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Endometrial Cancer Diagnosis and Treatment - A Detailed Guide

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Endometrial cancer needs a comprehensive care approach. Once the diagnosis is confirmed, specialists perform staging, which helps in determining the extent of the disease’s spread.

Once the stage is confirmed, specialists devise an individualized treatment plan. Along with the stage, the type of endometrial cancer, its exact location, its grade, the patient’s age, their overall health condition, and their preferences are considered while the treatment plan is made.

Procedures or Tests for Endometrial Cancer Diagnosis

Endometrial cancer diagnosis can be done through the following methods:

Medical History and Pelvic Examination

Several symptoms of endometrial cancer overlap with certain other conditions. Thus, it is important to rule out more serious conditions. The doctor may ask the patients about their medical history. Patients with Lynch syndrome, obesity, hereditary nonpolyposis colorectal cancer, and ovarian diseases have an increased risk of developing endometrial cancer. Further, hormone therapy for managing ovarian cancer also increases the risk of endometrial cancer.

The patients may also undergo a detailed pelvic examination. Pelvic examinations should be done regularly, especially in women with an increased risk for endometrial or vaginal cancer. During a pelvic examination, the doctor evaluates the external genitals. In addition, gloved fingers are inserted into the vagina to detect any tumor or abnormal growth. The signs of abnormalities or cancer can also be detected by inserting the speculum into the vagina, which improves the internal view.

Pap Test

Although a Pap smear does not diagnose endometrial cancer, it helps to detect cell changes that suggest a possibility of precancerous or cancerous conditions. It also helps diagnose non-cancerous conditions, such as inflammation or infection, which may also be the reasons for symptoms. Pathologists collect the cells from the uterine opening (cervix) during a Pap smear. The collected cells are examined under the microscope to detect abnormal cells.

Biopsy

The endometrial biopsy test is an accurate tool for diagnosing endometrial cancer. During a biopsy, samples of the abnormal cells or tissues are obtained and examined under the microscope to detect morphological changes. Endometrial biopsy is one of the most common methods to obtain endometrial tissue samples. It involves the use of a thin tube, which is inserted into the uterus. Suction is applied through the tube to collect the samples.

Hysteroscopy

Hysteroscopy, an endometrial cancer test, is performed with the help of a hysteroscope. A hysteroscope is a flexible, thin tube inserted into the uterus through the vagina and cervix. The hysteroscope has a camera at the tip that transmits images of the internal tissues of the endometrium and the uterus. This procedure can help in the collection of a biopsy sample.

Dilation and Curettage (D&C)

D&C is performed when the doctor cannot obtain enough abnormal tissues for examination during an endometrial biopsy. It is also done when there is a suspicion of endometrial cancer, but the results are not confirmatory. The procedure is done under sedation or general anesthesia. During the procedure, the cervix of the patient is dilated, and the uterine tissues are scrapped with an instrument. The procedure may or may not involve the use of hysteroscopy.

Ultrasound

Ultrasound is usually the initial imaging method used to evaluate the uterus, ovary, and fallopian tubes in women suspected of having gynecological issues.

Ultrasound, as an endometrial cancer radiology technique, uses sound waves to create images. Several types of ultrasound procedures are performed. These include transvaginal ultrasound and pelvic ultrasound. Transvaginal ultrasound provides better images of the uterus compared to pelvic ultrasound. To view the endometrial cancer on ultrasound more clearly, the doctor may also recommend a hysterosonogram or saline infusion sonogram. It involves infusing salt water into the uterus before an ultrasound.

MRI scan

An MRI scan plays an important role in assessing endometrial cancer. An MRI scan helps evaluate the depth of tumor invasion into the myometrium, which correlates with lymph node metastasis and tumor grade. It helps in staging the disease and determining the disease prognosis. MRI also assists in planning radiation ports, evaluating treatment responses, and surveillance after treatment.

Proctoscopy and cystoscopy

Proctoscopy and cystoscopy are performed when there is a suspicion of cancer being spread to the rectum or bladder. Proctoscopy is performed by inserting a tube into the rectum, while cystoscopy involves the insertion of a tube into the bladder. Both procedures are performed under local anesthesia. Sometimes, the doctor may also obtain sample tissues for further examination.

CT Scan

A CT scan cannot accurately diagnose endometrial cancer due to its poor soft tissue differentiation. The images obtained with a CT scan are less specific and sensitive in detecting myometrium invasion and cervix involvement than those obtained with an MRI. However, a CT scan may be used to detect the spread of cancer to other sites and the recurrence of cancer.

PET Scan

A PET scan is a powerful imaging technique to detect cancer cells throughout the body. It uses radioactive glucose derivatives. Due to their high metabolism, once the radioactive glucose enters the body, the cancer cells collect the substances in them. The scanner scans the body and detects the sites where the radioactive sugar is collected; these sites appear as bright spots. PET scans help in staging the disease by determining the extent of the disease.

Blood tests

Blood tests do not confirm the presence of cancer. However, they provide vital information about the overall body's health. Bleeding due to endometrial cancer may indicate anemia in blood tests. The doctor may also advise the patients to test for CA-125, which is a blood marker for endometrial cancer.

Chest X-ray

A chest X-ray may also be recommended in patients experiencing lung-related symptoms, such as shortness of breath or blood in mucus, which indicates that the cancer may have spread to the lungs.

Bone Scan

A bone scan is recommended for patients suspected of having cancer metastasis in the bones.

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What are Effective Endometrial Cancer Treatments?

No two endometrial cancer cases are the same, and therefore, it is necessary to devise a personalized treatment plan. Customized treatment plans help improve the clinical outcomes and the overall disease prognosis. The following are the commonly recommended endometrial cancer treatment options:

Surgery

Surgery is recommended as a primary endometrioid carcinoma treatment. The type of surgery depends on the stage of the disease. For early-stage endometrial cancers, surgery may be the only treatment required. However, for patients with advanced-stage cancer, multimodal or combination treatment is recommended.

Hysterectomy

Hysterectomy, an endometrial cancer surgery, is the process of removing the cervix and uterus. A hysterectomy performed through the abdomen is known as an abdominal or simple hysterectomy. When the uterus is removed via the vagina, it is known as a vaginal hysterectomy. In some cases, the doctors may also remove the ovaries and/or fallopian tubes along with the uterus.

Lymph Node Dissection

The doctor removes the lymph nodes of the pelvis to determine the presence of cancer cells in the lymph nodes. This procedure is known as lymph node dissection. The doctor may also perform sentinel lymph node mapping to determine which lymph node would be first affected by the cancer.

Minimally Invasive Surgery

Apart from the abdominal hysterectomy, minimally invasive surgery may also be performed to remove the cervix and uterus. The minimally invasive surgeries include laparoscopic surgery and robotic-assisted surgery. Laparoscopic surgery is performed through a laparoscope, while robotic-assisted surgery is performed on a robotic surgery platform wherein robotic arms that are controlled by a robotic surgeon perform the surgery.

Radiation Therapy

It is generally used in combination with surgery or chemotherapy as a part of endometrial adenocarcinoma treatment. Radiation therapy can be delivered through two techniques, namely external beam radiotherapy and internal beam radiotherapy (brachytherapy). In some cases, both procedures are used. Vaginal brachytherapy may be done after a hysterectomy. Brachytherapy may be administered at a high-dose or low-dose rate.

Chemotherapy

Chemotherapy is an endometrial cancer therapy wherein specific anti-cancer medications are used to kill or prevent the growth of cancer cells. These endometrial cancer medications are often recommended for aggressive and advanced-stage endometrial cancers.

Chemotherapy for endometrial cancer is usually administered in cycles, which include a treatment period followed by a rest period. Usually, the chemotherapy drugs are used in combinations. Sandwich therapy may also be used, including radiation therapy between the two cycles of chemotherapy drugs for endometrial cancer.

Hormone Therapy

Endometrial cancer is hormone-sensitive, and therefore, hormone therapy may be recommended as a treatment option. Hormone therapy works by killing the cancer cells or slowing their growth. This form of endometrial cancer treatment involves the use of hormones or drugs that block the hormones. The therapy is usually used in patients with advanced endometrial cancer. The oncologists generally combine hormone therapy with chemotherapy to improve outcomes.

Targeted Therapy

There are specific proteins and enzymes that regulate several vital cellular processes specific to cancer cells. As an endometrial cancer treatment, targeted therapy uses specific drugs that target these enzymes or proteins and interfere with these processes, thereby killing or preventing the growth of cancer cells. For instance, targeted therapy targets the proteins required to form new blood vessels and grow and divide cancer cells.

Clinical Trials

If the patients are not responding to any current treatments available, they are advised to enroll themselves in clinical trials related to endometrial cancer treatment and management. Clinical trials help cancer patients try new endometrial cancer drugs, treatment approaches or methods, etc., that may improve the survival rates and prognosis for these patients.

Why Choose HCG for Endometrial Cancer Diagnosis and Treatment?

HCG Cancer Center is a leading cancer hospital in India with world-class facilities for diagnosing and managing endometrial cancer. The center has an excellent diagnostic infrastructure, comprising the most modern techniques for accurate diagnosis. The center has all the high-end endometrial cancer treatment facilities. The expert team at the center is extensively experienced in offering value-based and patient-centric care to patients diagnosed with endometrial cancer.

Conclusion

Endometrial cancer diagnosis can be done through imaging techniques, blood tests, biopsies, medical history and physical examination, hysteroscopy, D&C, and Pap tests. Endometrial cancer treatment options include surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, and hormone therapy. Patients must focus on receiving personalized care for their condition as it positively impacts the survival rates and the overall disease prognosis.

Frequently Asked Questions

Can endometrial cancer be cured permanently?

It is possible to treat endometrial cancer successfully. However, in some cases, the cancer may recur. The endometrial cancer survival rates or the outcome quality depends on factors, such as the disease’s stage at diagnosis, treatment response shown by the patient, and overall patient health.

Endometrial cancer may result in bleeding. The CBC results of such patients might indicate anemia.

The likelihood of recurrence of endometrial cancer is within a few years after treatment completion. The recurrence rate of endometrial cancer in patients diagnosed at an early stage was 10 to 15%.

Endometrial tissue sampling and ultrasound are the two common tests for endometrial cancer.

In some cases, especially when endometrial cancer is in its early stages, surgery alone is recommended as a standalone treatment.