancer
Uterine Carcinomas
Uterine Leiomyosarcomas
Uterine Sarcomas

About Uterine/Endometrial Cancer

Uterine cancer is the most common type of gynecologic cancer in the United States. It arises from the lining of the uterus, called the endometrium and is also called endometrial cancer. It is most commonly diagnosed in the postmenopausal years.

The average age of diagnosis in the US is at age 61.

There are two main types of endometrial cancer, type I and type II.

• Type I is more common making up 80% of endometrial cancers. It is less aggressive than type II and has a more favorable outcome. It is often caught at an earlier stage due to its slower-growing nature.
• Type II is less common. It has high rates of metastasis and usually presents at a later stage. A precursor lesion is rarely identified

Signs and Symptoms of uterine/endometrial cancer include:
The most common symptom of uterine cancer regardless of type is abnormal bleeding, whether it is postmenopausal bleeding or irregular menstruation. It may start as a watery, blood-streaked flow that gradually contains more blood. If you have these symptoms, you should see a gynecologist for an endometrial biopsy. Other symptoms may include:

• abnormal spotting or discharge
• pain or difficulty when emptying the bladder
• pain in the pelvic area
• painful intercourse
• weakness and/or unexplained onset of fatigue
• persistent fever
• bloating
• unusual changes in fingernails, hair, and/or skin
• unexplained and sudden weight loss
• lump or swelling of lymph nodes (either in armpit and/or neck)
• night sweats
• loss of appetite, difficulty eating or feeling of fullness
• urinary frequency
• formation of ascites (collection of fluid in the abdomen, contributing to bloating & shortness of breath)
• nausea and vomiting
• pubertal development, and abnormal hair growth (with tumors that secrete hormones)

Risk Factors
Type I

• obesity
• unopposed estrogen therapy
• age>50
• heavy menstrual periods
• hyperplasia of endometrial lining
• late onset of menopause >55yrs of age
• early onset of menstruation
• not having children
• diabetes
• lynch syndrome
• family history of breast, ovarian, uterine, or colon cancer

• History of taking estrogen alone: The risk of uterine cancer is higher among women who used estrogen alone (without progesterone) for menopausal hormone therapy for many years.
• History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of uterine cancer.
• History of having radiation therapy to the pelvis: Women who had radiation therapy to the pelvis are at increased risk of uterine cancer.

Type II

• Unlike type I uterine cancer, type II has no absolute risk factors. Type II uterine cancer tends to be seen in more African American women than any other race. Patients with type II tend to be thinner and often have children compared to patients with type I cancer.

Screening and Diagnosis
Uterine/endometrial cancer can be diagnosed by getting a sample of the endometrium. This can be done by an endometrial biopsy in the office or an outpatient procedure called a hysteroscopy. Hysteroscopy is where a camera is placed inside the uterus and samples of the lining of the uterus can be taken.

Treatment
Uterine/endometrial cancer is surgically staged, meaning that only after surgery to remove the uterus, cervix, tubes, ovaries and lymph nodes, can the final stage be made. For advanced stages, radiation and/or chemotherapy maybe needed after surgery. The key to surgical staging is getting adequate samples of the lymph nodes in the pelvis and near the aorta to ensure that the cancer has not spread. Lymph nodes are located near major vessels, particularly the aorta, which makes lymph node dissections very difficult and dangerous to perform. Because of the complexity of lymph node dissection, it was thought that it could only be performed as an open abdominal procedure. Drs. Camran and Farr Nezhat pioneered the use of laparoscopy and robotic-assisted laparoscopy in treating uterine/endometrial cancer. They have shown that not only is the minimally invasive approach safer, it is as effective and thorough at sampling a larger number of lymph nodes than through the open abdominal approach. Through the use of small incisions, patients heal faster, have less postoperative problems, and leave the hospital sooner.

Contrary to popular beliefs, gynecological cancers can be treated minimally invasively
The removal of gynecological cancers previously required a large incision along the entire length of the abdomen (laparotomy), often hip bone to hip bone. These painful surgical methods of yesteryear often led to serious, life-threatening complications that often caused more injury (and mortality) than the cancer itself. However, Drs. Camran and Farr Nezhat proved that such debilitating large incisions were no longer necessary when they became the first to completely remove even the largest gynecological tumors (including para aortic lymph node dissection) laparoscopically and robotically. And, because laparoscopy provides better visualization of the abdominal cavity, it actually allows surgeons to remove even more cancerous growths and perform even more complete lymph node dissections than was possible using the traditional surgical technique of laparotomy.