About Endometrial Cancer

Endometrial cancer is the most common gynaecologic cancer and the 4th most common cancer overall in women.  It represents 6% of all cancers in Canada. The lifetime risk of a woman developing endometrial cancer is over 3%, or 1 in 39 women in Canada.

Most (95%) cancers of the uterus arise from the lining of the uterus, called the endometrium. These are referred to as endometrial cancers. Rare uterine cancers can also arise from the muscle layer of the uterus (called the myometrium) or the stroma of the endometrium. These are referred to as uterine sarcomas and are discussed separately.

The most important risk factor associated with endometrial cancer is unopposed estrogen which is highly associated with obesity. It can also be associated with use of estrogen supplements, hormone replacement therapy, and occasionally from estrogen producing tumors. The risk of developing endometrial cancer is highest in women over age 50. Certain genetic mutations can increase the risk of developing endometrial cancer. Our team of genetics experts can help patients determine if they have genetic risk factors.

Types

There are several types of endometrial cancers, with each having a different clinical behaviour and treatment:

• Endometrioid adenocarcinoma
  • This is the most common type of endometrial cancer
• Serous adenocarcinoma
• Carcinosarcoma
  • Clear cell carcinoma
  • Undifferentiated/de-differentiated
  • Very rare types:
    • Mucinous carcinoma
    • Mesonephric carcinoma
    • Neuroiendocrine carcinoma

Molecular Subtypes

Endometrial cancers are now categorized into four main molecular subgroups:

1. POLE ultramutated
2. Mismatch repair deficient (MMRd)
3. Copy number high/p53 abnormal
4. No specific molecular profile (NSMP)

Symptoms

The majority of women with endometrial cancer will experience abnormal vaginal bleeding. Any vaginal bleeding after menopause needs to be discussed with a doctor. Symptoms may include:

• Abnormal vaginal bleeding/abnormal vaginal discharge
• Pain or difficulty urinating
• Pelvic pain
• Change in bowel or bladder function
• Unintentional weight loss

Diagnosis

The diagnosis of endometrial cancer may consist of several investigations:

• Complete history & physical exam (including pelvic/vaginal exam)
• Endometrial biopsy (sample of the lining of the uterus)
• sometimes a dilatation & curettage (D&C) is required
• CT scan of the abdomen, pelvis & thorax
• MRI of the pelvis

Treatment

Management of endometrial cancer is based on the type, grade, stage, and molecular subtype of the cancer. Most women are diagnosed with early-stage endometrial cancer and require surgery. In many cases, our expert surgeons can perform the surgery with state-of-the-art technology using a minimally-invasive (laparoscopy or robotic) approach. Our approach identifies and removes only the necessary lymph nodes. Women with advanced stage or grade of cancer may require additional treatment prior to or following surgery, such as chemotherapy and/or radiation and/or immunotherapy.

Instructions: The current hyperlink linked to ‘minimally invasive’ does not work, so I propose you remove the hyperlink of the minimally invasive video below the paragraph and replace it with the current hyperlink in the paragraph. I’ve done it already in the above paragraph.

Also please make the following hyperlink mappings:

• Chemotherapy: Systemic Therapy Unit | Princess Margaret Cancer Centre
• Immunotherapy: Systemic Therapy Unit | Princess Margaret Cancer Centre

Five Things to Know About Endometrial Cancer