Endometrial Cancer Screening

What is endometrial cancer?

Endometrial cancer is a type of cancer that originates in the lining of the uterus, known as the endometrium. It is one of the most common gynecologic malignancies, affecting women primarily after menopause.

What are the types of endometrial cancer?

Endometrial cancer (EC) can be classified into two distinct groups – type I and type II, based on histology, which differs in molecular, clinical, and histopathological profiles. 

1. Type I: 

   • This is the most common form and is often associated with estrogen excess. It typically has a favorable prognosis.

2. Type II:

   • This less common type is not estrogen-dependent and is more aggressive. It often presents at an advanced stage, making early detection challenging.

What are the signs and symptoms of endometrial cancer?

Early detection of endometrial cancer is challenging as symptoms may not be apparent in the initial stages. However, women should be vigilant and seek medical attention if they experience:

• Abnormal vaginal bleeding, especially after menopause

• Unusual vaginal discharge

• Pelvic pain, pressure or discomfort

• Pain during intercourse

• Difficult or painful urination

• Mass in the pelvic area

• Unexplained weight loss

How is screening and diagnosis of endometrial cancer done?

Currently, there is no standard screening test for the general population. However, transvaginal ultrasound (TVUS) and endometrial biopsy may be recommended for women with specific risk factors or symptoms. 

1. Transvaginal Ultrasound (TVUS): 

   • Transvaginal ultrasound involves the insertion of an ultrasound probe into the vagina to create detailed images of the pelvic organs. This imaging test utilises sound waves to create detailed images of the uterus, aiding in the identification of abnormalities. While TVUS can detect abnormalities, it is not highly specific for endometrial cancer.

2. Endometrial biopsy: 

   • This procedure uses a small, flexible tube that is put into the uterus to collect an endometrial tissue sample. The sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor’s office.

3. Hysteroscopy and dilation curettage: 

   • This involves the insertion of a scope into the vagina to visualise the endometrial cavity and performing a curettage for histological diagnosis.

FAQs

What increases the risk of endometrial cancer?

1. Age:

   • The risk increases with age, particularly after menopause.

2. Hormone replacement therapy (HRT): 

   • Prolonged use of estrogen without progesterone in postmenopausal women can elevate the risk.

3. Obesity: 

   • Excess body weight is a significant risk factor, as fat tissue can produce estrogen.

4. Diabetes: 

   • Women with diabetes are at an increased risk.

5. Family history:

   • A family history of endometrial, ovarian, or colorectal cancer can contribute to a higher risk. 

6. Reproductive history: 

   • Early menarche, late menopause, and nulliparity increase the risk of endometrial cancer.

7. Personal history of polycystic ovary syndrome (PCOS) or atypical endometrial hyperplasia

8. Personal history of breast/ovarian cancer

9. Tamoxifen: 

   • This breast cancer drug can cause the endometrial lining to grow. If you take tamoxifen and have changes in your menstrual period or bleeding after menopause, it is important to let your doctor know.

10. Ovarian diseases: 

    • such as polycystic ovarian syndrome (PCOS).

11. Eating a diet high in fat

What are the challenges in endometrial cancer screening?

1. Lack of routine screening: 

   • Unlike some other cancers, there is no routine screening test for endometrial cancer, leading to delayed detection in many cases.

2. Non-specific symptoms: 

   • Symptoms such as abnormal bleeding are common in various gynecological conditions, making it challenging to attribute them to endometrial cancer.

3. Limited sensitivity of screening tests: 

   • TVUS and endometrial biopsy may not detect all cases of endometrial cancer, particularly in its early stages.

4. Resource constraints: 

   • Limited resources, both in terms of healthcare infrastructure and financial constraints, can impede the widespread implementation of screening programs. Access to advanced screening tools, diagnostic tests, and specialized care may be unevenly distributed, affecting the timely diagnosis and management of endometrial cancer.

5. Psychosocial barriers: 

   • Societal taboos and reluctance to discuss gynaecological symptoms may contribute to delayed presentation and diagnosis. Women may be hesitant to seek medical attention due to embarrassment, fear, or a lack of awareness about the significance of symptoms.

How to manage endometrial cancer?

The management of endometrial cancer involves a multidisciplinary approach:

1. Surgery: 

   • The primary treatment is often surgical removal of the uterus (hysterectomy) and may include removal of surrounding tissues and lymph nodes.

2. Radiation therapy: 

   • Uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. This may be recommended post-surgery to target any remaining cancer cells.

3. Chemotherapy:

   • Uses drugs to stop the growth of cancer cells, either by killing the cancer cells or controlling their growth.

4. Hormone therapy:

   • For hormone-sensitive cancers, hormonal medications may be prescribed.

5. Targeted therapy:

   • Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.  

6. Immunotherapy: 

   • The immune system finds and defends the body from infection and disease. Cancer is a complex disease that can evade and outsmart the immune system. Immunotherapy improves the immune system’s ability to eliminate cancer. 

References

1. Johns Hopkins Medicine, Endometrial Cancer, 2024.

2. PDQ® Adult Treatment Editorial Board. PDQ Endometrial Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated 13 November 2020.