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Women and Uterine/Endometrial Cancer

Ann Witt, M.D., and Natalie Staats Reiss, Ph.D.

Symptoms:

woman in painThe most common symptom of this type of cancer is abnormal uterine bleeding (such as someone who experiences vaginal bleeding after menopause). If a woman is still menstruating, the symptoms may include a change in her menstrual pattern such as heavier flow or spotting between periods.

Risks:

The lining of the uterus, or endometrium, grows with exposure to estrogen. Therefore, prolonged exposure to estrogen increases a women's risk of endometrial cancer. Women are at greater risk for developing uterine/endometrial cancer if they:

  • started their periods at a young age
  • experienced late menopause
  • are obese
  • use or have used estrogen hormone therapy alone (without progesterone)
  • have polycystic ovary syndrome (a hormonal syndrome associated with infrequent menstrual cycles decreased fertility, increased hair growth, acne and sometimes obesity)
  • have a family history of hereditary nonpolyposis colon cancer

Prevention:

Prevention strategies minimize a women's exposure to excess estrogen over her lifetime. Maintaining a healthy body weight and using progesterone during hormone replacement therapy, when a woman still has her uterus, decreases the risk of endometrial cancer. The use of oral contraceptive pills also decreases a women's risk because they stop ovulation (when a mature egg is released from the ovary) and decrease the total amount of estrogen to which they are exposed. Interestingly, each time a woman gets pregnant her risk of endometrial cancer decreases. During pregnancy, progesterone levels are higher relative to estrogen and therefore the women's lifetime exposure to estrogen is lower.

Women at high risk for endometrial cancer (individuals 35 years of age and older with a family history of hereditary nonpolyposis colon cancer) are the only people who need to be screened routinely.

Diagnosis and Treatment:

If a woman experiences abnormal uterine bleeding, the initial evaluation is usually an endometrial biopsy. An endometrial biopsy is performed during a pelvic exam and a small sample of the lining of the uterus is taken for laboratory examination. The biopsy procedure is usually relatively painless, but it may cause some mild cramping.

If abnormal cells are noticed with the biopsy, a Dilatation and Curettage (D&C) may be performed.  This is a procedure where the lining of the uterus is scraped. Typically, a woman is asleep during a D&C, but she often will go home that day. Often, endometrial cancer is diagnosed when the disease is local (only in the uterus) and can be treated with surgical removal of the cancer. However, depending on how far the cancer has advanced, surgery, radiation, hormone therapy and chemotherapy may also be necessary.

Prognosis:

Because a woman's first symptoms of endometrial cancer are usually uterine bleeding, many women are diagnosed with this cancer before it has spread. Therefore, there is usually a good prognosis. The survival rate drops if the endometrial cancer has spread to other areas in the pelvis, such as the ovaries.  It is also much lower if the cancer already metastasized.