By Emma Hill
JRNM 222

With all the headlines and news segments today dealing with breast cancer, other serious forms of the big “C” aren’t garnering the same awareness. Make no mistake about it, they are just as deadly.
Endometrial cancer is the most common cancer of the female reproductive organs in the United States. The average chance of a woman being diagnosed with this cancer during her lifetime is about one in 40. There are more than 500,000 women who are survivors of this cancer nationwide.

My mom, Patricia Hill, was one of 40 diagnosed and is among the 500,000 survivors. “I thought I was going through the change of life so I went to the doctor and she did a biopsy,” my mom said, “I got a call from the doctor’s office saying I needed to come in to talk to the doctor. She just came right out and said I had endometrial cancer and referred me to another doctor.”

The doctor she was referred to was the section head of Obstetrics and Gynecology at the Cleveland Clinic. “He was very nice and so were the nurses. They explained everything to me and answered all my questions,” my mom said.

Who is at risk?
Endometrial cancer is rare in women under the age of 40.  This cancer is more common in Caucasian women, but African-American women are more likely to die from it. Endometrial cancer starts in the endometrium or the inner lining of the uterus. Almost all of the cancers of the uterus start in the endometrium and are referred to as endometrial carcinomas. More than 80 percent of endometrial cancers are made up of what look like cells of the normal uterine lining but some cancers contain squamous cells (flat, thin cells that are found in the outer surface of the cervix) and glandular cells.
Endometrial cancers can be separated into three different grades according to the American Cancer Society (ACS).  “The grade of an endometrioid cancer is based on how much the cancer forms glands that look similar to the glands found in normal, healthy endometrium. In lower-grade cancers, more of the cancerous tissue forms glands. In higher-grade cancers, more of the cancer cells are arranged in a haphazard or disorganized way and do not form glands.”

The cancers are classified based on the following criteria: stage-I tumors have 96 percent or more of the cancerous tissue forming glands, stage-II tumors have between 50 and 94 percent of the cancerous tissue forming glands, stage-III tumors have less than half of the cancerous tissue forming glands. Stage-III cancers are called “high-grade.” They tend to be aggressive and have a poorer outlook than low-grade cancers (grades one and two).

My mom’s primary doctor  made the mistake of telling her she had stage-II cancer, but after talking with the doctor at the Cleveland Clinic she found out that she had grade-2 of stage-II  and it would not have been able to determine the stage from the biopsy. Clear-cell carcinoma, serous carcinoma, and poorly differentiated carcinoma are less common and more aggressive forms of endometrial cancer.

Types of treatment
There are four basic types of treatment for endometrial cancer: surgery, radiation therapy, hormonal therapy and chemotherapy. Surgery is the main treatment for endometrial cancer but a combination of these treatments may also be used. The treatment path for each woman is decided based on the stage of the cancer, type of cancer, overall health and desire to have children in the future.

The doctor at the Cleveland Clinic explained all the treatment options to my mom and they decided on a complete hysterectomy, removal of several lymph nodes, and several sessions of pelvic radiation. A complete hysterectomy is the removal of the uterus and cervix through the abdomen. The lymph nodes in the pelvis were removed to help determine what stage cancer it was. The recovery after a hysterectomy takes about four to six weeks and includes a three to seven day hospital stay.

“When you’ve had two children by C-section, recovering from this type of surgery is no big deal. I didn’t like the drainage tube though,” said my mom of her recovery,
“I had to go in for radiation five or six times. Then had to go back for follow up tests every three months for this first year, then every six months, now I only have to go once a year.”

Treatment and Survival
It is hard to watch a news program without hearing about a newly discovered risk factor for cancer, but it is important that people with known risk factors be checked for cancer. Early detection increases the chance of survival.

The overall five-year survival rate (the percentage of patients still alive five years after the date of diagnosis) for endometrial patients is 83 percent, but in cases that were caught early the survival rate is 96 percent.

Stage-I and stage-II endometrial cancers are linked to increased production of the hormone estrogen. The balance between progesterone and estrogen changes during a woman’s menstrual cycle, a shift towards more estrogen increases a woman’s risk of endometrial cancer. After menopause, the ovaries no longer produce the hormones but a small amount of estrogen is still made by fat issue.

Risks and Red Flags
Estrogen therapy is used to treat the symptoms of menopause. Estrogen is available in many forms, from pills to patches and is used to treat hot flashes and help prevent osteoporosis. Doctors have found using estrogen without progesterone can lead to endometrial cancer in women who still have their uterus. Even though using progesterone and estrogen after menopause does not cause endometrial cancer it can lead to breast cancer and serious blood clots. It is important to talk to a doctor about the risks before starting any hormone therapy.

Using birth control pills lowers the risk of endometrial cancer; the risk is lowest in woman who use the pill over a long period of time and the protection lasts for at least ten years after a woman stops taking it. Women who use an intrauterine device (IUD) as a birth control method have a lower risk of endometrial cancer. IUDs are sometimes used to treat pre-cancers and early endometrial cancers in women who wish to still be able to have children.

While at the doctor, my mom asked if her smoking had contributed to causing her cancer but was surprised to find out that in this particular cancer, nicotine could slow the growth down.
Having more menstrual cycles in a lifetime increases the risk of endometrial cancer. If a woman starts her periods before she is 12 years old or begins menopause later in life, she is at a higher risk.
When a woman is pregnant her hormones shift more to progesterone, so having many pregnancies protects against endometrial cancer.  Women with diabetes may be four times more likely to develop endometrial cancer.

Other risk factors include: family history, age, obesity, poor diet, breast or ovarian cancer, pelvic radiation used to treat another type of cancer or endometrial hyperplasia (an increased growth of the endometrium).

“At the time of menopause, all women should be told about the risks and symptoms of endometrial cancer and strongly encouraged to report any vaginal bleeding, discharge, or spotting to their doctor,” recommends the ACS.

Screening and Detection
At this time there are no screening tests or exams to find endometrial cancer in women who are at an average risk and have no symptoms. Women should talk to their doctors about getting regular pelvic exams. Pelvic exams can find some cancers but are not very effective in finding early endometrial cancers. Pap tests can find some early endometrial cancers but are not a good screening test for them. If a woman is at any increased risk for endometrial cancer it is recommended by the ACS that she speak with her doctor.

Dealing with cancer can be a very difficult process for the patient as well as their family, friends and care givers. There are many resources provided to help people in this situation. “The more I talked to women who had gone through the same thing, the more encouraged I became of having a positive outcome,” said my mom, “I met women in the doctor’s office for the same treatments I was getting who were very inspiring.”

Remedy and Recuperation
“I Am Not Alone” is a cancer support group provided by St. John Medical Center. It is held at 7-9 p.m. on the second Tuesday of every month at Saint John Medical Center in Westlake and is open to any cancer patient or survivor and their family and friends.

St. John West Shore Community Outreach Center holds meeting for caregivers on an as needed basis, call (440) 777-9036 for more details.
A support group for women living with gynecological cancers meets at 5:30-7 p.m on the first Thursday of each month at the Fairview Hospital Moll Pavilion in Cleveland. For more information and the RSVP, contact (216) 476-7241.

There are many other resources available for cancer patients and their loved ones. For a complete list, visit cancer.org/treatment/supportprogramsservices.

Karl Schneider contributed to this report.