Understanding Endometrial Cancer -- Diagnosis & Treatment
How Do I Know If I Have Endometrial Cancer?
If a woman has symptoms that suggest endometrial cancer, her doctor may check general signs of health and possibly order blood and urine tests.
Further tests include:
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Pelvic exam and Pap smears, which screen for cervical cancer, can also detect a small number of endometrial cancers before symptoms develop.
Transvaginal ultrasound, in which the doctor inserts a wand-like instrument into the vagina. The instrument aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. Saltwater (saline) can be placed into the uterus through the cervix before the ultrasound test to give a clearer picture. This is called a sonohystogram. If the endometrium looks too thick or irregular, the doctor can perform an endometrial biopsy in the office or a dilation and curettage (D&C) in the operating room.
The definitive test is a biopsy (taking and testing a tissue sample of the uterus). If a tissue biopsy confirms the diagnosis, your doctor will order imaging tests such as a CT scan or MRI, blood tests for CA-125, a marker seen both with ovarian and endometrial cancer, a colonoscopy, and/or exploratory surgery (opening the abdomen) to determine how far the disease has spread.
What Are the Treatments for Endometrial Cancer?
Surgery is standard treatment for endometrial cancer that has not begun to spread, and is an effective prevention for women at high risk of developing the disease. The most successful treatment for early cancer is total hysterectomy, in which the uterus, cervix, ovaries, and fallopian tubes are removed. In addition, any suspicious lymph nodes are biopsied and also may be removed. This surgery is most likely to prevent recurrence.
If the disease has spread beyond the uterus, the patient is given radiation therapy, often in combination with chemotherapy, post-surgery, to wipe out the remaining cancer cells. Some doctors also recommend radiation when the tumor is large but has not spread beyond the uterus.
Patients with widespread endometrial cancer usually receive hormone therapy, usually progesterone, to slow the cancer's growth. Chemotherapy or radiation is used after surgery for some patients. Chemotherapy or radiation might also be given to reduce the size and number of metastatic tumors -- all of which can prolong life and relieve symptoms. If it successfully destroys distant tumors -- and the remaining cancer is confined to the uterus, cervix, ovaries, and fallopian tubes -- surgery may also be performed.
Patients in remission need checkups every few months for several years. If cancer recurs, it usually happens within three years. Caught early, recurrent cancer may be cured with aggressive radiation therapy, alternatively chemotherapy, or further surgery.
To help cope with the emotional difficulties of having uterine cancer, patients might consider joining a support group. Counseling is especially beneficial for pre-menopausal women who become depressed after a hysterectomy.
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