An endometrial carcinoma is a cancer of the uterine cavity. About 290,000 women contract this form of cancer every year. It mainly affects women in or after menopause, peaking between the ages of 60 and 75 years.
The disease usually develops over a period of about one to two years and is more likely to occur in women with overweight, hypertension or diabetes. The tumour first attacks the lining of the uterus – the so-called endometrium. More rarely the tumour develops in the form of sarcomas in the muscle layers of the uterus. Any abnormal bleeding (irregular bleeding between periods before or even slight bleeding after the menopause) must be taken seriously and diagnosed. Bleeding accompanied by pain is usually an indication of an already advanced tumour.
Uterine cancer cannot be detected early through screening before symptoms have developed. It is therefore particularly important to consult a gynaecologist as soon as unusual or irregular bleeding takes place. Especially after the menopause, any suspicious finding in the uterine lining or the cause of bleeding is investigated with an outpatient biopsy of the uterine lining by means of a thin plastic tube (Pipelle method) or a hysteroscopy and curettage. Detected early enough, uterine carcinomas can usually be treated effectively.
If bleeding occurs between periods or after the menopause, a gynaecologist should be consulted immediately. Diagnosis consists of a vaginal sonography – an ultrasound examination through the vagina – of the uterus and ovaries. If the uterine lining has a thickness of more than five millimetres in a woman with post-menopausal bleeding, this is a strong indication of possible endometrial cancer. Although a transvaginal ultrasound provides some information about the condition of the endometrium, it does not allow valid conclusions to be drawn about the sensitivity and specific nature of the carcinoma.
An accurate diagnosis is reached by outpatient aspiration of the uterine lining by means of a thin plastic tube (Pipelle method) or a curettage of the uterus. The mucous membrane thus obtained is histologically examined in the laboratory to accurately identify any potential malignant changes in the uterine lining.
If a uterine cancer is diagnosed, the size and spread of the tumour can be determined by magnetic resonance imaging (MRI) and computer tomography (CT) before surgery.
Before a surgical removal of uterine cancer, a careful preoperative evaluation must be carried out. This allows an initial assessment of invasion depth and spread of the tumour and provides information about the condition of the pelvic and paraaortic lymph nodes.
Except in very advanced stages, the preferred treatment of endometrial cancer is its removal by surgery. Today this is usually done by keyhole surgery. The precise treatment depends on the nature of the tumour, its stage of development and the patient’s age. The first step is usually to remove the uterus complete with both ovaries. Often, the lymph nodes in the pelvic area and – in some cases – also in the area of the abdominal aorta or main vein must also be removed.
As far as possible, the procedure is performed with minimal invasion by keyhole or robotic surgery, so that there is no need for a large abdominal incision. Especially overweight women, who are particularly prone to uterine cancer, benefit from this method, as excess body fat tends to impair healing of abdominal incisions.
Following a full diagnosis, an interdisciplinary team – the tumour board – decides whether radiotherapy and/or chemotherapy are also necessary. Radiation therapy without surgery is considered only for patients that cannot be operated.
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