Endometrial cancer

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The diagnosis

The stage of the disease

How to care

Treatment based on the stage

Endometrial cancer is a disease characterized by the presence of tumor cells in the tissues of the endometrium, which then is distinguished from the tumoral form that affects the muscular part of the hollow organ that receives the fetus during pregnancy.

“> uterus, which is called uterine sarcoma .

“> diabetes and tamoxifen therapy in women with breast cancer.

The risk of developing endometrial cancer seems to be increased in women who undergo treatment with ovarian hormones that act on the development of female characters and menstruation.

“> hormones that can affect the growth of some forms of cancer, on the contrary, the intake of estrogens in combination with hormones Female hormones.

“> progestin does not seem to increase that risk.

“> Gynecologist in the presence of bleeding or loss other than menstruation, difficulty or pain in the emission of urine on the outside.

“> urination, painful intercourse, pain localized in the pelvic region.

The diagnosis

In the presence of these symptoms, the gynecologist proceeds to the visit. Taking into account the fact that endometrial cancer develops inside the uterus and for this reason is usually not found at the Pap test, it is necessary that the gynecologist take a sample of endometrial tissue and have it analyzed by microscope to ascertain the presence of any cancer cells. The gynecologist can choose between different techniques:

“> endometrial biopsy: consists of the introduction of a flexible instrument inside the uterine cavity, with which it gently scratches the wall of the uterus to draw small quantities of tissue to be analyzed under a microscope;

       dilatation and curettage (D & C): after dilating IS the neck of the uterus, ie the lower portion of this organ.

    “> cervix, the gynecologist inserts a spoon-shaped surgical instrument into the uterine cavity through which he can take larger tissue samples;

    hysteroscopy : with a thin instrument equipped with a small camera on the tip and a small loop, the gynecologist can visualize the uterine cavity and select a tissue sample to be analyzed in a targeted manner. It is now the most correct and most used technique.

    Such procedures may sometimes require anesthesia.

    “> stage of the tumor (if it is limited to the endometrium, if it affects the whole uterus or if it has spread to other organs), as well as from the general conditions of health.

    The stage of the disease

    Once the presence of the tumor has been confirmed, further investigations must be carried out to check whether the cancer cells have spread to other parts of the body (a process that establishes the extent and spread of the tumor, hence its aggressiveness.

    “> staging.) Staging is important for choosing the most appropriate treatment: endometrial cancer is classified in the following stages:

    stage I: the tumor is limited to the body of the uterus, but has not invaded the cervix. It is divided into stage IA and IB depending on the depth of infiltration of the muscular part of the uterus;

    stage II: the tumor has spread from the endometrium to the cervix, but not beyond the uterus;

    stage III: the tumor is extended out of the uterus into the lower portion of the large abdominal cavity.

    “> vagina and tube, and lymph nodes;

    “> distant metastasis;

    “> relapse: the tumor reoccurs after treatment and relapse may develop in the pelvic region, lymph nodes and / or other organs at a distance.

    How to care

    The treatment options currently available for endometrial cancer are as follows:


    • surgery;
    • Chemotherapy
    • therapy
    • Administration of hormones for therapeutic purposes.

      surgery is the most common treatment. The surgeon can decide to remove the tumor by performing one of the following types of surgery:

      “> bilateral: is the surgery by which the surgeon removes the uterus, the salpingi (or fallopian tubes) and the ovaries.To verify the state of the lymph nodes, the surgeon can proceed in the same seat to lymph node dissection by removing pelvic and / or aortic lymph nodes, while the role of sentinel lymph node research (the first lymph node that drains clear, transparent, colorless fluid that circulates in vessels) is still considered experimentallymphatics and which contains lymphocytes.

      “> lymph from the tumor region;

      Even if the surgeon removes all the tumor during surgery, in some cases, based on particular risk factors identified in the microscopic analysis of a tissue sample taken by biopsy.

      “> Oncologist may recommend radiotherapy or postoperative chemotherapy for the purpose of causing the death of any remaining tumor cells and preventing recurrence.

      The chemotherapy is the therapeutic modality that destroys the cancer cells through the administration of drugs, which can be taken by mouth in the form of tablets, or injected intravenously or intramuscularly. Chemotherapy is defined as systemic treatment , because the drug enters the bloodstream, spreads through the body and in this way can reach and destroy the cancer cells that have spread at a distance.

      radiotherapy (also called radiation therapy) uses high frequency radiation to destroy neoplastic cells. Radiation can be delivered by a machine outside the body (external radiotherapy ) or the radioactive substance ((or radionuclide)
      Substance capable of emitting radiation.

      “> radioisotope ) can be placed directly into the area affected by the tumor by means of plastic tubes (internal radiotherapy or intracavitaria ). endometrial cancer radiotherapy can be performed alone or in combination with surgery or chemotherapy or with both.

      The hormone therapy (or hormone therapy ) consists in the administration of hormones to block the growth of cancer cells. Estrogens and progestogens are hormones that can somehow influence the growth of some cancer cells. If the tests performed show that in the tumor cells there are Proteins that recognize and bind in a selective way particular substances (eg hormones, antigens, sugars) or even microorganisms (eg viruses, bacteria). Receptors are located on the surface or inside cells.

      “> receptors for estrogens and / or progestogens, hormone therapy may be considered a therapeutic option.

      Treatment based on the stage

      The specialist may propose standard treatment for its proven efficacy, confirmed by previous experience, or participation in a clinical trial. Standard therapy does not necessarily work for all patients and sometimes involves more side effects than you think. For this reason, clinical trials are conducted in order to identify more effective treatment methods, based on the most up-to-date information currently available.

      Stage I

      The treatment options are as follows:

      – in selected cases, with very initial very early stage tumors and in young patients desiring pregnancies, a conservative therapy of the uterus can be proposed with hormone therapy and possible hysteroscopic removal only of the small endometrial area affected by cancer;

      – hysterectomy and bilateral adnexectomy;

      – hysterectomy and bilateral adnexectomy with pelvic and / or abdominal lymph nodes dissection, followed by internal or external radiotherapy on the pelvis. After surgery, a plastic tube can be inserted into the vagina, inside which the radioactive source is placed, with the purpose of destroying any residual tumor cells;

      – radiotherapy alone for inoperable patients.

      Stage II

      The treatment options are as follows:

      – hysterectomy and bilateral adnexectomy, with pelvic and abdominal lymph nodes dissection, followed by radiotherapy;

      – hysterectomy and bilateral adnexectomy with or without dissection of pelvic and abdominal lymph nodes, followed by internal or external radiotherapy on the pelvis. After surgery, internal radiotherapy may be recommended;

      – radiotherapy alone for inoperable patients.

      Stage III

      The treatment options are as follows:

      – radical hysterectomy with pelvic lymph node dissection, followed by internal and external radiotherapy;

      – radiotherapy alone for inoperable patients;

      – chemotherapy plus radiotherapy.

      Stage IV

      The treatment options are as follows:

      – radiotherapy to relieve symptoms;

      – palliation surgery, aimed at relieving symptoms.

      Recurrent endometrial carcinoma

      In this case the therapeutic options are as follows:

      – palliative radiotherapy, ie aimed at breedingto reduce symptoms and improve quality of life;

      AIMaC is grateful to Prof. G Scambia and Dr. R. De Vincenzo (Women’s and Child Health Center – A. Gemelli University Polytechnic Foundation, Catholic University of the Sacred Heart – Rome) for critical revision of the text.

      Last revision: December 2016
      Original title: Endometrial Cancer Treatment (PDQ®)

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