Endometrial cancer, also known as uterine cancer, develops within the endometrium, the tissue lining the uterus. Type 1 endometrial cancer is the most frequently diagnosed form. It is characterized by being less aggressive and having a more favorable outlook compared to other types.
Understanding Type 1 Endometrial Cancer
Type 1 endometrial cancer is primarily influenced by estrogen. These cancers are often low-grade, meaning the cells resemble normal tissue, and they grow at a slower rate. It accounts for 75% to 90% of endometrial cancer cases. It frequently originates from a precancerous condition known as atypical hyperplasia, which involves an abnormal overgrowth of endometrial cells.
Several factors can increase the likelihood of developing Type 1 endometrial cancer. Obesity is a significant risk factor, as excess fat tissue can convert other hormones into estrogen, leading to higher levels of this hormone in the body. Longer lifetime estrogen exposure, such as early menstruation or late menopause, also increases risk. Women who have never been pregnant are also at a higher risk.
Other risk factors include certain hormone therapies, specifically estrogen replacement therapy used without progesterone. Genetic predispositions, such as Lynch syndrome, account for a small percentage (two to five percent) of cases. Conditions like polycystic ovary syndrome (PCOS) and diabetes, along with the use of the breast cancer drug tamoxifen, are associated with increased risk.
Recognizing and Diagnosing Type 1 Endometrial Cancer
The most common sign of Type 1 endometrial cancer is abnormal vaginal bleeding. This can manifest as bleeding after menopause, unusually heavy or prolonged menstrual periods, or bleeding between periods. Prompt medical evaluation is important for any such bleeding, as early detection aids effective treatment.
The diagnostic process begins with a physical examination, including a pelvic exam, where a healthcare provider checks the reproductive organs for any abnormalities. A transvaginal ultrasound may then be performed to assess the thickness and appearance of the uterine lining. While useful for evaluating symptoms, it is not recommended for routine screening.
The definitive diagnosis of endometrial cancer is made through an endometrial biopsy. This procedure involves taking a small tissue sample from the uterine lining, examined under a microscope for cancer cells. If biopsy results are unclear, a dilation and curettage (D&C) may be performed to remove a larger tissue sample for analysis. Once cancer is confirmed, further tests determine the disease’s extent, a process known as staging.
Treatment Options for Type 1 Endometrial Cancer
Surgery is the primary treatment for Type 1 endometrial cancer. This involves a hysterectomy (surgical removal of the uterus and cervix). Often, fallopian tubes and ovaries are also removed (bilateral salpingo-oophorectomy, BSO). Lymph nodes in the pelvic area may also be removed to check for cancer spread.
Surgical approaches vary, including traditional open abdominal surgery or minimally invasive techniques such as laparoscopic or robotic-assisted surgery. Minimally invasive procedures often result in less pain, reduced blood loss, and faster recovery. Open surgery may be necessary for complex or extensive disease.
After surgery, adjuvant therapies may be recommended based on cancer characteristics and recurrence risk. Radiation therapy, using high-energy beams to destroy cancer cells, can be external or internal (brachytherapy). It is considered for higher-risk cases.
Hormone therapy is another option, especially for early-stage cases desiring fertility preservation, or for advanced or recurrent disease. This treatment involves progestins, anti-estrogen drugs, or aromatase inhibitors, targeting the estrogen-dependent nature of Type 1 cancers.
Chemotherapy is reserved for advanced or recurrent cases, as early-stage Type 1 endometrial cancer often responds well to surgery, radiation, or hormone therapy. Targeted therapy and immunotherapy are emerging options for advanced disease.
Life Beyond Treatment for Type 1 Endometrial Cancer
After initial treatment, ongoing follow-up care is important. Regular check-ups monitor recovery and detect recurrence, ensuring prompt addressing of potential issues.
The prognosis for Type 1 endometrial cancer is favorable, especially with early detection. A significant majority (75-80%) are diagnosed when cancer is confined to the uterus, contributing to better outcomes.
Life beyond treatment involves managing potential side effects. If ovaries are removed, women will experience menopausal symptoms, which can be medically addressed. Lymph node removal can sometimes lead to lymphedema, a swelling from lymphatic fluid accumulation. Addressing emotional and psychological aspects of a cancer diagnosis and treatment is also part of survivorship, with resources available for support.