What is Uterine Body Cancer
Endometrial cancer is the uncontrolled proliferation of cells within the uterus, the organ where the fetus develops. The disease can begin in the inner lining, in the muscle, or in the supporting tissue of the uterus and occurs in women of any age, but is more common in women who are already in menopause.
It is the sixth most common type of cancer among women worldwide, with around 380,000 new cases per year.
In Brazil, endometrial cancer ranks eighth among the most incident malignant tumors in the female population (excluding non-melanoma skin cancer). For 2022, the National Cancer Institute (INCA) estimated 7,840 new cases in the country.
Types of endometrial cancer
There are two types of endometrial cancer: carcinoma and sarcoma.
More than 95% of malignant uterine tumors are carcinomas. They begin in the endometrium – the inner lining of the uterus – and are called endometrial carcinomas.
The other cases are sarcomas, which originate in the muscle or uterine tissues and are classified according to the type of cell from which they develop. They are divided into:
- Uterine leiomyosarcomas – they begin in the myometrium (muscular wall of the uterus) and represent 2% of tumors;
- Endometrial stromal sarcomas – they develop in the supportive connective tissue of the endometrium (the stroma). They represent 1% of uterine cancers and offer the best recovery prognoses among uterine sarcomas; and
- Undifferentiated sarcomas – although they are often considered a subtype of endometrial stromal sarcoma, they are more aggressive and require different treatment. They also represent 1% of uterine malignant tumors.
In addition, there is the rare carcinosarcoma. Tumors originate in the endometrium and have characteristics of both carcinomas and sarcomas. They are known as mixed mesodermal tumors or malignant mixed mullerian tumors.
Symptoms of endometrial cancer
There is no screening test for endometrial cancer, so it is important to pay attention to the symptoms of this disease. Vaginal bleeding is the most common symptom of uterine body cancer. This includes:
- Vaginal bleeding between menstrual cycles or more intense than usual during the cycle. It is worth noting that only about 20% of cases are diagnosed in fertile women and therefore with menstrual cycles; and
- Any vaginal bleeding in a woman who is already in menopause.
In addition to bleeding, symptoms include:
- Pelvic pain;
- Fatigue;
- Anorexia;
- Weight loss without apparent reason.
Diagnosis of endometrial cancer
In the presence of symptoms, the gynecologist proceeds with the detection of endometrial cancer. To do so, the professional performs exams and procedures that allow visualization of the uterus and its interior to assist in the diagnosis. These include:
- Physical examination;
- Transvaginal ultrasound;
- Hysteroscopy (visualization of the inside of the uterus through a camera inserted through the vagina); and
- Endometrial biopsy (removal of a small sample of the inner layer of the uterus for microscopic analysis).
Once endometrial cancer is detected, its staging is determined – the stage at which it is and whether it is confined to the original site or has spread to other organs. The following exams are then performed:
- Pelvic exam (with a speculum and vaginal touch);
- Imaging tests (such as X-ray, ultrasound, computed tomography, magnetic resonance imaging).
From there, the treatment for cancer is defined.
Treatment for endometrial cancer
The decision on the type of treatment for endometrial cancer will depend on factors such as the stage of the disease, age and general health of the patient, type of tumor, and future intention of having children.
The following types of treatments are employed, either alone or in combination, in the quest to cure endometrial cancer:
- Surgery – removal of cancer through surgical intervention. In most cases, hysterectomy is performed, which is the surgery to remove the uterus, ovaries, and fallopian tubes;
- Radiation therapy – complementary to surgery, it uses high-dose radiation to eliminate cancer cells that may still be present. It can be external (applied outside the body) or internal (applied directly inside the vagina);
- Chemotherapy – use of drugs to inhibit growth and kill cancer cells;
- Hormone therapy – use of medications to inhibit the activity of hormones that may cause the growth of endometrial cancer tumors.
Prevention of endometrial cancer
The best prevention against cancer is to avoid factors or quickly treat/control diseases and health conditions that promote its development.
The main factors to be avoided in preventing endometrial cancer are:
- Excess body fat;
- Sedentary lifestyle;
- Diets with high glycemic load (high amount of carbohydrates and/or a diet rich in processed and ultra-processed foods);
- Use of estrogen for hormone replacement therapy after menopause.
Among the diseases and health conditions to be treated or controlled quickly to prevent the development of endometrial cancer are:
- Genetic predisposition;
- Diabetes mellitus;
- Endometrial hyperplasia;
- Chronic lack of ovulation;
- Polycystic ovary syndrome;
- Lynch syndrome
