Endometrial cancer
10,680 new cases per year
With approximately 10,680 new cases annually, malignant tumors of the uterine body (corpus or endometrial carcinoma) are the fifth most common cancer in women and the most frequent of the female genital organs. One in 50 women will develop uterine body cancer during her lifetime, and one in 200 will die from the disease. Due to the good prognosis, the share of all cancer-related deaths is comparatively low at 2.9 percent. The relative five-year survival rate for uterine body cancer in Germany is around 80 percent. The median age at diagnosis is 69 years.
01
Uterine body cancer
… is also called endometrial cancer. Malignant tumors of the uterine body (corpus carcinoma, from the Latin “corpus”: body) almost always originate in the lining of the uterus (endometrium), which lines the inside of the organ. In Germany, cancers of the uterine body are the second most common malignant disease of the female reproductive organs after breast cancer and the fourth most common form of cancer in women.
02
Main risk factors
… for the development of uterine body cancer, in addition to age, obesity (especially after menopause) and the intake of hormone preparations containing only estrogen during and after menopause must be considered. In contrast, taking “the pill” during the reproductive years, especially when using a combined preparation with estrogen and progestogen, protects against the development of endometrial carcinoma. Physical activity and pregnancies also have a protective effect. Other risk factors include childlessness, an early first period (menarche), a late onset of menopause (last period), or long cycles without ovulation. Furthermore, high blood pressure, diabetes mellitus, previous radiation treatment, and hereditary factors play a role. The hereditary disease Lynch syndrome (HNPCC), in which colorectal cancer occurs at an early age, is associated with an increased risk of endometrial cancer, ovarian cancer, and other types of cancer.
03
Estrogens
… are mainly produced in the ovaries and in fatty tissue and cause the growth of glandular cells in the lining of the uterus. During the female monthly cycle, the effect of estrogen is reduced after ovulation by progestogens, the second type of female sex hormones. If no pregnancy occurs and hormone levels drop again, this ultimately leads to the shedding of the lining (menstruation) and prevents degeneration.
Scientists see an important cause of cancer development in the hormonal transition process during menopause. In this phase of life, the body stops producing progestogens but initially continues to produce estrogens. A significant portion of estrogen is formed in the fatty tissue—depending on the degree of obesity. If estrogens act on the endometrial cells for a long time, this continuous stimulus for division can favor the development of a malignant tumor. This is also the case if only estrogens are taken for hormone replacement during menopause. If estrogen is continuously combined with a progestogen, as recommended in the guidelines, there is no increased risk of uterine body cancer.
04
Symptoms
The most important early symptom of endometrial cancer is unusual vaginal bleeding. Any bleeding after menopause is particularly suspicious!
In addition, the following symptoms may occur:
- Pelvic pain
- Difficulty urinating or irregular bowel movements
- Bloody or flesh-colored, often foul-smelling discharge outside of the menstrual period
- Lower abdominal pain
- Unexplained weight loss.
Such symptoms can also have completely harmless causes. Nevertheless, you should take the warning signs seriously and consult your gynecologist to clarify the cause!
05
Diagnosis
If endometrial cancer (endometrial carcinoma) is suspected, the doctor will initiate the necessary examinations. These can clarify whether it is actually cancer, what type of tumor is present, and how far the disease has progressed.
Important diagnostic steps for detecting endometrial cancer are:
- Medical history and physical examination with a speculum and palpation, Pap test
- Ultrasound examination (transvaginal sonography)
- Hysteroscopy
- Fractionated curettage of the cervix and the uterine lining (fractionated abrasio)
The histological, microscopic examination of the tissue is crucial for confirming the diagnosis.
06
Treatment
… of endometrial cancer is divided into various therapeutic pillars. These primarily include surgery and chemotherapy.
07
Surgery
… is almost always at the beginning of treatment upon initial diagnosis. The result of the initial surgery is one of the most important prognostic factors in endometrial cancer.
If you and your doctors decide that a surgical procedure is the best option for you, the following procedures may be recommended:
Open surgical technique
In a conventional open procedure, a long abdominal incision is made. The incision provides a direct view of the surgical field. The operation is performed with hand-held instruments.
Conventional laparoscopic surgical technique
A special technique for performing operations in which several small incisions are made in the abdominal wall, through which a laparoscope (endoscope for laparoscopy) and other hand-held instruments can be inserted to see the structures in the abdominal cavity and pelvis and to perform procedures on the affected organs.
Robot-assisted laparoscopic surgery
In a robot-assisted procedure, surgery is performed through several small incisions of less than 2 cm. From a console in the operating room, the surgeons control a camera and robot-guided instruments to perform the procedure.
08
Chemotherapy
and targeted maintenance therapy
… refers to cancer treatments with medications intended to kill tumor cells or prevent them from growing. In endometrial cancer, this is the second pillar of treatment.
09
Patient-doctor consultation
… is the heart of the treatment. Only through trust, openness, and transparency in a mutual conversation is it possible for the doctor to respond appropriately to your concerns, wishes, and complaints.
