Endometrial Cancer Treatment in Delhi, India

Endometrial cancer is a type of cancer that originates in the lining of the uterus, known as the endometrium. It is the most common form of uterine cancer and typically occurs in postmenopausal women, although it can develop at any age. The cancer develops when the cells in the endometrium begin to grow uncontrollably, forming a tumour. If not detected early, endometrial cancer can spread to other parts of the body, including the ovaries, fallopian tubes, and lymph nodes.

Endometrial cancer is classified into several types based on the characteristics of the cancer cells and how they behave. The main types include:

Adenocarcinoma

Adenocarcinoma is the most common type of endometrial cancer, accounting for about 80-90% of cases. It develops from the glandular cells of the endometrium and can vary in aggressiveness depending on its subtype.

Uterine Carcinosarcoma

Uterine carcinosarcoma is a rare and aggressive form of endometrial cancer that contains both carcinomatous (epithelial) and sarcomatous (connective tissue) components. This type of cancer tends to behave more aggressively than other forms and often requires intensive treatment.

Squamous Cell Carcinoma

Squamous cell carcinoma of the endometrium is a rare type of cancer that originates from the squamous cells, which are flat cells that can be found in the outer layer of the endometrium. This form of cancer is less common and usually occurs in conjunction with adenocarcinoma, forming what is known as adenosquamous carcinoma.

Small Cell Carcinoma

Small cell carcinoma is an extremely rare and aggressive type of endometrial cancer. It is characterised by small, tightly packed cancer cells that tend to spread quickly to other parts of the body. Due to its aggressive nature, small-cell carcinoma often has a poor prognosis.

Transitional Carcinoma

Transitional carcinoma of the endometrium, also known as urothelial-like carcinoma, is a rare type that resembles the transitional cells found in the bladder. It is a highly aggressive form of cancer and is often diagnosed at an advanced stage, requiring a combination of surgery, radiation, and chemotherapy.

The exact cause of endometrial cancer isn't fully understood, but it's believed to result from a combination of genetic, hormonal, and environmental factors. The primary underlying factor is often a hormonal imbalance, particularly an excess of oestrogen relative to progesterone. This imbalance can cause the endometrium to thicken excessively, leading to the potential for abnormal cell growth and, eventually, cancer.

Several risk factors are associated with the development of endometrial cancer, including:

Hormonal imbalance

Hormonal imbalance, particularly an excess of oestrogen without enough progesterone, is one of the leading causes of endometrial cancer. This imbalance can stimulate the endometrial lining to thicken excessively, increasing the risk of abnormal cell growth and cancer.

Age and menopause

The risk of endometrial cancer increases with age, especially after menopause. The majority of cases are diagnosed in women who are in their 50s or older. After menopause, the body's hormone levels change, which can contribute to the development of endometrial cancer.

Obesity

Obesity is a significant risk factor for endometrial cancer. Fat tissue can convert other hormones into oestrogen, leading to higher levels of oestrogen in the body. This excess oestrogen can increase the risk of developing endometrial cancer, particularly in postmenopausal women.

Genetic predisposition

A family history of endometrial cancer or genetic conditions such as Lynch syndrome can increase the risk of developing the disease. Lynch syndrome, in particular, is an inherited condition that raises the risk of several types of cancer, including endometrial cancer.

Use of hormone replacement therapy (HRT)

Women who use hormone replacement therapy (HRT), particularly oestrogen-only therapy, after menopause may have an increased risk of endometrial cancer. The risk is higher when HRT is used without progesterone, as oestrogen alone can stimulate the growth of the endometrium.

Other risk factors 

Other factors that may increase the risk of endometrial cancer include:

• Polycystic ovary syndrome (PCOS): A condition that leads to hormonal imbalance and irregular menstruation, which can increase the risk of endometrial cancer.
• Diabetes: Women with diabetes may have a higher risk due to associated obesity and insulin resistance.
• Never having been pregnant: Women who have never been pregnant have a higher risk of endometrial cancer, likely due to prolonged exposure to oestrogen without the counterbalancing effects of progesterone during pregnancy.

Endometrial cancer symptoms can vary, but often include:

• Abnormal Vaginal Bleeding: This is the most common symptom, especially bleeding that occurs between periods or after menopause. It can also include unusually heavy or prolonged menstrual periods.
• Pelvic Pain: Persistent pain or discomfort in the pelvic area, unrelated to menstruation, may be a sign of endometrial cancer.
• Abnormal Vaginal Discharge: A watery, pink, or bloody discharge that is not related to menstruation can indicate cancer.
• Painful Intercourse: Discomfort or pain during sexual intercourse may be a symptom of endometrial carcinoma.
• Unexplained Weight Loss: Significant, unexplained weight loss can sometimes be associated with endometrial cancer.
• Frequent Urination or Difficulty Urinating: If the cancer spreads, it may cause pressure on the bladder, leading to urinary symptoms.

These symptoms can also be associated with other conditions, so it's important to consult one of the best endometrial cancer doctors in India for an accurate diagnosis.

Diagnosing endometrial cancer involves several steps to confirm the presence of cancer and determine its extent. Common diagnostic methods include:

Ultrasound

An ultrasound uses sound waves to create images of the uterus and can help detect abnormal thickening of the endometrium. This procedure can be performed transabdominally (through the abdomen) or transvaginally (through the vagina) for better imaging of the endometrium.

Endometrial biopsy

During an endometrial biopsy, a small sample of the endometrial tissue is removed and examined under a microscope. This test is crucial for confirming the presence of cancerous cells. The biopsy can be done in a doctor’s office or clinic.

Hysteroscopy

Hysteroscopy involves inserting a thin, lighted tube (hysteroscope) through the vagina and cervix into the uterus. This allows the doctor to directly view the endometrial lining and take tissue samples if necessary.

Imaging studies

Additional imaging studies such as CT scans, MRI scans, or PET scans may be used to determine if the cancer has spread beyond the uterus. These imaging techniques help assess the size and extent of the tumour and detect any metastasis.

Stage 1

In Stage 1, endometrial carcinoma is confined to the uterus. The cancerous cells are found only within the endometrium (the lining of the uterus) and possibly the myometrium (the muscle layer of the uterus). There is no evidence of spread beyond the uterus. This stage is the earliest and most localised form of the disease, making it the most treatable with a higher chance of successful outcomes if diagnosed early.

Stage 2

At Stage 2, the cancer has extended from the uterus to involve the cervix. While it has not spread to other parts of the body, it has reached deeper tissues within the pelvic region. The involvement of the cervix indicates a more advanced disease compared to Stage 1, but it is still contained within the pelvic area. This stage often requires more extensive surgical treatment and may include radiation therapy.

Stage 3

In Stage 3, the cancer has spread beyond the uterus and cervix to other parts of the pelvic region. This can include nearby structures such as the vagina, pelvic sidewalls, or lymph nodes in the pelvis and abdomen. The spread to these areas indicates a more advanced stage of cancer and often requires a combination of surgery, chemotherapy, and/or radiation therapy to address the cancer in multiple locations.

Stage 4

Stage 4 is the most advanced stage of endometrial cancer, where the disease has spread to distant parts of the body. This can include organs outside the pelvis such as the bladder, rectum, liver, lungs, or other distant sites. The cancer's spread to these distant areas makes treatment more complex and typically involves a combination of chemotherapy, targeted therapy, and sometimes radiation therapy to manage the disease and alleviate symptoms.

Surgery

Surgery is often the primary treatment for endometrial cancer and aims to remove the cancerous tissue. The type of surgery depends on the stage and extent of the disease.

• Hysterectomy: This procedure involves the removal of the uterus. For endometrial cancer, a total abdominal hysterectomy is commonly performed, which includes the removal of the uterus, cervix, and often the upper part of the vagina. In some cases, a radical hysterectomy, which also involves removal of the surrounding tissues, may be recommended.
• Lymph Node Removal: During surgery, nearby lymph nodes may be removed and examined to determine if the cancer has spread. This procedure, known as lymphadenectomy, helps in staging the cancer and planning further treatment.
• Oophorectomy (Removal of Ovaries): Oophorectomy involves the removal of one or both ovaries. This is often performed along with hysterectomy to reduce the risk of cancer spreading and to manage hormone levels.

Radiation therapy

Radiation therapy uses high-energy rays to target and destroy cancer cells. It may be used in conjunction with surgery or as a primary treatment if surgery is not an option.

• External Beam Radiation: This method delivers targeted radiation from outside the body to the pelvic area. It is commonly used to destroy any remaining cancer cells after surgery or to shrink tumours before surgery.
• Brachytherapy: Also known as internal radiation, brachytherapy involves placing a radioactive source directly inside or near the tumour. This method allows for a high dose of radiation to be delivered to the cancerous tissue while minimising exposure to surrounding healthy tissues.

Hormone therapy

Hormone therapy aims to block or lower the levels of hormones that fuel the growth of certain types of endometrial cancer. It is often used for cancers that are hormone receptor-positive.

• Progestins: These are synthetic forms of progesterone that can slow or stop the growth of cancer cells by counteracting the effects of oestrogen.
• Oestrogen Receptor Modulators: These medications block oestrogen from binding to its receptors on cancer cells, which can help slow the growth of hormone-sensitive tumours.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. It is typically used for endometrial cancer that has spread beyond the pelvis or for aggressive forms of the disease.

Targeted therapy

Targeted therapy involves drugs that specifically target cancer cells' unique characteristics, such as genetic mutations or proteins while sparing normal cells.

• Monoclonal Antibodies: These are designed to bind to specific proteins on cancer cells, marking them for destruction by the immune system.
• Tyrosine Kinase Inhibitors: These drugs block enzymes that help cancer cells grow and spread.

Immunotherapy

Immunotherapy helps the body's immune system recognize and attack cancer cells. It is used for some advanced or recurrent endometrial cancers. These drugs block proteins that prevent immune cells from attacking cancer cells, thereby enhancing the body’s natural immune response against the tumour.

Endometrial cancer, like many cancers, can lead to various complications, especially if it is not diagnosed early or treated effectively. Some common complications include:

• Spread of Cancer (Metastasis): Endometrial cancer can spread to other organs such as the bladder, rectum, or distant sites like the lungs or liver. This can complicate treatment and reduce the chances of successful outcomes.
• Lymphedema: If lymph nodes are removed during surgery, there is a risk of developing lymphedema, which is swelling due to fluid build-up in the lymphatic system. This can cause discomfort and limit mobility.
• Infection: Surgery and other treatments can increase the risk of infections, particularly in the surgical area. Proper care and monitoring are necessary to manage this risk.
• Bowel or Bladder Dysfunction: Surgery and radiation therapy can sometimes affect the bowel or bladder function, leading to issues such as incontinence, frequent urination, or bowel problems.
• Sexual Dysfunction: Treatments, especially those involving the removal of reproductive organs, can lead to changes in sexual function or libido.
• Emotional and Psychological Effects: A cancer diagnosis and its treatment can have significant emotional and psychological impacts, including anxiety, depression, and changes in body image.
• Recurrence: Even after successful treatment, there is a risk that endometrial cancer may return. Ongoing monitoring and follow-up care are essential to manage and detect any recurrence early.

Preventing endometrial cancer involves reducing risk factors and adopting healthy lifestyle choices. While not all cases can be prevented, several strategies may lower the risk:

• Maintain a Healthy Weight: Obesity is a known risk factor for endometrial cancer. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce the risk.
• Hormone Regulation: For women using hormone replacement therapy (HRT), especially those taking oestrogen without progesterone, it's important to discuss with healthcare providers the risks and benefits and explore alternatives if necessary.
• Manage Hormonal Conditions: Conditions such as polycystic ovary syndrome (PCOS) that affect hormone levels should be managed appropriately to reduce the risk of endometrial cancer.
• Regular Gynaecological Check-ups: Regular screenings and pelvic exams can help detect early signs of endometrial changes. For women with a family history of cancer or genetic predispositions, more frequent monitoring may be recommended.
• Use of Birth Control: Some studies suggest that using oral contraceptives can lower the risk of endometrial cancer. Discussing birth control options with a healthcare provider can help in making informed decisions.
• Genetic Counselling and Testing: Women with a family history of endometrial cancer or genetic conditions such as Lynch syndrome may benefit from genetic counselling and testing.

How is endometrial cancer different from other types of uterine cancer?

Endometrial cancer starts in the lining of the uterus, called the endometrium. Other types of uterine cancer, like uterine sarcoma, begin in the muscle or other tissues of the uterus. The main difference is the starting point of the cancer within the uterus, which affects how the cancer behaves and is treated.

What are the early signs of endometrial cancer that should prompt a visit to the doctor?

Early signs of endometrial cancer include unusual vaginal bleeding, such as bleeding after menopause or between periods, and spotting or discharge that is not typical for you. If you experience these symptoms, it's important to see a doctor, as they could be early indicators of endometrial cancer.

Can endometrial cancer recur after treatment, and how is it monitored?

Yes, endometrial cancer can recur after treatment. To monitor for recurrence, regular follow-up visits with your doctor are essential. These visits may include physical exams, imaging tests, and blood tests to check for any signs that the cancer has returned.

What are the options if endometrial cancer is diagnosed during pregnancy?

If endometrial cancer is diagnosed during pregnancy, the treatment options depend on the stage of the cancer and how far along the pregnancy is. In some cases, treatment may be delayed until after the baby is born. In other cases, a doctor may suggest treatment during pregnancy, which could include surgery. The decision is made carefully, considering both the mother’s and baby’s health.

How does endometrial cancer impact fertility, and what are the options for preserving fertility?

Endometrial cancer can affect fertility, especially if the treatment involves removing the uterus or ovaries. However, if preserving fertility is important, there may be options such as hormonal therapy to delay more aggressive treatments, or fertility preservation techniques like egg freezing before treatment begins. Discussing these options with a doctor is important before starting treatment.

Can endometrial cancer be detected through routine pap smears?

No, routine pap smears are not designed to detect endometrial cancer. Pap smears are primarily used to detect cervical cancer. Endometrial cancer is usually diagnosed through other methods, such as an endometrial biopsy or imaging tests.

Reviewed By Dr. Nitin Leekha, Director - Cancer Care / Oncology, Surgical Oncology, Gynecologic Oncology, Robotic Surgery, Breast Cancer, Head & Neck Oncology, Uro-Oncology, Thoracic Oncology on 23 Dec 2024.