Uterine Cancer (Endometrial Cancer): Causes, Symptoms & Treatment

In the early stages, uterine cancer or endometrial cancer is usually easily treatable. Depending on the patient, different treatment methods are available. Uterine cancer should not be confused with cervical cancer.

What is uterine cancer?

Uterine cancer is also called endometrial carcinoma in medicine. Derived from the words carcinoma (malignant growth) and endometrium (lining of the uterus), the term endometrial cancer is used to describe uterine cancer. As the name endometrial carcinoma suggests, uterine cancer usually develops in cells of the uterine lining. Alternative technical terms for uterine cancer include corpus carcinoma or uterine carcinoma. Doctors also distinguish between two different types of uterine cancer: so-called estrogen-dependent carcinoma (type I carcinoma) and estrogen-independent carcinoma (type II carcinoma). Statistically, endometrial carcinoma mainly affects women of advanced age (on average women in the late 7th decade of life). Within Germany, uterine cancer is among the most common cancers affecting women.

Causes

The causes leading to endometrial cancer have not yet been conclusively determined. However, it is suspected that the female sex hormone estrogen also affects developing endometrial carcinoma through its influence on the mucous membrane of the uterus. In medicine, it is currently assumed that the risk of developing uterine cancer increases approximately with the lifelong period during which the body is confronted with a high concentration of estrogens; this period can be increased, for example, by a very late onset of menopause (the time when a woman has her last menstrual period) or by an early onset of puberty. The risk of developing estrogen-dependent endometrial cancer may be increased in the presence of various risk factors. These include, for example, diseases such as high blood pressure or lipid metabolism disorders, but also a long intake of hormone preparations that contain only estrogen.

Symptoms, complaints and signs

  • Vaginal bleeding after menopause.
  • Abdominal pain, if any
  • Blood in the urine
  • Urinary tract infection
  • Selter back pain

Diagnosis and course

Uterine cancer in the early stages can be diagnosed, for example, with the help of palpation of the cervix or swabs performed by a gynecologist (specialist in gynecology). Indications of endometrial cancer can also be bleeding that occurs during menopause. A suspected diagnosis of uterine cancer can be supported by an ultrasound examination, for example. A so-called scraping (a removal of endometrial tissue) can also provide information about the presence of cancer cells. The course of endometrial cancer depends, among other things, on the stage of development at which the uterine cancer is detected: If an endometrial carcinoma is in an early stage and is limited to the mucous membrane of the uterus, the prognosis is usually very good. In advanced stages, endometrial carcinoma can form daughter tumors that affect the lungs or liver, for example. This can make it difficult to cure.

Complications

Uterine cancer is treated surgically in almost all cases. During surgery, adjacent organs as well as anatomical structures may be damaged. Another complication is nerve damage, which can cause paralysis and numbness. The urinary bladder may also be temporarily impaired. In addition, adhesions in the abdominal region develop more frequently. Complications such as swelling due to lymphatic congestion usually develop during treatment for uterine cancer. In some cases, serious as well as life-threatening complications occur. These include peritonitis and intestinal obstruction. Furthermore, inflammatory connecting ducts between the urethra and urinary bladder and between the vagina and rectum often develop. Infections, wound healing disorders and excessive scarring may occur. These are often accompanied by loss of function, pain or allergies.Young patients in particular are often menopausal after surgery. Uterine cancer may be treated with chemotherapy. This can cause other temporary complications such as hair loss, diarrhea and nausea. It cannot be ruled out that these complaints may take a chronic course. If uterine cancer is diagnosed late or is not treated, metastases are a complication. These cause additional discomfort and are no longer treatable in the later course. Uterine cancer leads to death if left untreated.

When should you go to the doctor?

For prevention, women should always see a gynecologist for an annual checkup. In these examinations, cancer screening takes place by palpating the uterus and taking a vaginal swab, which allows early detection of uterine cancer. In addition, consultation with a doctor is necessary as soon as irregularities in the abdomen are noticed. If there are changes in the monthly cycle due to absence of menstruation or prolonged bleeding, a doctor should be consulted. If there is pain in the abdomen, bleeding between periods or discomfort during sexual activity, a visit to the doctor is advisable. If there is a general feeling of illness, reduced performance or fatigue, the signs should be discussed with a doctor. Repeated blood in the urine, urinary tract problems or signs of inflammation should be medically examined and treated. Severe weight loss, loss of appetite and inner restlessness are indications of existing irregularities that should be discussed with a doctor. If bleeding recurs after menopause, this is considered unusual. A visit to the doctor is necessary so that the cause can be determined. If there is a change in vaginal discharge, odor in the intimate area or swelling of the abdomen, it is advisable to consult a doctor. If the general well-being decreases and the need for sleep increases, the observations should be discussed with a physician.

Treatment and therapy

The highest chances of cure for uterine cancer are usually seen as a result of surgical intervention. For endometrial cancer, a common surgical procedure is called a hysterectomy (the removal of the uterus). If the uterine cancer is treated surgically, it is also possible for the surgeon to determine how far the endometrial cancer has spread. If an endometrial carcinoma still leaves tumor residues after a surgical intervention, these can be treated, among other things, by the application of radiation therapy (electron or X-rays are used, for example). In individual cases, it may be possible to remove the entire uterus in the case of endometrial carcinoma, but the cancer of the uterus has come very close to the vagina; in this case, postoperative local (localized) radiation therapy is possible. Radiation therapy can also be performed if endometrial cancer has spread and, for example, pelvic lymph nodes are affected. Such radiation is usually administered externally; that is, from the outside. Although radiation therapy for early uterine cancer can also take place as an alternative to surgery, due to the statistically lower chances of cure, this usually only takes place when surgery is not possible.

Outlook and prognosis

Endometrial cancers are among the most curable cancers in women. If detected early in the first or second stage, the chances of a complete cure are usually still quite good. This also depends on the type of cervical cancer. Type I has a better prognosis than type II at any stage. In the initial stages, attempts are made to prevent a complete hysterectomy and to remove only the tumor. However, this varies in each case and depends on the location of the tumor, its spread, the options for surgical removal, and the patient’s general health. If the patient’s fertility cannot be preserved, there is an option to freeze eggs before treatment – this is mainly offered to young patients without children. If, on the other hand, the endometrial carcinoma is discovered in the third stage, the prospects of recovery are also still quite good, but consequential damage is to be expected.Fertility can be severely affected by the surgical removal as well as the subsequent cancer therapy. In the fourth and final stage, when the endometrial carcinoma has already spread, the prognosis deteriorates immensely. At this stage, the tumor has already spread to adjacent organs such as the bladder and intestines. Since many lymph nodes are located here, further spread is not unlikely.

Prevention

It is hardly possible to actively prevent endometrial carcinoma. However, since the chances of recovery from early-stage uterine cancer are usually very good, regular checkups with a gynecologist (women’s doctor) can help ensure that endometrial cancer is detected and treated early. Doctor visits for heavy bleeding during menopause can also be useful.

Follow-up care

After therapy for uterine cancer is completed, follow-up visits with a gynecologist are scheduled every three to six months for the first three years. In the fourth and fifth years, a six-monthly checkup is sufficient. The gynecologist conducts a consultation and a gynecological examination. During the interview, not only physical symptoms are relevant, but also psychological, social and sexual. Patients who are asymptomatic usually do not require imaging studies or special blood tests. Imaging procedures, such as ultrasound, MRI, or computed tomography, are used when symptoms occur during the course of the disease. These include abdominal pain, bleeding, back pain, constipation or urinary urgency. These symptoms may indicate a recurrence of uterine cancer. They should definitely be taken seriously and discussed with the treating gynecologist, even independently of the recommended follow-up examinations. Regular participation in follow-up examinations with the gynecologist are necessary in order to detect and treat possible recurrences at an early stage. In the event of a recurrence of uterine cancer, there are several effective treatment options to choose from, depending on the size and location of the tumor. If a recurrence, a recurrence of endometrial cancer after therapy has been completed, is detected at a later stage due to inadequate follow-up, this can reduce the prognosis and chance of cure.

Here’s what you can do yourself

The cure of uterine cancer requires medical treatment and, in most cases, surgery. In everyday life, therefore, the options for self-help are limited to mental and psychological stabilization. This can be done in different ways, which are very individual. The support of self-help groups, for example, can be beneficial. In a protected setting, people who are ill and those who have recovered can exchange ideas. They share their experiences, give helpful tips and talk about their feelings. This can give the patient hope and new confidence. Through mutual exchange, fears can be reduced and unanswered questions can be discussed. Various relaxation methods have also proven effective. The exercises of methods such as yoga, meditation, Qi Gong or autogenic training have the goal of mental relaxation and the reduction of stress. Cognitive measures, the building of positive thoughts and optimism also help during the disease, as they strengthen the general well-being. In addition, a healthy lifestyle and individual leisure activities can build up strength and strengthen the immune system. A healthy diet rich in vitamins supports the organism. Furthermore, sufficient exercise in fresh air and light sporting exercises improve life satisfaction. The application is to be carried out depending on the physical condition. A stable social environment has proved particularly beneficial.