The most common female genital cancer is endometrial cancer, in which cancer cells are attached to the lining or the muscular wall of the uterus (womb). Endometrial cancer is the fourth most common malignancy among women in the United States with an estimated 47,000 new cases diagnosed in 2012 and an estimated 8,000 deaths as a result of diagnosis in the same period.
Endometrial cancer is linked to high levels of the female sex hormone called estrogen. In a normal menstrual cycle, estrogen is produced during the first two weeks. The hormone causes the cells that line the uterus wall to grow and increase in number. During the next two weeks, progesterone (another type of female sex hormone) is produced. This hormone helps the cells to mature so that the lining of the uterus can hold and nurture the fertilized egg. However, if there is not enough progesterone, cells lining the uterus will multiply quickly, causing a mass or tumor that could become cancerous.
Genetic screening can help determine if a woman is a carrier of a mutated (changed) gene that increases the susceptibility for endometrial cancer. The screening test does not tell when or if the disease will occur, but it can determine if an individual is at greater risk for developing the disease.
Approximately 15 to 20% of women with endometrial cancer may not have any symptoms. Symptoms that do occur may include:
- Unusual bleeding
- Abdominal cramps, which are caused when the tumor blocks the cervical canal and keeps the blood from being expelled
- Postmenopausal bleeding
- Irregular bleeding in younger women. Profuse bleeding that does not stop in a few days like a normal menstrual cycle should be screened.
- In advanced stages, symptoms include intense pain, weight loss and anemia (low red blood cell count)
Causes and Risk Factors
The following factors may put a woman at higher risk of developing endometrial cancer:
- Being older than 40 years old (Less than five percent of endometrial cancers are diagnosed in women younger than 40)
- Being menopausal (90% of women with endometrial cancer are postmenopausal)
- Being between the ages of 60 and 70 years old (65% of women who have endometrial cancer are in these age ranges)
- Younger female patients who have Stein-Leventhal syndrome
- Having a tendency to gain weight
- Being unable to have children
- Having diabetes and other disorders affecting the endocrine glands
- Having had breast cancer and taking Tamoxifen. This anti-cancer drug may cause production of estrogen in certain organs, such as the uterus. Women on Tamoxifen must be regularly screened for abnormalities in the uterus.
Tests for finding endometrial cancer are more complex and more uncomfortable than those used for cervical cancer. Although Pap smears are commonly used and accurate test for cervical cancer, they are not a reliable way of detecting endometrial cancer. Endometrial cancer can be detected in the following ways:
- The doctor manually probes the uterus for lumps or thickening
- Vaginal ultrasound
- Dilation and curettage (also known as a D and C)
Endometrial cancer is general treated with hormone therapy, surgery, chemotherapy or a combination of these approaches.