Q&A: Endometrial Cancer Treatment, Diagnosis
April 27, 2008
Q&A: Endometrial Cancer Treatment, Diagnosis
More is known today about endometrial (uterine) cancer than a few years ago, and that knowledge is driving steady progress in the treatment and early diagnosis of the disease, experts say.
Endometrial cancer is the most common gynecologic cancer in women and the fourth leading cause of cancer death in women.
Answering common questions about the disease and progress in its detection and treatment is Karen Lu, M.D., associate professor in the Department of Gynecologic Oncology at M. D. Anderson.
What are the current statistics for endometrial cancer?
Approximately 41,200 women are expected to be diagnosed with endometrial cancer in the United States in 2006, and 7,350 will die from the disease, according to the American Cancer Society.
Are there screenings for endometrial cancer?
No, and the Pap test is only used to screen for cervical cancer. In rare cases, the Pap test identifies endometrial cancer, but it usually does not.
How is endometrial cancer diagnosed?
Usually, endometrial cancer is identified only after women become aware of certain symptoms, the most important of which is vaginal bleeding. At that point, additional tests, including an endometrial sampling (a procedure in which a sample of tissue is taken) or a D&C (dilatation and curettage – a scraping of the uterine lining) are conducted to confirm the diagnosis.
What are the symptoms of endometrial cancer?
- Any post-menopausal bleeding
- Bleeding between periods or heavy periods
- Unusual discharge
- Pelvic pain or pressure
What progress is being made in diagnosis?
We now have a better understanding of who is at risk, which means women can be diagnosed earlier.
Survival for women with early stage disease (cancer confined to the uterus) is greater than 90%. However, survival for women with disease that has spread beyond the pelvis (stage IV) is less than 20%.
What key risk factors are linked to endometrial cancer?
These two risk factors are of great help in identifying cancer:
Lynch Syndrome – Women with a family history of colon or endometrial cancer have a higher risk of developing both diseases if they test positive for a condition called Lynch Syndrome [also known as hereditary nonpolyposis colorectal cancer (HNPCC) syndrome.]
Women with Lynch Syndrome have a 40% to 60% risk of developing endometrial or colon cancer. The risk of endometrial cancer for the general population of women is 3%.
We now have genetic testing to identify people with Lynch Syndrome. If we identify Lynch Syndrome, we can prevent endometrial cancer by performing a hysterectomy. We also can conduct a colonoscopy to screen for polyps that might indicate early colon cancer.
Women with Lynch Syndrome should undergo an annual endometrial biopsy beginning at age 35. Lynch Syndrome counts for 5% to 10% of women with endometrial cancer.
Obesity – The largest group at risk for endometrial cancer is women who are obese. The risk is two- to four-fold greater than the general population, and more than 50% of women with endometrial cancer are obese.
Knowing this, physicians can educate their patients about the risks of obesity in an effort to reduce the risk of endometrial cancer.
What are the other risk factors of endometrial cancer?
Women should be aware of these risk factors:
Hormone therapy – Women with a uterus who use estrogen replacement therapy without progesterone may increase their risk of developing the disease.
Tamoxifen – Women taking tamoxifen should be counseled that any irregular bleeding calls for an endometrial sampling.
Infertility – Women who have been unable to conceive have a higher risk.
What improvements have been made in treatment?
The newest innovations in treating endometrial cancer include:
Increased staging recommendations – The American College of Obstetrics and Gynecology strongly recommends that most women with endometrial cancer undergo comprehensive surgical staging. That means that in addition to removing a woman’s uterus and ovaries, lymph nodes from the pelvis and the pera-aortic region are removed and evaluated for spread of cancer.
New targeted therapies – We now are conducting a Phase II clinical trial studying an oral medicine called RAD001 that targets a specific protein (mTor) found in endometrial cancer.
RAD001 has been well tolerated by the 20 patients in the study, and there is pre-clinical rationale that this drug may be helpful in controlling tumors. The drug has been shown to block the mTor protein, which means it then may stop the tumor from growing.
Combining therapies in rare disease – We are studying a combination of chemotherapy and radiation in a rare and aggressive subtype of endometrial cancer called uterine papillary serous carcinoma or UPSC. The standard treatment of early stage UPSC is surgery alone.
Five percent of all endometrial cancers are UPSC, which has a very high rate of recurrence – even when diagnosed in early stages. In general, the majority of endometrial cancers that are diagnosed early are treated successfully.
Related story:
Women Need Endometrial Cancer Awareness
Resources:
Endometrial cancer (M. D. Anderson)
