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Understanding endometrial cancer

The good news about endometrial cancer (cancer of the tissue that lines the uterus) is that it’s almost always curable if diagnosed early—which it usually is. However, diagnosis depends frequently on a woman’s ability to recognize signs of the disease, which can be subtle, and report them to her physician.

Although Pap smears can detect cancer in the lining of the uterus, they do so in fewer than 50 percent of cases. In its early stages, the only symptom that endometrial cancer (also called uterine cancer) is likely to produce is vaginal bleeding. Even this may not seem significant because it can start as a watery discharge that contains only streaks of blood. The key is to report any abnormal bleeding to your physician. This is especially important if you have reached menopause because endometrial cancer appears most often around or after menopause, between ages 50 and 70. Pelvic pain or pressure caused by fluid accumulation in the abdomen can be the warning signs of a later-stage cancer.

The cause of endometrial cancer is unknown, but scientists believe that the hormone estrogen may play a role. Many of the major risk factors for the disease are conditions that involve extended exposure to estrogen (see “Who’s At Risk”). By the same token, pregnancy, breastfeeding and use of oral contraceptives—all of which reduce a woman’s exposure to estrogen by suppressing ovulation—have a protective effect against endometrial cancer.

To diagnose this cancer, doctors must examine tissue samples from the endometrium. These samples can be collected in a quick, simple procedure called endometrial biopsy, during which a thin sampling instrument is inserted through the vagina and cervix. An alternative is diagnostic hysteroscopy, in which a thin, lighted telescope is inserted into the uterus. After examining the endometrium, the physician selects specific tissue for removal and analysis.

Treatment options depend on how severely cancer has penetrated the uterine wall and whether the disease has spread beyond the uterus. When cancer is confined to the uterus, hysterectomy is the safest bet for extracting cancerous tissue without spreading cancer cells. The ovaries and fallopian tubes may be taken out as well because the disease commonly spreads to those areas. If the cancer has spread, lymph nodes may have to be removed, too.

Radiation is valuable if the cancer has spread. This treatment can be delivered externally (by X-ray) or internally (by a radium implant inserted in the uterus or vagina). In advanced cases, chemotherapy can be used as well.