Hysterectomy: cancer of the endometrium

HYSTERECTOMY: CANCER OF THE ENDOMETRIUM
This form of cancer arises in the lining of the uterus and is diagnosed in approximately 1000 Australian women each year. Most are aged between fifty and sixty-five, and those affected are more likely than average to have diabetes or high blood pressure, to be overweight, to have polycystic ovarian syndrome or to have continued menstruating beyond the age of fifty. Women who have never had children and those who are on oestrogen after menopause without also using a progestogen are also at higher risk. This is why many doctors are reluctant to prescribe oestrogen on its own in pill, patch or implant form to women with a uterus, preferring to add progestogen hormone to protect the endometrium. (They may, however, safely prescribe forms of oestrogen that are made for absorption through the vagina such as creams and pessaries, as long as these are limited to two or three applications a week.)
As only about half the women who develop endometrial cancer are in identified high risk groups, it is vital that all women are aware of tell-tale symptoms of the disease. The most common sign of endometrial cancer is unusual bleeding. This means any sort of bleeding — including just a few spots of blood — for women who have gone through menopause. For women who are still menstruating, it means unusually heavy bleeding during, or between, periods.
Diagnosis usually involves one of two techniques, aspiration curettage or D and C. Aspiration curettage is a simple procedure that can be performed in a doctor's office. A thin tube is inserted through the cervix into the uterus and a small sample of endometrial tissue is obtained under suction. This can then be sent to a laboratory for examination. If a D and C is performed, a general anaesthetic is usually required. The cervix is stretched, or dilated, and a small instrument inserted into the uterus. Cells from the endometrium are scraped off and this sample is sent for laboratory examination.
If early pre-cancerous changes are detected, the situation is usually watched carefully to make sure that they do not develop. More serious pre-cancerous changes may warrant an endometrial resection or the triggering of a period using a medical therapy. A woman with a uterus who is using oestrogen on its own either needs to add progesterone to her hormone intake (for at least part of the cycle) or she should be prepared to have endometrial biopsies on a regular basis.
If cancerous changes are evident in the endometrium an abdominal or vaginal hysterectomy is usually performed, with or without radiotherapy, chemotherapy and progestogen hormone therapy. Endometrial cancer detected in its early stages can be treated successfully about 75% of the time. The outlook is poor if the cancer has spread beyond the uterus.

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