Learning medicine is hard work! Osmosis makes it easy. It takes your lectures and notes to create a personalized study plan with exclusive videos, practice questions and flashcards, and so much more. Try it free today! Endometrial carcinoma, or endometrial cancer ,is when malignant or cancer cells arise in the glands of the endometrium, the lining of the uterus. The uterus is a hollow organ that sits behind the urinary bladder and in front of the rectum.
The top of the uterus above the openings of the fallopian tubes is called the fundus, and the region below the openings is called the uterine body. The uterus tapers down into the uterine isthmus and finally the cervix, which protrudes into the vagina. Zooming into the cervix, there are two openings ,a superior opening up top, and an inferior opening down below, both of which have mucus plugs to keep the uterus closed off except during menstruation and right before ovulation.
The uterus is anchored to the sacrum by utero-sacral ligaments, to the anterior body wall by round ligaments, and it’s supported laterally by cardinal ligaments as well as the me , which is part of the broad ligament. The wall of the uterus has three layers: the perimetrium, which is a layer continuous with the lining of the peritoneal cavity, the my osmeterium ,which is made of smooth muscle that contracts during childbirth to help push the baby out ,and the endometrium, a mucosal layer, that undergoes monthly cyclic changes.
The endometrium is itself made up of a single layer of simple columnar epithelium, which has ciliated and secretory cells, that sit on top of connective tissue, or stroma. There any many grooves in the stroma which is lined by the epithelium and these are the uterine glands which secrete a glycogen rich fluid that’s essential for the developing embryo during early pregnancy. Endometrial carcinoma involves the abnormal growth of the epithelial cells that make up endometrial glands, and there are two main types.
The most common is Type 1 endometrial carcinoma ,which is also called endometrioid carcinoma because the tumors grow in a way that looks like normal endometrial glands. It usually involves several genetic mutation sin endometrial cells, including of PTEN, a tumor suppressor gene; PIK3CA, an on co gene and ARID1A, a gene regulating chromatin structure. All of these mutations increase signaling in the PI3K/AKT pathway, which promotes growth and replication of endometrial cells.
More signaling in the PI3K/AKT pathway also enhances the expression of genes which are linked to estrogen receptors. So having high levels of estrogen will cause the endometrium undergoes hyperplasia, leading to increased risk of developing type 1 endometrial carcinoma. Now, excessive estrogen can come from obesity ,because fat cells convert adrenal precursors into sex hormones; taking tamoxifen, a breast cancer medication that blocks estrogen receptor in the breasts, but stimulates them in the uterus; and postmenopausal estrogen therapy given without a progestin to “balance” it out.
Other risk factors related to high estrogen levels are never having been pregnant; chronic anovulation, when the ovaries don’t release an egg during a menstrual cycle; and having many menstrual cycles. Age is also a factor since endometrial carcinoma tends to develop in women who have gone through menopause, usually around 55 to 65 years of age. Finally, a hereditary condition called Here ditary non polyposis colorectal cancer, also called Lynch syndrome, causes a high risk of developing certain cancers, including colon cancer and endometrial carcinoma.
The good news is that there are actually factors that protect against Type 1 endometrial carcinoma! Taking hormonal contraceptives, being older at the time you give birth, and breastfeeding all reduce the risk of developing this type of cancer. Now, type 2 endometrial carcinoma is more rare, and it has a number of subtypes. The most common subtype is serous carcinoma. The genetic mutations found most often in serous carcinoma involve the TP53 gene, another tumor suppressor, and aneuploidy, or an abnormal number of chromosomes after cell division.
Type 2 carcinomas don’t appear to be linked with estrogen levels. These cancers typically affect women who have endometrial atrophy and who have lower body weight. They also tend to develop later in life than Type 1 and are more common in women of African descent. Even though there are two distinct types of endometrial carcinomas, we use the same stages to describe their development. In stage 1, the carcinoma is only in the uterus. In stage 2, it has spread to the cervix. In stage 3, it has spread outside the uterus but is still within the lesser, or “true” pelvis.
This means it could affect structures like the vagina and pelvic lymph nodes. In stage 4, it has spread beyond the pelvis. Most Type 1 endometrial carcinomas are diagnosed in stage 1 and aren’t very aggressive, and because of that they have a good prognosis. But type 2 carcinomas are trickier and much more aggressive and often spreads to other parts of the body via the lymphatic system or the fallopian tubes. The main symptom of endometrial carcinoma is abnormal vaginal bleeding, usually without pain. If it’s more advanced, there might be enlargement of the uterus if the tumor or tumors are large enough, and this can cause abdominal pain and cramping.
Diagnosing endometrial carcinoma usually involves doing a transvaginal ultrasound to determine if the endometrium is abnormally thick. If it’s more than 4 millimeters thick, then a biopsy or a dilation and curettage procedure is used to remove some endometrial cells and confirm the diagnosis. Surgery is the treatment for all types and stages of endometrial carcinoma. This typically means the removal of the uterus ,both ovaries, and both fallopian tubes, also called a hysterectomy with bilateral salpingooophorectomy ,combined with the removal of pelvic and para-aortic lymph nodes.
In some cases where the cancer is more advanced or is likely to spread, for example a Type 1 carcinoma that’s stage II and above and all Type 2 carcinomas, radiation therapy and/or chemotherapy is also done after surgery. All right, as a quick recap, endometrial carcinoma is a very common cancer of the lining of the uterus. Type 1 is associated with having abnormally high levels of estrogen over a long period of time, and is usually preceded by endo metrial hyperplasia. Type 2, which has several subtypes, isn’t linked with estrogen levels, and is more aggressive than type 1.
The most common symptom is abnormal vaginal bleeding after menopause and the treatment is hysterectomy with bilateral salpingo-oophorectomy.
Don’t Ignore These Invisible Symptoms Of Menopause Women Must Be Aware
Menopause marks the end of reproductive years in a woman’s life when menstrual periods stop permanently. Menopause usually occurs naturally, as a result of declining levels of reproductive hormones, estrogen, and progesterone, produced by the ovaries; but it may also happen prematurely after surgical removal of the ovaries, as a side effect of cancer treatments, or in a condition known as primary ovarian insufficiency, where the ovaries fail to produce hormones. Menopause is usually preceded by a transient period called perimenopause when hormone levels start to drop.
The last couple of years leading to menopause may bring symptoms such as hot or cold flashes, mood swings, insomnia, vaginal dryness, urinary urgency, and dry skin. Some women may also experience temporary heart racing, headaches, and hair loss. The most telling sign that menopause is approaching the irregularity of periods. Skipping a period or two is common. The cycles may also be shorter.
Periods may be heavier or lighter than usual. Most symptoms usually ease in the years after menopause, but low levels of estrogen may cause other health problems. Because estrogen influences bone density and has a protective action on blood vessels against cholesterol plaques, low estrogen levels increase risks for bone loss, known as osteoporosis, and cardiovascular diseases. Low estrogen also weakens the tissues supporting the urethra, causing urine leakage, or urinary incontinence. Risks for urinary tract infections also increase after menopause.
While menopause is a natural stage of life and does not require medical treatment, it is important to maintain a healthy lifestyle including physical exercise and diets sufficient in calcium and vitamin D, to counter the risks of heart diseases and osteoporosis.
Women with persisting or severe symptoms may also benefit from certain treatment options: – Topical estrogen in the form of cream, tablet, or ring, administered directly to the vagina, can be effective for the treatment of vaginal dryness and urinary problems. – Kegel exercises strengthen pelvic floor muscles and may help treat urinary incontinence. – Estrogen replacement therapy is effective for the treatment of severe hot flashes and may help prevent osteoporosis. However, it is associated with higher risks for cardiovascular diseases and breast cancer and should be considered only for women with high risks of osteoporosis who cannot take non-estrogen medicines. Hormone therapy should be used at the lowest dose for the shortest duration needed to achieve treatment goals.