What is Uterus?
Uterus (womb) is a hollow, inverted pear-shaped organ that accommodates the growing fetus during pregnancy. It is situated between the urinary bladder and rectum in the pelvic cavity and it is held in position by several uterine ligaments. It is made-up of mainly 3 tissue layers:
- the outermost, perimetrium (an extension of peritoneum that is composed of areolar connective tissue and forms few uterine ligaments and covers several organs in the pelvis);
- the middle layer, myometrium (composed of smooth muscle fibers that produce powerful coordinating contractions to expel the fetus during labor); and
- the innermost, endometrium (which is the site for endometrial cancer and is further divided into basal and functional layer). The functional layer is transient which develops and shed in cycles in response to mainly two hormones estrogen and progesterone until the menopause (cessation of menstrual cycles in women). The basal layer is permanent and gives rise to a new functional layer after each menstrual cycle.
What are the types of Endometrial Carcinoma?
Endometrioid adenocarcinomas are the most commonly encountered (about 95% of all cases) endometrial cancer. Other less common but aggressive subtypes of endometrial adenocarcinoma include clear-cell carcinoma, mucinous adenocarcinoma, and papillary serous adenocarcinoma. Most endometrial cancers develop from precancerous lesions known as endometrial hyperplasia (an abnormally increased growth of endometrium). Endometrial hyperplasia is divided into four subtypes: simple hyperplasia, complex hyperplasia, simple atypical hyperplasia, and complex atypical hyperplasia. The risk of developing endometrial cancer is highest (about 29%) in complex atypical hyperplasia. All the pre-cancerous lesions are generally treated to avoid a development into invasive disease.
How is the Staging of Endometrial Cancer done?
FIGO (International Federation of Gynecology and Obstetrics) Staging is the most commonly used staging system for endometrial cancer.
FIGO Stage IA
Tumor limited to endometrium or involves <1/2 of myometrium.
FIGO Stage IB
Tumor involves >/= 1/2 of myometrium.
FIGO Stage II
Tumor limited to uterus and extends only upto cervical tissue.
FIGO Stage IIIA
Tumor spread to the serosa, fallopian tube, ovary and/or round/broad ligament (adnexa).
FIGO Stage IIIB
Tumor spread to the vagina or the parametrium.
FIGO Stage IIIC1
Tumor spread to regional pelvic lymph nodes but not to the non-regional lymph nodes.
FIGO Stage IIIC2
Tumor spread to the lymph nodes along the aorta (para-aortic lymph nodes).
FIGO Stage IVA
Tumor spread to the mucosa of the rectum or urinary bladder.
FIGO Stage IVB
Tumor spread to distant body parts such as non-regional lymph nodes, lungs, bones, liver, etc.
What is the Treatment of Endometrial Cancer?
The endometrial cancer treatment depends on stage and grade of the tumor, type of endometrial cancer, patient’s preference (for example, to retain fertility or not), performance status of the patient, along with other factors.
FIGO Stage I
Hysterectomy is the standard treatment. Depending on stage, grade, and other risk factors, it may be followed by observation, or radiotherapy with/without chemotherapy.
FIGO Stage II
Hysterectomy may be followed by radiotherapy with/without chemotherapy in most cases.
FIGO Stage III
If surgical resection is possible, consider hysterectomy followed by radiotherapy and/or chemotherapy. If not resectable, chemotherapy with/without radiotherap may be considered.
FIGO Stage IV
Chemotherapy or hormone therapy is the standard treatment. Surgery or radiation therapy may be considered for symptom relief.
What is the role of Hormonal Therapy in Endometrial Cancer Treatment?
This treatment approach is based on the fact that most endometrial cancer cells grow under the influence of estrogen. Estrogen is predominately produced by the ovaries and a small amount is also produced by the fat tissue in females.
Depriving the endometrial cancer cells of the estrogen or by lowering the estrogen level in the blood cause their shrinkage or make them grow very slowly. Following are some common types of hormonal therapy used for the treatment of endometrial cancer:
Progestins: Drugs like medroxyprogesterone acetate and megestrol acetate are commonly used progestins which act similar to progesterone and inhibit estrogen to produce its eliciting effect on endometrial cancer cells.
Tamoxifen: Tamoxifen is a drug commonly used in breast cancer and can be used to treat advanced-stage endometrial cancer. It blocks the estrogen receptors in cancer cells and can act as a weak estrogen in other body tissues like bones.
Luteinizing hormone-releasing hormone agonists: These drugs (e.g. leuprolide, and goserelin) decrease the level of estrogen in the blood by acting on the pituitary gland which in turn signals to stop the production of estrogen from the ovaries. These drugs can be used alone or in combination with other hormonal drugs in pre-menopausal women.
Aromatase inhibitors (AIs): Aromatase is an enzyme that helps in the production of estrogen from fatty tissue. In post-menopausal women, fatty tissue is the main source of estrogen. Thus, AIs (e.g. letrozole, anastrozole, and exemestane) help in lowering estrogen levels in post-menopausal women and used for the treatment of endometrial cancer in such patients.
Best Endometrial Cancer Specialist in Delhi
Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating endometrial cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.
He has a vest experience of treating endometrial cancer patients in all stages of disease. He is well versed with Hormonal therapy and Chemotherapy for Endometrial Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.
Call +91 9686813020 for appointment.