Endometrial Cancer

Endometrial cancer is a type of cancer that attacks the endometrium or uterine lining. This cancer usually occurs in postmenopausal women (60 to 70 years).

There are two main types of endometrial cancer, namely:

• Types of endometrial cancer 1. The most common type of endometrial cancer. The development of cancer cells in this type occurs slow (non-aggressive) and can be detected quickly.
• Endometrial cancer type 2. Endometrial cancer is more aggressive, so the development and spread of cancer cells occur more quickly.

Causes of endometrial cancer

The cause of endometrial cancer is not yet known with certainty. However, it is thought that the imbalance of the hormones progesterone and estrogen in a woman's body is one of the causes of endometrial cancer. Lower levels of the hormone progesterone compared to estrogen can cause thickening of the uterine lining. If thickening continues, cancer cells can develop over time.

In addition, several factors can increase the risk of endometrial cancer in women. Among others are:

• Obesity.
• Entering menopause.
• Start menstruation very early (<12 years) or postmenopausal later than women in general (> 50 years).
• Never been pregnant.
• Follow hormonal tamoxifen therapy for breast cancer sufferers.
• Suffered from hereditary colorectal cancer syndrome without polyposis (HNPCC).

Symptoms of endometrial cancer

The most common symptom of endometrial cancer is vaginal bleeding. These symptoms usually appear since the cancer is in its early stages. However, bleeding has different signs depending on whether the patient is experiencing menopause or not. If the patient is not yet menopausal, vaginal bleeding is characterized by:

• Blood that comes out during menstruation is longer and menstruation is longer (more than 7 days).
• Blood spots appear outside the menstrual period.
• Menstrual cycles occur every 21 days or faster.
• Bleeding occurs before or after sex. 

For menopausal patients, any form of bleeding or blood staining in the vagina that occurs at least one year after menopause is considered abnormal and should be immediately consulted with a doctor.

Besides bleeding, other symptoms of endometrial cancer are:

• Leucorrhoea is fluid and occurs after menopause.
• Pelvic pain or lower abdomen.
• Pain during sex.

Advanced endometrial cancer will cause additional symptoms, such as back pain, nausea, and loss of appetite.

Diagnosis of endometrial cancer

Doctors may suspect patients with endometrial cancer if they have symptoms that are confirmed by physical examination. But to be safer, you have to do another test. Doctors usually carry out several types of tests to diagnose endometrial cancer, namely:

• Pelvic examination (pelvis). During a pelvic exam, the doctor will examine the outside of the vagina and then insert two fingers into the vagina. At the same time, the doctor will press the patient's stomach with the other hand to detect abnormalities of the uterus and ovaries. The doctor can also use a speculum to detect vaginal and cervical abnormalities.
• Transvaginal ultrasonography. This examination is carried out using a special device called a transducer that enters the vagina and can emit high-frequency sound waves into the uterus. This tool can produce images of the uterus so the doctor can see the texture and thickness of the endometrium.
• Hysteroscopy. The examination uses a hysteroscope, a special instrument with a small camera and a lamp, which is inserted into the uterus through the vagina. This tool allows the doctor to see the condition of the endometrium and uterus.
• Endometrial biopsy, which involves taking tissue samples from the uterine wall for laboratory analysis to detect the presence of cancer cells.
• Dilation and curettage (dilation and curettage), also known as curettage, are procedures for erosion or erosion of tissue from the uterus using special tools. This procedure is done if the sample taken during endometrial biopsy is not enough to detect cancer cells or if the doctor still doubts the results of the analysis.

If the doctor suspects advanced endometrial cancer, he will perform imaging tests to determine whether the cancer has spread to other organs, including X-rays, CT scans, computer CT scans and MRI. In addition, doctors can also do cystoscopy or colonoscopy to detect whether cancer cells have spread to the bladder or digestive tract.

Then, the doctor will determine the stage of endometrial cancer based on the extent of its spread. Endometrial cancer has four stages, namely:

• Stage I - Cancer is still in the womb.
• Stage II - Cancer has spread to the cervix.
• Stage III - Cancer has spread outside the uterus (pelvic lymph nodes), but has not yet reached the large intestine or bladder.
• Stage IV - Cancer has spread to the bladder, large intestine, even organs or other body parts.

Treatment of endometrial cancer
Treatment for endometrial cancer is usually determined by several factors, namely:

• The stage or rate of spread of cancer cells in the uterus.
• The general state of health of the patient.
• Endometrial cancer type and tumor size.
• Place of endometrial cancer.

There are several types of endometrial cancer treatments. Among others are:

• Surgery is one of the most effective treatment steps in the treatment of endometrial cancer. Surgery will be performed if the cancer is still in its early stages. There are two types of operations that can be performed, namely:
• Hysterectomy, which is a procedure for removing the uterus. However, this operation prevents patients from having children later in life.
• Salpingo-oophorectomy, removal procedure of the ovaries and fallopian tubes (fallopian tubes). This type of surgery also prevents patients from having children.
• Chemotherapy. Treatment methods use drugs that kill cancer cells and prevent their spread. The types of drugs used are cisplatin, carboplatin, doxorubicin and paclitaxel.
• Radiotherapy (radiotherapy). The method of treating cancer uses high-energy jets to destroy cancer cells. Radiation therapy is usually associated with other treatment methods, such as chemotherapy. This therapeutic treatment can also be used to inhibit the spread of cancer cells when surgery is not possible. There are two types of radiotherapy, namely:
• External radiotherapy, radiotherapy uses a machine that directs energy emissions to parts of the body affected by cancer cells.
• Internal radiotherapy (brachytherapy), radiotherapy by placing radioactive substances in the vagina.
• hormone therapy. This therapy involves the use of drugs that can affect hormone levels in the body. Hormone therapy is used in patients with advanced endometrial cancer and cancer cells have spread outside the uterus. There are two types of hormone treatment, namely:
• Increased progesterone hormone to inhibit the development of cancer cells, for example with progestin.
• The hormone estrogen is reduced to destroy cancer cells that are dependent on estrogen to develop, for example with tamoxifen. 

Prevention of endometrial cancer

Most endometrial cancer is unavoidable, but some action can be taken to reduce the risk. Among others are:

• Perform routine checks on the reproductive organs, such as pelvic examination and smears. This test can help your doctor detect problems or other abnormal signs.
• Consider using a contraceptive pill. Use of oral contraceptives for at least one year can reduce the risk of endometrial cancer. However, every oral contraceptive has side effects. Discuss the benefits and risks with your doctor before using them.
• Maintain or maintain ideal body weight, because obesity can increase the risk of endometrial cancer. Eat foods that are low in calories and saturated fat.
• Exercise regularly. Try to exercise for 30 minutes every day.
• Discuss the risks and benefits of hormone therapy after menopause. The use of hormone therapy, especially a combination of progestin and estrogen, can increase the risk of breast cancer.

Complications of endometrial cancer
Possible complications due to endometrial cancer, including:

• Anemia, which is caused by vaginal bleeding.
• A tear (perforation) in the uterus, which can appear during biopsy or endometrial curettage.
• Side effects of chemotherapy and radiotherapy, such as nausea and vomiting, loss of appetite, constipation, hair loss, and rashes. 

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