Cancer of the endometrium, the lining of the womb, is the most common pelvic malignancy in South Africa after cancer of the cervix. In the Western world it ranks fourth in frequency after breast, colorectal and lung cancers.

It is most common in postmenopausal women, with a peak incidence between the ages of 50 and 60.

Who is at risk?
 Risk factors for endometrial cancer are generally thought to be:

  • Obesity
  • Not having had any children
  • Starting periods early and then entering the menopause late
  • Polycystic ovarian syndrome
  • Other cancers: Cancer of the breast, ovary and endometrium tend to occur as multiple primary tumours more often that would be expected by chance
  • The use of continuous oestrogen therapy without opposing progesterone in women who still have their womb intact

    Diagnosis
     Symptoms of endometrial cancer are postmenopausal bleeding or recurrent abnormal bleeding in a premenopausal woman. As many as one third of all cases of postmenopausal bleeding are due to endometrial cancer.

    Diagnosis can be made in a number of ways.

  • A PAP smear may be useful, although abnormal endometrial cells are not always found, resulting in a 30 to 40 percent false negatives. Cellular material may be obtained by aspirating the cervix, which increases the rate of detection by PAP test to 70 percent.

  • Biopsy of the endometrium will detect cancer in more than 90 percent of cases.

  • D & C, dilation and curettage, may be used for diagnosis as well, since it allows examination of the curetted lining of the womb, and is sometimes used to stage the disease. However, it is not all that accurate for staging, often overestimating the stage of the disease.

    The stage of endometrial cancer ranges from Stage 1, in which the cancer is confined to the lining of the womb, to Stage 4, where the cancer involves the bladder and rectum, and extends outside the pelvis.

    Teatment
     In the relatively early stages of the disease, hysterectomy with removal of both ovaries, a wide cuff of vagina and sampling of the pelvic lymph nodes is the treatment of choice. Radiotherapy may be used before or after surgery. Survival rates are better for surgery with radiotherapy than with surgery alone. Patients with Stage 4 disease usually get hormone treatment with progesterone, and no surgery.

    Recently progesterone therapy in patients with advanced or recurrent disease has led to regression of tumour in 30 to 40 percent of cases. This treatment can continue indefinitely if there is a good response. Progesterone has also produced regression of tumour spread to the lungs, vagina and abdomen. Remissions can last as long as three years, sometimes longer.

    The prognosis depends on the stage of the disease. Treated Stage 1 disease has a reported five-year survival of between 70 and 89 percent. The overall five-year survival, with no signs of the disease, is 63 percent. Twenty-eight percent may die within five years of treatment, and nine percent are alive with disease still present.


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