Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis
The uterus, or womb, is located between the bladder and the rectum. The inner layer of the uterus is called the endometrium. Endometrial cancer is cancer of the cells of this layer. More than 30,000 new cases of endometrial cancer are diagnosed each year in the United States. The cause is not known. The cancer usually occurs among women between 55 and 70 years of age but can occur among younger women before they go through menopause. Women at risk for endometrial cancer are obese, have diabetes, and have never been pregnant or given birth. Another risk is taking estrogen as replacement therapy for the effects of menopause. The only sure way to diagnose endometrial cancer is to obtain tissue by means of biopsy and examine it with a microscope. This is usually done because a woman reports abnormal vaginal bleeding. Endometrial cancer detected early can be cured.

Living With Your Diagnosis
Vaginal bleeding after menopause is the primary symptom for nearly 90% of patients. If you go through menopause and start bleeding again, this is abnormal and should be evaluated. For women who have not yet gone through menopause, any abnormal vaginal bleeding (heavy bleeding, minimal bleeding, bleeding between menstrual cycles) should be evaluated. Endometrial cancer if left untreated spreads locally to nearby structures, causing a foul vaginal discharge, pain in the pelvic area, bloating, bowel symptoms such as constipation and blood in stools, and urinary symptoms such as frequency, urgency, or pain with urination. If the cancer continues to spread, it can cause local swollen lymph glands and an abdominal mass and eventually involve the liver, lung, and bone.

To confirm the diagnosis of endometrial cancer for a woman with abnormal vaginal bleeding, a biopsy specimen is obtained from the uterus by means of a procedure called dilation and curettage (D & C). The cervix is dilated (widened) and a curette (a small spoon-shaped instrument) is inserted to remove tissue. Once the diagnosis is confirmed, a physician determines the extent of cancer (staging). Staging tells whether the cancer has spread. Blood tests, chest radiographs (x-rays), and computed tomographic (CT) scans of the abdomen and pelvis are obtained to look for any spread. Treatment can be surgical, radiation, hormonal, or chemotherapy. The treatment used depends on the stage of the cancer (stage I, tumor confined to the uterus; stage II, tumor invading the cervix; stage III, tumor involving the vagina, ovary or abdominal cavity; stage IV, tumor invading the bladder and intestine). Most endometrial cancers are in the early stages (I or II), and surgical removal of the uterus, fallopian tubes, and ovaries (hysterectomy and bilateral salpingo-oophorectomy) generally is recommended. Radiation may be given after the operation if the cancer extends beyond the uterus. The patient and physicians must discussed this. Side effects of surgical treatment include pain and soreness in the pelvic area and difficulty in emptying the bladder or moving the bowels. Side effects of radiation therapy are red, dry, itchy skin, fatigue, diarrhea, discomfort with urination, dryness of the vagina, and pain with intercourse. The hormone called progesterone may be recommended if the cancer has spread extensively or has returned after treatment. Chemotherapy also may be recommended in this situation. Side effects of hormonal therapy include breast tenderness, leg swelling, acne, nausea, and headaches. Side effects of chemotherapy include nausea, vomiting, hair loss, easy bruising and bleeding, and infections.

The DOs
• Remember that sexual intercourse and desire are not affected by hysterectomy. Sexual intercourse and normal activity can be resumed 4 to 8 weeks after the operation.
• Remember you will no longer have periods (menstrual cycles). If your ovaries are removed or damaged by irradiation, menopause occurs, and you can experience hot flashes, sweating, and other symptoms of menopause.
• Keep all your follow-up visits during and after treatment. It is important to undergo examinations to look for response to treatment or recurrence of cancer.

The DON’Ts
• Do not ignore any vaginal bleeding after menopause.
• Do not ignore any abnormal vaginal bleeding (excess, between periods) before menopause.
• Do not forget the risk of using estrogen replacement, and discuss this with your physician.
• Do not forget the importance of exercise and diet both before the diagnosis and after therapy for endometrial cancer.
• Do not forget there is evidence that shows the use of birth control pills may decrease risk for ndometrial cancer, presumably because of the progesterone in the pill.

When to Call Your Doctor
• If there is any vaginal bleeding or abnormal vaginal bleeding.
• If you have any abnormal vaginal discharge (smell, quantity, color).
• If you need emotional support after treatment.
• If you have any side effects of treatment (surgical, radiation, hormonal, or chemotherapy).