Endometrial cancer(uterine cancer): Is endometrial cancer genetic?

In this video SimpliHealth expert gynecologists Dr. Heena Chawla is talking about Endometrial cancer(uterine cancer). Also she is answering some very common questions like:

• Is endometrial cancer genetic?
• What are the symptoms of Endometrial cancer?
• How can we tell who has endometrial cancer?

Endometrial cancer or uterine cancer or what we call common language can be uterine cancer. Endometrial cancer occurs, that is, the innermost layer of the uterus – the endometrium, the presence of any abnormal growth inside it, which can further turn by multiplication of cells leading to cancer; we call it endometrial cancer. 

Endometrial cancer symptoms

90% of endometrial cancer is found in postmenopausal females. The woman does not menstruate for one year, perhaps at the age of 50-45 years, we say it is menopausal. Any kind of bleeding after menopause, Even if it is spotting, experts should get it checked, consult your doctor to find out the bleeding is happening. Earlier this cancer used to be more prevalent in the western world also due to changes in lifestyle, the prevalence of endometrial cancer has increased here drastically. 

In addition, it can also be found in some younger age groups, especially as per our experts its Peri-Menopause, which is the age group of 40 when we are going towards menopause as well as heavy bleeding. For women, it is a very good cancer that gives us symptoms early, like bleeding after already menopause; this is the first sign. It is not necessary that if we are bleeding after menopause, then we have endometrial cancer; no, endometrial cancer occurs in only 10% of women who have bleeding after menopause. 

There can be many other reasons why we do have bleeding after menopause, but until we can prove that it is not cancer, we continue to accept that there is bleeding; we have to do a biopsy to prove whether it is cancer or not. Biopsy means we take a piece test. From inside the innermost lining of the uterus, we take a piece and send it to the lab for testing. 

Then we know what kind of changes are happening inside the cell and what kind of cells are developing. 

Is it precancerous, is it progressing to cancer, or is there another reason that can cause bleeding? 

This biopsy is what we call an endometrial biopsy. What this biopsy is, based on the findings of your ultrasound. First of all, whenever we go to the gynecologist that we are bleeding after menopause, we need to do a basic ultrasound. Ultrasound sees the measurement of the inner lining of the uterus, its thickness, which is what we call endometrial thickness. 

If this thickness is more than 11mm after menopause which is a normal state should be between 4-5mm. So if it is more than 11 mm, your doctor will recommend a biopsy. But if you are bleeding and have gone to the doctor, and your endometrial thickness is less than 11 mm, they will still recommend you for a biopsy. Now, based on your ultrasound findings, your doctor will go for a hysteroscopy. A thin, lighted tube is inserted inside the uterus, which we call hysteroscopy. 

What are the benefits of hysteroscopy? 

Suppose inside the uterus; if there is a small area inside its wall where those cells lie together, or there is growth, we can see with the lighted tube and even take the sample for biopsy, we send it to the lab for examination. According to the report of endometrial Biopsy, your doctor will guide you further treatment. 

Suppose if experts have endometrial carcinoma, say Biopsy, we have endometrial carcinoma. On that basis, your doctor gives you further investigation, or MRI, PET-CT, such a test, wherein the body cancer has spread, we get all the simple information. Based on that, your decision is made about what treatment we have to give. Your doctor will examine you clinically, look at your PET-CTor MRI report, and then the decision is made whether or not to have surgery first. 

Endometrial cancer treatment

The most crucial treatment for endometrial cancer is your surgery, which we call Staging surgery, which is done by gynae cancer specialists i.e., gynaec-oncologists. This surgery is not just to remove the uterus. It is an extensive surgery in which your uterus is removed, all the tubes and ovaries are removed, apart from that we lymph nodes, that is, all the vessels that are lying around our uterus, Small lymph nodes are lying on them, arteries, veins. It is necessary to remove them because this is endometrial cancer. When the body may spread, it spreads only through the lymph nodes. 

First of all, it spreads by going inside the lymph nodes in our pelvis. After the pelvis, it spreads to our main blood vessel above the aorta, the lymph nodes lying around them, which we call para-aortic lymph nodes, then it spreads till there. So this is our lymph node dissection; it is an important rather than the first part of Staging surgery, which is the first surgery, this significant part of it. Apart from this, we may have surgery, wherever we find cancer to be spread, all of them come out, and we send them as much as our specimen, we send them to the lab for examination. Many patients ask, 

what will be the treatment further, or will I have to take chemotherapy, or will have to take radiotherapy further, what kind of treatment will come. 

See, whenever the specimen goes to Lab, its report comes. So, according to that report, some of our primary criteria are fixed, depending on what is your age, what is the size of your cancer or what is the stage of your tumour, what is the grade of your tumor, it depends on all these, your lymph nodes. It depends on the above factors whether you need any other type of treatment or not, and if there is, then there are different types of chemotherapy, different types of radiotherapy, what kind of treatment is needed. The second important thing, when we say that all the patients also ask that if there is cancer, 

How much time do we have and how long will we do it? 

See, the survival rates inside endometrial cancer are pretty good because it is such cancer that tells itself by giving a signal; like our experts said before that bleeding happens right after menopause. So somewhere it tells itself by giving its symptoms, but yes there are some aggressive varieties that are also inside it or there are bad variants in which it has survival rate, its survival rate is less, such as sarcoma, or clear cell carcinoma is done. 

So it is such a 2-3 variety in which the cells of endometrial cancer multiply rapidly and spread to the rest of the body as well. Apart from that, patients ask a common question: 

What do we need to do a Biopsy? 

If we come straight out of the uterus and give it, then the work will be done. So see, this is the significance of Biopsy that we have done Biopsy, then after that our treatment is defined as to what kind of surgery we need. Suppose we did not do a biopsy and remove the uterus directly, what will happen after the removal of the uterus that we came to know later that cancer came, then we have a second surgery or We will have to take more radiotherapy chemotherapy sessions because our initial surgery was incomplete, there were neither proper lymph nodes inside it nor proper staging, nor where it had spread, it could be taken out. So that’s why Biopsy is the first step which we should get done according to our doctor’s advice. After that, all our treatment depends on it.

That’s why our experts advises everyone that if you have any kind of heavy bleeding or spotting or heavy bleeding after menopause, then immediately talk to your doctor. Take advice from them, do necessary investigations and if they recommend you for biopsy, then definitely get it done from them. Your entire treatment plan will be according to that. Thank you.