Endometrial cancer

Endometrial cancer is a malignant tumour, a mass of cells that have lost their ability to repair or die for various reasons and will then multiply indefinitely at the expense of healthy tissue and the body.
Endometrial (body of the uterus) cancer is the most common cancer in women after breast cancer. It's a hormone-dependent cancer. It occurs 8 times out of 10 in postmenopausal women but 10 to 15% of cases occur in non-menopausal women, including 2 to 5% in women under 40 years of age. There is no recognized screening test. The most frequent (80%) is an adenocarcinoma, classified into 3 grades.
Endometrial cancer is a cancer of the inside of the uterus, the endometrium being the mucous membrane that lines the inside of the uterus. In women with cancer at this level, endometrial cells multiply abnormally.
RISK FACTORS:
• Family history of endometrial cancer
• Personal or family history of breast, colon or ovarian cancer
• Exposure to estrogens in the absolute or relative absence of progestin
• Nulliparity
• Early puberty and/or late menopause
• Obesity
• Polycystic ovarian syndrome
• Tamoxifen hormone therapy
• HTA and diabetes
• Pre-cancerous lesions of the endometrium
• History of pelvic irradiation
• Ageing process
• Absence of pregnancy
SYMPTOMS:
• Spontaneous, painless, irregular bleeding in a woman who is peri/menopausal
• Purulent and fetid vaginal discharge
• Lower abdominal pain
• At the vaginal touch made by the gynaecologist: uterus is soft and sensitive.

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The choice of your treatments depends on the characteristics of the cancer you have: where it is located, its stage, i.e. its degree of extension, its histological type, i.e. the nature of the cells involved, and, in some cases, its grade, i.e. its degree of aggressiveness. These characteristics are determined by the diagnostic check-up examinations.
DIAGNOSIS:
• Pelvic ultrasound: allows to see an increase in the thickness of the mucous membrane (wall constituting the uterus); allows to see a potential damage to the myometrium (muscle of the uterus), looks for a lymph node, abnormal vascularization at the cancer level.
• Hysteroscopy: is performed under local or general anesthesia to assess the site, the extension of the tumor, and especially to perform biopsies.
• Endocervical and endo-uterine biopsy curettage: allows precise histological diagnosis
EXTENSION ASSESSMENT:
• Chest X-ray
• Hepatic ultrasound scan
• Pelvic MRI: allows to see the invasion of the myometrium, damage to the bladder, rectum, lymph nodes…
According to the symptoms:
• Cystoscopy, intravenous urography, colposcopy
• Bilateral comparative mammography
• Operability check-up: electrocardiogram, complete blood biology.
Here is the classification of endometrial cancers:
Stage I: tumour limited to the uterine body. Stage II: tumour invading the cervix. Stage III: tumour invading the vagina, tubes or ovaries, pelvic lymph nodes. Stage IV: tumour invading the bladder, intestine, or distant metastases.

Surgery is the main treatment for endometrial cancer. It is very often performed as long as the tumour has not spread to the bladder, intestine or more distant organs in the form of metastases.
The consultation with the surgeon:
The surgeon will explain the objectives of the operation, the technique he will use, the consequences and possible complications.
The consultation with the anaesthetist:
The procedure is performed under general anesthesia. The consultation allows you to assess the risks associated with anesthesia by taking into account your medical and surgical history.
To know: Quitting smoking a few weeks before an intervention reduces the risk of post-operative complications.
Stages I and II:
The surgery in 3 steps:
• Laparotomy (opening the abdominal wall) for a complete peri-abdominal exploration
• Total hysterectomy (removal of the uterus with retention of the cervix) with Bilateral adnexectomy (removal of the ovaries and fallopian tubes)
• Lymphadenectomy (removal of lymph nodes from the iliac region).
The surgery requires a few days of hospitalization and 3 weeks of convalescence.
In the case of obesity: lymphadenectomy by laparoscopy is performed first, followed by a total hysterectomy by the vaginal route.
External pelvic radiotherapy will be performed on a case-by-case basis based on anatomopathological findings.
Brachytherapy is also to be discussed on a case-by-case basis (brachytherapy consists of placing a radioactive element, usually iridium, directly in contact with the area to be treated.)
Stages III and IV.
• Extended colpohysterectomy (uterus and cervix removed), lymphadenectomy, external radiotherapy and brachytherapy +/- adjuvant chemotherapy.
ASSOCIATED MEASURES:
• Prevention per and postoperatively of phlebitis risks: compression stockings, anticoagulant injection, early lifting.
• Psychological support
• Treatment of overweight, diabetes
• Definitive contraindication to hormone replacement therapy
• Regular monitoring every 3 months by vaginal smear and clinical examination.

Once the operation is completed, you are taken to the recovery room where the medical team will monitor you, especially when you wake up from the anaesthesia.
As after any surgical procedure, pain is frequent in the operated area. They are systematically treated, usually with morphine or one of its derivatives.
If you are not sufficiently relieved, report it promptly to the medical team so that treatment can be adapted. One or more drains were installed in the operated area during the intervention. These very thin tubes allow the evacuation of liquids (blood, lymph) that can accumulate during the healing process.
They are removed by decision of the surgeon, often around the fourth day after the operation. A urinary catheter could also be used to monitor kidney function for a few days. Finally, to avoid phlebitis, doctors will prescribe an anticoagulant medication and ask you to get up fairly quickly after the procedure. In addition, the use of compression stockings is frequently recommended.
On average, the duration of hospitalization is 4 to 5 days. But this varies depending on the procedure performed and how you have handled it.
What has been removed during the surgery will be sent to the laboratory for analysis. This examination is carried out by a specialist doctor called a pathologist. It consists of observing the tissues collected under a microscope to determine how far cancer cells have spread. It also checks whether the edges of the tissue surrounding the tumor are healthy, which proves that the tumor has been completely removed. It is through this examination that the stage of cancer is confirmed and doctors decide whether further treatment is necessary after surgery.
You will be reviewed by the various doctors who will have treated you at a rate of one consultation every 4 to 6 months for 3 years and then annually. Endometrial cancer has a very good prognosis because of its slow progression, early diagnosis and accessibility to surgery.

About Endometrial cancer

Side effects:
• Urinary disorders: difficulty to urinate, or even a blockage for a few days.
• Lymphatic system disorders
• Hematoma or wound infection
• Tiredness
• Impact on fertility
• Sexual disorders
Some complex diseases such as cancer can lead some patients to seek a second medical opinion. Almost 50% of patients using the second medical opinion have seen their treatment options evolve. Seeking a second medical opinion is perfectly legitimate when faced with a serious illness.
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