GYNAECOLOGICAL CANCER

Endometrial Cancer

Epidemiology

Endometrial cancer tends to affect patients who have gone through the menopause, particularly those in the 65 to 75 year old age group. It is more common in patients who are overweight or who have diabetes or high blood pressure. It is more common in women who have had no children and less common in women who have been on the oral contraceptive pill. It is a disease which is more common in the Western world and has one of the highest incidences in the United States. Approximately 3000 women per year will develop endometrial cancer in England and Wales.

Pathology

The majority of endometrial cancers arise from the columnar epithelium which lines the uterine cavity (endometrium). Over 85% of the tumours are adeno carcinomas and this histological sub type carries the best prognosis.

Presentation

The vast majority of patients will present with an episode of vaginal bleeding after the menopause. Any episode of bleeding after the menopause requires investigation. Patients should undergo an abdominal and vaginal examination and a cervical smear should be taken. The lining of the uterus should be sampled. Sometimes this is possible in the outpatient department and sometimes the patient needs to come into hospital and have a hysteroscopy examination. All patients with post menopausal bleeding would have an ultrasound scan to look at the thickness of the lining of the uterus and to look at the ovaries. Any patient who has endometrial cancer diagnosed should have an MRI scan to look as closely as possible at the tumour. This scan is used to determine how deeply the tumour invades into the muscle layer of the uterus (myometrium).

Treatment

Over 80% of women who develop endometrial cancer will present whilst that tumour is still confined to the uterus. Therefore, the correct treatment in almost all cases of endometrial cancer is to perform a hysterectomy operation. This can be performed either through an incision in the abdomen or very often through keyhole surgery. The keyhole surgery approach is particularly advantageous in the obese patients because it allows them to recover so much quicker. It may be necessary to remove some lymph nodes from the pelvis at the same time as the hysterectomy, but this is not a common procedure.

Approximately 40% of patients with endometrial cancer will be offered Radiotherapy treatment of the pelvis following their hysterectomy. The Radiotherapy is thought to decrease the chances of cancer recurrence. The need for Radiotherapy is determined by examination of the tumour and uterus under the microscope.

Generally speaking the prognosis from endometrial cancer is very good because the majority of patients present relatively early. Most patients are seen and examined at follow-up three monthly for the first two years and six monthly for two years after that. Their doctor may decide to take a smear from the top of the vagina as it is often the top of the vagina which is the commonest site for disease recurrence.