Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination or sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause. The signs and symptoms of endometrial cancer include: • Vaginal bleeding after menopause • Bleeding between periods • An abnormal, watery or blood-tinged discharge from your vagina • Pelvic pain • Pain during intercourse. Approximately 40% of cases are related to obesity. Endometrial cancer is also associated with excessive estrogen exposure, high blood pressure and diabetes. Whereas taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and progesterone in combination, as in most birth control pills, decreases the risk. Between two and five percent of cases are related to genes inherited from the parents. Endometrial cancer is sometimes loosely referred to as "uterine cancer", although it is distinct from other forms of uterine cancer such as cervical cancer, uterine sarcoma, and trophoblastic disease. The most frequent type of endometrial cancer is endometrioid carcinoma, which accounts for more than 80% of cases. Endometrial cancer is commonly diagnosed by endometrial biopsy or by taking samples during a procedure known as dilation and curettage. A pap smear is not typically sufficient to show endometrial cancer. Regular screening in those is at normal risk. In 2012, endometrial cancers occurred in 320,000 women and caused 76,000 deaths. This makes it the third most common cause of death from women's cancers, behind ovarian and cervical cancer. It is more common in the developed world and is the most common cancer of the female reproductive tract in developed countries. Rates of endometrial cancer have risen in a number of countries between the 1980s and 2010. This is believed to be due to the increasing number of elderly people and increasing rates of obesity. The present study assessed the impact of correcting the estimated corpus and cervix uteri cancer mortality in the city of São Paulo, Brazil.
The epidemiologic assessment of death rates comprised the estimation of magnitudes, trends (1980-2003), and area-level distribution based on three strategies: i) using uncorrected death certificate information; ii) correcting estimates of corpus and cervix uteri mortality by fully reallocating unspecified deaths to either one of these categories, and iii) partially correcting specified estimates by maintaining as unspecified a fraction of deaths certified as due to cancer of "uterus not otherwise specified". The proportion of uterine cancer deaths without subsite specification decreased from 42.9% in 1984 to 20.8% in 2003. Partial and full corrections resulted in considerable increases of cervix (31.3 and 48.8%, respectively) and corpus uteri (34.4 and 55.2%) cancer mortality. Partial correction did not change trends for subsite-specific uterine cancer mortality, whereas full correction did, thus representing an early indication of decrease for cervical neoplasms and stability for tumors of the corpus uteri in this population. Ecologic correlations between mortality and socioeconomic indices were unchanged for both strategies of correcting estimates. Reallocating unspecified uterine cancer mortality in contexts with a high proportion of these deaths has a considerable impact on the epidemiologic profile of mortality and provides more reliable estimates of cervix and corpus uteri cancer death rates and trends. In the United States, endometrial cancer is the most frequently diagnosed gynecologic cancer and, in women, the fourth most common cancer overall, representing 6% of all cancer cases in women. In that country, as of 2014 it was estimated that 52,630 women were diagnosed yearly and 8,590 would die from the disease. Northern Europe, Eastern Europe, and North America have the highest rates of endometrial cancer, whereas Africa and West Asia have the lowest rates. Asia saw 41% of the world's endometrial cancer diagnoses in 2012, whereas Northern Europe, Eastern Europe, and North America together comprised 48% of diagnoses. Unlike most cancers, the number of new cases has risen in recent years, including an increase of over 40% in the United Kingdom between 1993 and 2013. Some of this rise may be due to the increase in obesity rates in developed countries, increasing life expectancies, and lower birth rates. The average lifetime risk for endometrial cancer is approximately 2–3% in people with uteruses. In the UK, approximately 7,400 cases are diagnosed annually, and in the EU, approximately 88,000. Endometrial cancer appears most frequently during perimenopause, between the ages of 50 and 65, overall, 75% of endometrial cancer occurs after menopause. Women younger than 40 make up 5% of endometrial cancer cases and 10–15% of cases occur in women under 50 years of age. This age group is at risk for developing ovarian cancer at the same time. The worldwide median age of diagnosis is 63 years of age, in the United States, the average age of diagnosis is 60 years of age. White American women are at higher risk for endometrial cancer than black American women, with a 2.88% and 1.69% lifetime risk respectively. Japanese-American women and American Latina women have a lower rates and Native Hawaiian women have higher rates.
The treatment of endometrial cancer varies depending on the stage of the cancer. Staging is based on the findings from the initial surgery, which involves the removal of the entire uterus and cervix (total abdominal hysterectomy), the fallopian tubes, and the ovaries. These organs are examined to determine the extent of the cancer (staging). During this operation, cells are collected from the peritoneal cavity and tested for cancer. The lymph nodes in the pelvis and surrounding areas are removed and examined for cancer. Only then is a decision made about treatment. Treating endometrial cancer will depend on the characteristics of your cancer, such as the stage, your general health and your preferences. The other treatment methods are: Surgery, Radiation, Hormone therapy, Chemotherapy. Surgery is done to remove the uterus is recommended for most women with endometrial cancer. Most women with endometrial cancer undergo a procedure to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo oophorectomy). A hysterectomy makes it impossible for you to have children in the future. Also, once your ovaries are removed, you'll experience menopause, if you haven't already. While surgery, surgeon will also inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps determine your cancer's stage. Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove. If you aren't healthy enough to undergo surgery, you may opt for radiation therapy only. In women with advanced endometrial cancer, radiation therapy may help control cancer-related pain. Radiation therapy can involve: radiation from a machine outside your body. Called external beam radiation, during this procedure you lie on a table while a machine directs radiation to specific points on your body, Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time. Hormone therapy involves taking medications that affect hormone levels in the body. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus and include, medications to increase the amount of progesterone in your body. Synthetic progestin, a form of the hormone progesterone, may help stop endometrial cancer cells from growing, medications to reduce the amount of estrogen in your body. Hormone therapy drugs can help lower the levels of estrogen in your body or make it difficult for your body to use the available estrogen. Endometrial cancer cells that rely on estrogen to help them grow may die in response to these medications. Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). Chemotherapy may be recommended for women with advanced or recurrent endometrial cancer that has spread beyond the uterus. These drugs enter your bloodstream and then travel through your body, killing cancer cells. The treatment of endometrial cancer varies depending on the stage of the cancer. Staging is based on the findings from the initial surgery, which involves the removal of the entire uterus and cervix, the fallopian tubes, and the ovaries. These organs are examined to determine the extent of the cancer (staging). During this operation, cells are collected from the peritoneal cavity and tested for cancer. Usually, the lymph nodes in the pelvis and surrounding areas are removed and examined for cancer. Only then is a decision made about treatment. As of 2014, approximately 320,000 women are diagnosed with endometrial cancer worldwide each year and 76,000 die, making it the sixth most common cancer in women. It is more common in developed countries, where the lifetime risk of endometrial cancer in people born with uteri is 1.6%, compared to 0.6% in developing countries. It occurs in 12.9 out of 100,000 women annually in developed countries.