Ask the Doc: An In-Depth Discussion About Endometrial Cancer

By Guest Editor on Jan 1, 2018

We talked to Dr. Jeffrey Wrightson, with WellHealth, a DaVita Medical Group, to learn more about
the ways to diagnosis and treat endometrial cancer.

CareConnection: What is uterine cancer?

Dr. Jeffrey Wrightson: Uterine cancer for the most part refers to endometrial cancer.  Endometrial cancer is the most commonly diagnosed  gynecologic malignancy and refers to cancer of the lining of the uterus.  Approximately 50,000 women a year will be diagnosed with endometrial cancer.  There is also a type of cancer that can develop from the muscle of the uterus and is called leiomyosarcoma. These cancers are fairly rare and at times are associated with uterine fibroids.

CareConnection: What causes endometrial cancer?

Dr. Jeffrey Wrightson: Though we do not yet know the specific cause of endometrial cancer, there are well identified risk factors. The most important risk factor is prolonged exposure to unopposed estrogen.  Though this exposure can come from taking estrogen alone (meaning without progesterone included) for a prolonged period of time, prolonged endogenous exposure is more common. Conditions where this can happen include obesity and polycystic ovary syndrome. Women with a body mass index greater than 25 have a 200 to 400 percent increase in risk. Other risk factors include older age, white race, smoking and diabetes. There are also genetic conditions such as Lynch syndrome that put some women at higher risk.

CareConnection: What are the types of endometrial cancer?

Dr. Jeffrey Wrightson: There are two types of endometrial cancer.  Type 1 is called endometrioid adenocarcinoma and it accounts for more than 75 percent of all cases. Most of these cancers are low grade, meaning less aggressive, and are diagnosed earlier leading to better survival.  Type 2 cancers are more likely to be high grade and carry a higher risk of spreading outside the uterus. 

CareConnection: What are the symptoms of endometrial cancer?

Dr. Jeffrey Wrightson: The most common presenting symptom is abnormal bleeding. Since many women are menopausal when diagnosed, any bleeding after menopause should be investigated.  In women who are not menopausal, irregular bleeding and irregular periods can be signs. This is important with increasing rates of obesity in pre menopausal women. Other signs can include abdominal or pelvic pain, bloating and change in bowel habits. 

CareConnection: Will obesity increase the risk of endometrial cancer?

Dr. Jeffrey Wrightson: Women that are overweight have higher amounts of estrogen in there bodies. This stems from production and storage that occurs in fat tissue. This increased estrogen leads to continuous stimulation and growth of the uterine lining, which over time leads to overgrowth of the lining and eventual progression to cancer.

CareConnection: How can I reduce my risk of endometrial cancer?

Dr. Jeffrey Wrightson: The way to reduce risk is to eliminate risk factors that can be controlled. Weight loss to achieve a BMI less than 25, smoking cessation and control of diabetes, hypertension and thyroid disease are important. If you're on medications that include estrogen, discuss long-term use with your physician, especially if it is being given without a progesterone.

CareConnection: If I have endometrial cancer, what are the treatments? Will I need a hysterectomy?

Dr. Jeffrey Wrightson: The initial treatment for most endometrial cancers are a hysterectomy. The cancer involves the uterus, and there is no lesser procedure that is effective.  Usually, removal of the ovaries and lymph node sampling is also included.  This approach helps to decide if additional treatment may be needed. Depending on the extent of the disease, other treatments such as radiation therapy or chemotherapy may be needed. 

CareConnection: What type of checkups will I need after being treated for uterine cancer?

Dr. Jeffrey Wrightson: Follow up after treatment for endometrial cancer will usually include visits every three to six months for two years, every six months for three years and annually thereafter. Physical exam including pelvic exam should be done at each visit. Further testing may be ordered based on the exam findings and may include X-rays, CT or PET scans. Lifestyle changes are very important and should be discussed at follow-up visits.