Endometrial cancer (body of the womb)
Endometrial cancer is cancer of the inside of the uterus, where the endometrium is the lining that lines the inside of the uterus. In women with cancer at this level, the endometrial cells multiply abnormally. Endometrial cancer generally occurs after menopause, but 10 to 15% of cases affect premenopausal women, including 2 to 5% of women under 40 years old.
Box: What is the endometrium normally used for? In a premenopausal woman, during the first half of the menstrual cycle, the normal endometrium thickens and its cells multiply during the first half of each menstrual cycle. The role of this endometrium is to host an embryo. In the absence of fertilization, this endometrium is evacuated each cycle in the form of rules. After menopause, this phenomenon stops. |
Le endometrial cancer is the second most frequent gynecological cancer in France, after breast cancer. It is located at 5e rank of cancers in women in terms of incidence with approximately 7300 new cases estimated in 2012. In Canada, it is the 4the in incidence in women (after breast, lung and colon cancers), with 4200 new cases in 2008 in Canada. Mortality is steadily decreasing for this type of cancer, which is increasingly being treated.
When endometrial cancer is treated at its early stage (stage I), the survival rate is 95%, 5 years after treatment1.
Causes
A significant proportion of endometrial cancers would be attributable to a excess estrogen hormones produced by the ovaries or brought in from outside. The ovaries produce 2 types of hormones during the female cycle: estrogen and progesterone. These hormones act on the endometrium throughout the cycle, stimulating its growth and then its expulsion during menstruation. An excess of estrogen hormones would create an imbalance conducive to the poorly controlled growth of endometrial cells.
Several factors can increase estrogen levels, such as obesity or hormone therapy to estrogen alone. This type of hormone therapy is therefore reserved for women who have had the uterus removed or hysterectomy who are no longer at risk of endometrial cancer. For more information, see the People at risk and Risk factors sections.
For some women, however, endometrial cancer does not seem to be caused by a higher level of estrogen.
Other causes are involved in endometrial cancer, such as advanced age, overweight or obesity, genetics, hypertension …
Sometimes cancer occurs without a risk factor being identified.
Diagnostic
There is no screening test for endometrial cancer. The doctor therefore performs examinations to detect this cancer in front of signs such as gynecological bleeding occurring after menopause.
The first exam to be done is a pelvic ultrasound where the probe is placed on the stomach and then into the vaginal space in order to visualize an abnormal thickening of the endometrium, the lining of the inside of the uterus.
In case of an abnormality on the ultrasound, to detect endometrial cancer, the doctor does what is called an “endometrial biopsy”. This involves taking a little mucous membrane from inside the uterus. The endometrial biopsy can be done in the doctor’s office without the need for anesthesia. A thin, flexible tube is inserted through the cervix and a small piece of tissue is removed by suction. This sample is very quick, but it can be a bit painful. It is normal to bleed afterwards a little after.
The diagnosis is then made in the laboratory by microscope observation of the area of mucous membrane removed.
In the event of illness or medication, the doctor should be informed if he or she needs to perform this examination.