Cancer of Endometrium/Endometrial Cancer

Endomatrial Cancer
Endometrium is the inner lining of the mammalian uterus and very susceptible hormone change, particular to menstrual cycle. Endometrial cancer is a late adulthood cancer defined as a condition of which the cells of the endometrial lining of uterus have growth uncontrollable or become cancerous as a result of the alternation of cells DNA. It's the fourth most common cancer among women overall, after breast cancer, lung cancer, and bowel cancer.

Causes and risk factors
1. Age
Most endometrial cancer occurs to women in mid thirty and older. It may be caused by often than other tissue in growth and repair of the uterus lining over decade or many decades.

2. Estrogen
Because of accumulation and exposure of estrogen hormone over a prolonged period over a life time, risk of endometrial cancer is much higher in older women. In fact risk of endometrial cancer increase with age after age of 40. Women who are under age of 40 have low risk of the disease unless under usually risk factors.

3. Hormone replacement therapy (HRT)
Women who is either with ovaries removed or in stage of menopause use hormone replacement therapy to relieve the symptoms of menopause, such as frequency of hot flash, loss of bone density, mineral deficiency, etc may slightly increase the risk of endometrial cancer due to exposure to synthesis estrogen.

4. Oral contraceptive pills
The study used population-based cancer registries in eight geographic regions across the United States showed that women who had used sequential oral contraceptives (estrogen and progestin components taken at different times of the month) appeared to have an increased risk of endometrial cancer.

5. Tamoxifen
Tamoxifen is a common chemotherapy medication for patients with breast cancer or to prevent the recurrence of breast cancer by blocking the action of estrogen on the breast cancer cells. might increase risk of endometrial cancer as tamoxifen is also acts like estrogen itself.

6. Obesity
Fatty tissue is a good source for the production of bad estrogen in large amounts in obese women, leading to high levels of estrogen in women resulting in increasing risk of endometrial cancer.

7. Heredity
Family history of endometrial, colon and breast cancer increases the risk of endometrial cancer.

8. Abnormal overgrowth of the endometrium
Women diagnosed with endometrial hyperplasia (abnormal overgrowth of cells in the lining of the uterus) have a higher risk of developing endometrial cancer.

9. Infertility
Study found that women who have never been pregnant have a slightly higher risk to develop endometrial cancer.

10. Early puberty before age 12
Women who begin their periods before 12 years of age have a higher risk to develop endometrial cancer due to increased the number of years that the immature inner uterine lining is exposed to estrogen.

11. Menopause after age 55
Women who go through Menopause after age 55 are at a higher risk of developing endometrial cancer because of increased the number of years that the inner uterine lining is exposed to estrogen.

12. History of having radiation therapy to the pelvis
Frequent use of radiation therapy to the pelvic may alter and damage the DNA of cells, leading to uncontrollable cells growth of inner lining of the uterus, causing endometrial cancer.

13. Other reproductive cancers
Breast or ovary cancer are associated with an increased risk of endometrial cancer due exposure to higher than normal amount of estrogen.

14. Intake high amount of fat
Intake high amount of fat is also linked to higher amount of estrogen produced by our body, the "good" source hormone for the development of endometrial cancer.

15. Heavy daily alcohol consumption
researcher found that high alcohol consumption not only affect just the liver, but increases the risk of with breast and endometrial cancer.

16. Etc.
Symptoms
Abnormal uterine bleeding may be the early stage of endometrial cancer
1. Abnormal vaginal bleeding
Vaginal bleeding between period with in inappropriate amounts of blood flow should be checked with doctor as soon as possible. It may be caused by expansion of over growth of pre cancer uterine lining cells causes of infection or breaking off the endometrial capillaries or blood vessels.

2. Increase amount of vaginal discharge
An increase in the amount of vaginal discharge accompanied with abnormal odor or pain, itching, or burning sensation may be caused by infection or inflammation.

3. Painful urination
Painful urination, most of the time is caused by infection of the urinary tract that affect the bladder in emptying, but sometime it can be caused by infectious diseases, and may be an indication of pre endometrial cancer.

4. Pain during sex
Painful during most of the time is caused by vestibulitus and vaginismus sex, but in some cases, it can be caused by cancer or other reproductive diseases.

5. Pain in the abdomen
There are many reproductive disease can cause pain in the pelvic, such as appendicitis, salpingitis, uterine descensus, etc. but it can be caused by early stage of endometrial cancer.

6. Swelling or Lump in the pelvic
Swelling can be caused by inflammation of sexual transmitting virus or infection by bacteria. Lump may be caused by abnormal cells growth of the uterine lining or reproductive tissue.

7. Weight loss
Unintentional weight loss due to loss of appetite may be a first sign of cancers, including uterine inner limning.

9. Anemia
Anemia may be caused by chronic loss of blood due to prolonged or heavy abnormal menstrual bleeding.

10. Etc.

Diagnosis and testsIf you have any of above symptom and accompanied with abnormal uterine bleeding, the diagnosis beside required a detail of you health history, including family medical history, menstrual and pregnancy history, lifestyle, etc.
1. Pelvic examination
Pelvic examination taken when there is no menstruation and advised not to have sex for at least 24 hours, is type of complete physical exam of a woman pelvic organ by a medical instrument to detect any infection, abnormal cells growth such as cysts, fibroid and specially for virus which can cause early stage of endometrial cancer. The pap test usually is also taken. If your doctor found any abnormal cells growth or suspected uterine cancer, further tests may be required.

2. Endometrial curettage
Ednometrial curettage can be done in the doctor office or in the hospital as an outpatient by taking a sample of tissue from the inner lining layer of the uterus. In some cases, if the example taken by endometrial curettage does not review a sufficient diagnostic result, a dilation and curettage (D&C) is necessary.

3. Dilation and curettage (D&C)
Dilation and curettage is a types of examination by gently opening the cervix and then removing some of the inner lining (endometrium) of the uterine cells. During the test, you doctor may remove any endometrial polyps, if found.
The 2. and 3. are operated under local anesthesia with anti-inflammatory and pain medication before and during examination.

4. Hysteroscopy
Hysteroscopy is the pelvic examination by the use of an endoscope that carries optical and light channels or fibers that go through the opening of the vagina then into uterus and allows your doctor can see the uterine inner lining (endometrium) on a video screen with the help of fluids or CO2 gas is introduced to expand the cavity during the examination. A small sample is taken for viewing under microscope.

5. Endometrial biopsy
Endometrial biopsy or aspiration is another procedure to remove a sample from the uterine inner lining with the inserting of biopsy curettage into the uterine and with a scraping and rotating motion. During this procedure
a. A speculum helps to spread the walls of the vagina apart to expose the cervix.
b. A tenaculum helps to hold the cervix steady.
c. Local anesthesia may or may not be given.

6. Trans-vaginal ultrasound
Trans-vaginal ultrasound is a type of pelvic ultrasound used to diagnose the thickness of the uterine inner lining of the women with post-menopause bleeding for endometrial cancer with the help of a transducer (The transducer is necessary for sending out sound waves, which reflect off body structures), into the vagina.

7. Sonohysterography
In some cases, more clearly view the uterus is necessary to get a better view of the size of tumor, then sonohysterography is used with saline (sterile salt water) injected into the uterus before the ultrasound.

8. Computerized tomography (CT) scan
CT scanning combines special x-ray equipment with sophisticated computers to produce multiple cross-sectional images of any susceptible area of the inner uterus lining and surrounded organs if need, to the computer screen around a single axis of rotation.

9. Magnetic resonance imaging (MRI)
MRI uses a powerful magnetic and radio frequency field to capture 3D image of organs, soft tissues, bone and virtually all other internal body structures, including endometrial cancer to the computer screen for examination.

10. Etc.

Most common types of endometrial cancer
A. Adenocarcinomas
Adenocarcinomas is accounted for accounts for over 80% of cases of endometrial cancer and begun with the abnormal cells growth in the surface cells of the inner lining of the Researcher found that women who have an early onset of symptoms of peri-menopause are in higher risk of adenocarcinomas.

B. Uterine sarcoma
Uterine sarcoma,a rare uterine cancer containing malignant cells of the muscle and connective tissue of the uterus, is accounted for only account for only 2 percent of all uterine cancer.
a.Endometrial stromal sarcomas
Endometrial stromal sarcomas are also endometrial cancers originated in the non-glandular connective tissue of the endometrium, therefore the cell of origin is unknown.

b. Leiomyosarcomas
Leiomyosarcomas is a form of endometrial cancer originated from the smooth muscles of the uterus. The cancer has a resistant tendency and not very responsive to chemotherapy or radiation.

c. Carcinosarcoma
Carcinosarcoma is a type of cancer caused by both epithelial and connective tissues of the uterus.

E. Etc.

Grades of endometrial cancer
1. Type 1 endometrial cancers
endometrial cancers are caused by excess estrogen. These types of cancer is not very aggressive and are slow to spread to other tissues and considered as low grade.
2. Type 2 endometrial cancer
Endometrial cancer not caused by excess estrogen. These types of cancer are invasive and have a tendency to spread to distant parts of the body and considered high grade.

Stage of endometrial cancer
Stages and grade of endometrial cancer is important to determine the best treatment with the aim is to cure and prevent recurrence, if that it is possible.
1. Stages 0
Cancer is found in the surface of the endometrial lining.
2. Stage I
Cancer have penetrated into the endometrial lining but within the uterus.
a. Stage IA
Cancer is limited to the endometrium
b. Stage IB:
cancer have penetrated to middle layer of the endometrial linning wall
Stage II
Cancer is now present in both the uterus and cervix.
Stage III
Cancer has spread beyond the uterus and cervix to the lymph nodes, but hasn't reached the rectum and bladder.
a. Stage IIIA:
Cnacer has spread beyond outermost layer of the uterus and to the ovaries or fallopian tubes
b. Stage IIIB:
Cancer has spread to the vagina and to the lymph node area
c. Stage IIIC
Cancer has spread to the lymph nodes but not to distant organs
Stage IV
Cancer has spread to distant parts of the body
a. Stage IVA:
Cnacer has spread to rectum and bladder
b. Stage IVB
Cancer has spread to distant organs of the body.
Prevention
1. Maintain a healthy weight
Obesity increases the risk of endometrial cancer.
2. Reduce intake of alcohol
Researcher found that association of alcohol intake and endometrial cancer is stronger among lean women than among overweight or obese postmenopausal women.
3. Birth-control pills
Birth control bill is found to reduce the risk of endometrial cancer
4. Avoid unopposed estrogen therapy
Excess estrogen increases the risk of endometrial cancer.
5. Antioxidants
Antioxidants is found to reduce the risk of cancer caused by oxidation, inducing free radical scavenging such vitamin A, C, E and others.
6. Enhance immune system
By getting enough sleep, eating healthy diet, exercise and living healthy lifestyle.
7. Vitamin D
Vitamin D has been shown to be helpful in a number of cancers, it may also good for endometrial cancer.
8. Etc.

Treatments
Depending to the grade and stage of the cancer
1. Surgery
Most patients with invasive or non invasive cervical cancer are required surgery. While non invasive cancer patients are not needed further treatment, invasive cancer patients usual needed further treatments, including radiation therapy, chemotherapy. In some cases, example of lymph node is also remove, ovaries and uterus also removed, depending to the surgery needed.

2. Radiotherapy
Radiation may be used for stages II, III, and IV and usually given after surgery to kill any cancer cells remaining in the body. By using high-energy x-rays or other types of radiation, radiation therapy kills endometrial cancer cells and keeps them from growing or regrowing. If the cancer is small in size, cancer can be cured. If the cancer is large, radiation therapy can be used to control local bad symptoms.
a. External beam irradiation
In External beam therapy (EBT), a beam of high-energy x-rays or or other types of radiation is directed to a patient's tumor externally depending to the stage of the cancer.
b. Brachytherapy
By placing a small quantity radioactive seeds or sources by a medical instrument into uterus or vagina, before using high-energy x-rays or other types of radiation to kill cancerous cells without causing radiation affects in the nearby healthy tissues.
c. Side effects
c.1. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.

3. Chemotherapy
a. Chemotherapy is most use to treat with advance stage of cervical cancer combined with radio therapy, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

4. Hormone therapy
Hormone therapy is used in the pre-endomatrial cancer stage or where surgery is either feasible or unnecessary. Use of right types of hormone can cause the shed of endometrial lining or endometrial cancer to shrink or sometimes disappear completely.

Other unconventional treatments
A. With herbs
1. Trifolium pratense
Trifolium pratense is best known as Red clover, a genus Trifolium, belongs to the family Fabaceae, native to Europe, Western Asia and northwest Africa. Researcher found that genistein inhibits of cancer cell growth, promotes apoptosis.


2. Trifolium pratense
Trifolium pratense is best known as Red clover, a genus Trifolium, belongs to the family Fabaceae, native to Europe, Western Asia and northwest Africa. Researcher found that genistein inhibits of cancer cell growth, promotes apoptosis.

3. Soy isoflavone distillate
Soy isoflavone distillate is a extract of the beans of the soy plant or herb, it contains high amount of phytoestrogen by binding to estrogen in the human cells. Researcher found that soy isoflavones wards off estrogen from the cells which are receptive to estrogen, including the cancerous or malignant cells endometrium. There is some conflicts in the studies of the use of phytoestrogen in treating estrogen related cancer, please be careful not to use them unless with the suggestion of your specialist in the related field

4. Astragalus
Astragalus is herb, genus of Astragalus, belonging to the legume family Fabaceae. In rat study, researcher found that astragalus extract possess cytostatic properties in inhibiting tumor growth and delay chemical-induced hepatocarcinogenesis.

5. The inner bark of Cat's claw
The herb has been used in herbal medicine to boost function of the immune system and treat and prevent infection. In vivo and in vitro, cat's claw showed inflammation inhibiting effect. It also contains vary chemicals such as tannins, catechins, and procyanidins which demanstrated antioxidant and anti-inflammatory properties.

6. Etc.

B. With Chinese herbs
1. Xia Ku Cao
Xia Ku Cao is also known as Self heal plant. The acrid, bitter and cold herb has been used in TCM to treat headache, dizziness, tuberculosis of the lungs, vaginal infection, excessive bleeding during menopause as it clears liver and heat, dissipates nodules and dissolves phlegm by enhacing the functions of liver and gallbladder channels.
Researcher found that Xia Ku Cao significantly reduced the endometrial cancer cells growth, in mice implanted with human endometrial cancer cells and demonstrated the anti-estrogen effect in the study as well.

2. Dong Ling Cao
Gong ling Cao is also known as blushred rabdosia. The sweet, bitter and cold herb has been used in TCM to treat chronic bronchitis, chronic inflammation of the pelvic area, swelling of throat, insect bites and snake bites as it clears heat and toxins, nourish yin, remove blood stasis and relieves pain by enhancing the functions of stomach, lung and liver channels. In vitro, researcher found that Gong ling Cao has cytotxicity activity against CaEs-17 human esophageal cancer cell line, at 2 and 3ug/ml, the inhibiting rates were 40% and 75%. Can it be used effective against endometrial cancer? Further studies is needed.

3. Lu Feng Fang
Lu feng Fang is also known as Honeycomb. The sweet, acrid, neutral and toxic herb has been used in TCM as diuretic and to strengthen the heart activity, lower blood pressure temporary, promote the coagulation of blood, treat of cancer, bleeding in tumors as it relieves toxicity, expels wind, alleviates pain, dries dampness by enhancing the functions of lung, liver, spleen, stomach and large intestine channels. In vitro experiments researchers found that lu feng fang demonstrate the inhibition of human liver cancer cells. In insect study by using HeLa cells originating from human cervix and uterine cancer, researchers also found that Lu Feng Fang extract showed a potent anticancer activity.

4. Bai Hua She She Cao
Bai Hua She She Cao is also known as spreading hedyotis, The bitter, sweet and cold herb has been used in TCM as anti-bacteria, anti-inflammation, anti-tumor, anti-virus agent and to treat snakebite and enhances immune system as it clears heat, drains dampness, expels toxins and resolves abscesses by enhancing the functions of liver, stomach, large intestine channels.
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

5. Qing Hao
Qing Hao is also known as Worm Wood. The bitter and cold herb has been used in TCM as anti malaria agent and to trealupus, schistosomiasis as it disperses cold and dampness, expels wind and calms pain by enhancing the functions of kidney, liver and gallbladder channels.
Researchers found that qing hao elevates the calcium ions of leukemia white cells, triggering apoptosis, a self-destruct mechanism in cancer cells. A University of Washington study showed that qing hao selectively kills several cancer cell lines in the test tube.

6. Etc.

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