Uterine body cancer (endometrial cancer)

The main articles are:

• Cancer (cancer)
• Woman's uterus

Uterine body cancer (RTM), or endometrial cancer, is a malignant formation that develops in the epithelial layer of the uterine body.

RTM forms

The form of endometrial cancer is determined by histological examination. WHO highlights 10 variants of endometrial cancer. The most common of these are endometrioid, serous, and light cell.

There are 3 degrees: high (grade 1), moderate (grade 2) and low (grade 3). The more "normal" the cells look, the higher the degree of differentiation will be.

The most common form is endometrioid endometrial cancer. Most endometrioid tumors have a degree of differentiation of 1 or 2, they are often diagnosed at an early stage. This allows you to limit yourself to surgery or hormone therapy only. Endometrioid tumors have a good prognosis with a five-year survival rate of about 80%.

Serous endometrial cancer accounts for approximately 10% of cases. It often spreads to nearby tissues and lymph nodes. After surgical removal of the tumor, chemo- or radiation therapy may be required.

Light-cell tumors are even rarer and resemble serous ones in flow.

Varieties such as low-differentiated and dedifferentiated endometrial cancer are also aggressive. They are usually diagnosed in advanced stages and progress rapidly.

Carcinosarcoma is rare, mainly in older women. The prognosis in this case is worse than that of low-differentiated (grade 3) endometrial cancer. Surgery is the main method of treatment, but postoperative chemo- or radiation therapy can also be used.

Mesonephro-like adenocarcinoma accounts for less than 1% of endometrial tumors, often metastasizes. It is usually diagnosed in the late stages. This type of tumor is treated surgically.

Mesonephral adenocarcinoma is an even rarer tumor, there are no standards of treatment for it.

Squamous cell carcinoma of the endometrium is another extremely rare variant that may be associated with chronic inflammation. For its treatment, total hysterectomy (surgical removal of the uterus) is usually chosen.

Symptoms

Abnormal uterine bleeding is the most common (over 90% of cases) and an important early symptom of endometrial cancer. This symptom can manifest itself in different ways:

• bloody secretions from the postmenopausal genital tract,
• unusually abundant, irregular menstruation,
• bloody discharge between periods.

Postmenopausal bleeding is the most common symptom. It is manifested by bloody secretions from the genital tract that occur after 12-month amenorrhea (lack of menstruation) in women who do not take hormone replacement therapy.

In premenopause and perimenopause (transition to menopause), a change in the nature and volume of menstruation should be alerted. Abundant, prolonged or intermenstrual bleeding can be associated with endometrial cancer. However, the probability of this is much lower than in postmenopause (about 1%).

Other possible symptoms are:

• watery vaginal discharge (may have an unpleasant smell),
• difficult or painful urination,
• pain during sexual intercourse,
• pelvic pain,
• palpable formation or swelling in the pelvic region.

If endometrial cancer spreads to other organs, the following symptoms are possible:

• weight reduction of more than 5% of body weight in the last 6 months;
• weakness in the legs;
• back pain;
• defecation disturbance;
• in the presence of metastases in the lungs - persistent chronic cough, shortness of breath, chest pain;
• in the presence of metastases in the liver - pain in the right hypochondrium, decreased appetite, jaundice, itchy skin, swelling on the legs;
• in bone damage - excruciating pains that intensify at night, pathological fractures that occur due to weakening of bone tissue.

Causes of the disease

Hereditary factor

The presence of endometrial cancer in a woman's immediate family increases her risk of getting sick by 2-3 times. This is caused by the inheritance of genetic "breakdowns." Some of these genetic failures significantly increase the likelihood of developing the disease, others - moderately or weakly. Most of all, the risk is increased by mutations that lead to the formation of hereditary diseases - such as Lynch syndrome and Cowden syndrome.

Effect of age on the risk of getting sick

The chance of developing endometrial cancer increases with age. More than half of women are diagnosed with endometrial cancer after 55 years (the average age of the sick is 61 years).

Effects of hormonal factors

A key factor in the development of endometrial cancer is the increase in estrogen levels in the woman's body. Elevation can occur in two ways:

• exogenous, that is, external, exposure (the supply of estrogen with drugs);
• endogenous, that is, internal, exposure (increased estrogen in the body).

How overweight and diet affect your risk of developing endometrial cancer

Obesity increases the risk of developing endometrial cancer. Overweight people have high levels of estrogen in the body through estradiol formation in peripheral adipose tissue. An increase in body mass index (BMI) for every 5 kg/m2 is associated with a 54% increased risk of endometrial cancer.

A high-fat diet can increase the risk of many cancers, including endometrial cancer. Since fatty foods are also high in calories, a high-fat diet can lead to obesity, which is a well-known risk factor for endometrial cancer.

How taking drugs or IVF affect your risk of developing endometrial cancer

The higher the number of menstrual cycles during a woman's life, the higher the risk of developing endometrial cancer. The onset of menstrual cycle (menarche) before the age of 12 years and/or the onset of menopause later in life (after 55 years) increases this risk.

Fertility treatment and IVF (in vitro fertilization) do not lead to increased incidence of endometrial cancer. Risks in infertility patients are associated with lack of pregnancy and are not associated with the fertility treatment itself.

Spread of the disease

In the world

According to 2020 data in the world, uterine body tumors (90% are endometrial cancer) are the second most common among malignant gynecological tumors - after cervical cancer. Among tumors of all localizations in women, endometrial cancer ranks sixth. So, about one in twenty detected malignancies in women is endometrial cancer.

In 2020, more than 417 thousand cases of the disease were registered in the world. On average, 8.7 cases were recorded per 100 thousand population. At the same time, two of them, unfortunately, led to death (relative risk 1.8 per 100 thousand).

These figures reflect world statistics, but in some countries the indicators may differ tenfold. Such a spread in statistics is associated with different life expectancy, genetic characteristics, the quality of diagnosis and treatment and other risk factors.

Over the past 15 years, both the incidence of endometrial cancer and deaths from it have been increasing almost annually. For example, for the period 2013-2018. morbidity on average increased annually by 1.3%, mortality - by 2%. Although in some cases such statistics may not be associated with a real increase in the number of cases, but with the fact that diagnosis has become better, and cancer is detected more often.

In Russia

In Russia, uterine body cancer is more common than the average according to world statistics. So, among all malignant tumors in women, uterine body cancer ranks third - after breast cancer and malignant skin neoplasms. And nearly one in twelve tumors found is endometrial cancer.

In 2020, more than 24 thousand cases of the disease were detected in Russia. This corresponds to about 16 cases per 100 thousand women of different ages. In 1 of 4 cases, endometrial cancer led to the death of the patient.

In the dynamics of the incidence of endometrial cancer in Russia, there is also an increase in the number of detected cases (on average, with an annual increase of 1.4%). However, the risk of death from endometrial cancer is reduced by about the same amount - 1.46%. This suggests that in 10 years it was possible to prevent one in seven deaths from endometrial cancer.

2023: In 10 years, every seventh death from endometrial cancer was prevented in the Russian Federation

As of the beginning of 2023, uterine body tumors (90% are endometrial cancer) occupy the sixth place in the world in the world and the third in Russia among the most common malignant tumors in women. In Russia, almost one in twelve detected tumors is endometrial cancer.

"Endometrial cancer most often manifests itself in the early stages, when the chances of successful treatment are as high as possible. Knowing the symptoms will allow you to see a doctor in a timely manner and start treatment. Mortality from this disease is decreasing, as progressive methods of treatment appear in the everyday life of doctors, for example, immunotherapy. For 10 years in Russia, it was possible to prevent every seventh death from endometrial cancer, "said Asya Suvorova, coordinator of the Onko Viki project.

The chance of developing endometrial cancer increases with age. More than half of women are diagnosed with endometrial cancer after 55 years (the average age of the sick is 61 years). The presence of endometrial cancer in a woman's immediate family increases her risk of getting sick by 2-3 times.

See also

• Cervical cancer

Links

"Cancer of the endometrium (uterine body)," section of the Onko Vicky online cancer encyclopedia