Learn about endometrial cancer

Post by Doctor Specialist I Nguyen Thi Minh Thuyen - Pathologist - Laboratory Department - Vinmec Danang International General Hospital

If you've been diagnosed with endometrial cancer or are worried about the disease, you probably have a lot of questions and want to learn some basics about the disease. Understanding the condition of the disease will help patients choose better nutrition, care and treatment.

Endometrial cancer occurs when cells in the endometrium (inner lining of the uterus) start to grow out of control.
1.1 Uterus and Endometrium The uterus is a hollow organ, about the size and shape of a pear. The uterus is where the fetus grows and develops during pregnancy. The uterus has 2 main parts:
Body of the uterus: is the upper part of the uterus Cervix: is the lower end of the uterus that connects to the vagina When people talk about uterine cancer, it means that the cancer originates in the uterus. body of the uterus, not the cervix. (Cervical cancer is a separate cancer)
The body of the uterus has 2 main layers:
Muscle layer: the outermost layer. This layer of muscle is thick, needed to push the baby out at birth. The endometrium: the inner layer. During the menstrual cycle, hormones cause the endometrium to change. Estrogen causes the endometrium to thicken so it can nourish the embryo if a pregnancy occurs. If there is no pregnancy, estrogen levels are lower and more progesterone is produced, causing the endometrium to shed and become menstrual flow. This cycle repeats until menopause. There is also a thin layer called the serosa that covers the outside of the uterus.
1.2 Types of endometrial cancer Endometrial cancer (also called endometrial carcinoma) begins in the cells of the inner lining of the uterus (endometrium). This is the most common cancer of the uterus.
Endometrial carcinomas can be divided into different subtypes based on the cells seen under the microscope (called histological types), including:
Adenocarcinomas (most endometrial cancers) Endometrial cancer is an adenocarcinoma called endometrioid cancer Uterine Carcinosarcoma Squamous cell carcinoma Small cell carcinoma Transitional carcinoma serous carcinoma Clear cell carcinoma, mucinous adenocarcinoma, serous adenocarcinoma, and undifferentiated carcinoma are less common types of endometrial cancer. They tend to grow and spread more quickly than most endometrial cancers, which often have spread beyond the uterus at the time of diagnosis.

Most endometrial cancers are adenocarcinomas, and endometrioid cancer is the most common type of adenocarcinoma, by far. Endometrial cancer starts in glandular cells and looks a lot like normal endometrium, and has many different variations.

Uterine sarcomas arising from the muscular or connective tissue layer of the uterus, including:
smooth muscle sarcomas (leiomyosarcomas) Endometrial stromal sarcomas Histological grade of endometrial cancer based on number Cancer cells produce glandular structures that look like normal, healthy endothelial glands.
In low-grade cancers (grades 1 and 2), many cancer cells form glandular structures. In advanced cancer (grade 3), many cancer cells are messy and do not form glandular structure.
Tumor grade 1 (grade 1): 95% or more of the cancer tissue forms an glandular structure. Grade 2 (grade 2): 50% to 94% of the cancerous tissue forms an glandular structure. Grade 3 (grade 3): less than 50% of the cancerous tissue forms an glandular structure. This type tends to grow and spread quickly and has a worse prognosis than grades 1 and 2.

Two systems commonly used for staging endometrial cancer
are the FIGO system (International Federation of Obstetricians and Gynecologists) and the TMN staging system (American Cancer Commission), which is basically alike.
Both of these cancer classifications are based on 3 factors:
Tumor size (T - tumor): How far has the cancer grown to the uterus, has spread to nearby structures or organs without lymph nodes nearby lymph nodes (N - lymph nodes): Cancer has spread to para-aortic lymph nodes without Metastasis to distant sites (M - metastasis): Cancer has spread to distant lymph nodes or other organs of the body not The numbers or letters after T , N and M give more details about each element. A higher number means the cancer is more advanced. Once T, N, and M have been determined, this information is combined together called a stage group, to indicate an overall period.
The staging system in the table below is the pathological (or surgical) stage, as determined after surgery. If immediate surgery is not possible, the cancer will be determined instead by a clinical stage, based on the results of clinical examination, biopsy and imaging tests before surgery.
The staging system described below is the latest AJCC system, effective January 2018.

Endometrial cancer staging can be complicated, so ask your doctor to explain it in a way you can understand.
3.1 Stage I: T1 N0 M0 Cancer is growing inside the uterus, may also have spread to the glands of the cervix, but not to the connective tissue of the cervix (T1) Has not spread to the lymph nodes nearby lymph nodes (N0) No metastasis to distant sites (M0) 3.2 Stage IA: T1a N0 M0 The cancer is in the endometrium and may have grown to less than 1/2 of the uterine muscle layer ( T1a) Has not spread to nearby lymph nodes (N0) Has not spread to distant sites (M0) 3.3 Stage IB: T1b N0 M0 Cancer has grown from the endometrium into more than 1/2 of the muscle layer uterus, but has not spread outside the body of the uterus (T1b) Has not spread to nearby lymph nodes (N0) Has not spread to distant sites (M0) 3.4 Stage II: T2 N0 M0 The cancer has spread Has spread to the body of the uterus and is spreading to the connective tissue of the cervix (cervical stroma), but has not spread outside the uterus (T2) Has not spread to nearby lymph nodes (N0) Has not spread to other organs distal (M0) 3.5 Stage III: T3 N0 M0 The cancer has spread outside the uterus, but has not has spread to the lining of the rectum or bladder (T3) Has not spread to nearby lymph nodes (N0) Has not spread to distant sites (M0) 3.6 Stage IIIA: T3a N0 M0 The cancer has spread to the surface outside of the uterus (serosa) and/or to fallopian tubes or ovaries (appendices) (T3a) Has not spread to nearby lymph nodes (N0) Has not spread to distant sites (M0) 3.7 Stage stage IIIB: T3b N0 M0 Cancer has spread to the vagina or to tissues around the uterus (peritoneum) (T3b) Has not spread to nearby lymph nodes (N0) Has not spread to distant sites (M0 ) 3.8 Stage IIIC1: T1-T3 N1/N1mi/N1a M0 The cancer is growing in the body of the uterus, may have spread to some nearby tissue, but has not invaded the inside of the bladder or rectum (from T1 to T3) Has spread to pelvic lymph nodes (N1, N1mi or N1a) Has not spread to lymph nodes around the aorta or distant sites (M0) 3.9 Stage IIIC2: T1-T3 N2/ N2mi/N2a M0 Cancer is growing in the body of the uterus, which may have spread to one year Tissue staining nearby, but not inside the bladder or rectum (T1 to T3) Has spread to lymph nodes around the aorta (N2, N2mi, or N2a) No metastasis to distant sites (M0) 3.10 Stage IVA: T4 Nany M0 Cancer has spread to the lining of the rectum or bladder (T4) May or may not have spread to nearby lymph nodes (any N) Has not spread to other sites distant location (M0). 3.11 Stage IVB: Any N Any M1 Cancer has spread to the lymph nodes in the groin, upper abdomen, omentum, or to organs distant from the uterus such as the lungs, liver, or bones (M1) The cancer may be of any size. Any size (any T) ​​​ May or may not have spread to other lymph nodes (any N) The following additional categories are not listed in the table above:
TX: Primary tumor cannot be evaluated due to lack of information. T0: No evidence of primary tumor. NX: Regional lymph nodes could not be evaluated due to lack of information. Currently, endometrial cancer is a dangerous disease with a high incidence, so a routine check-up at least once a year is the most effective way to prevent this dangerous disease.
Vinmec International General Hospital is the first private hospital to achieve JCI global medical certificate, Vinmec always brings the best cancer screening and treatment services to customers, including cancer. Endometrial endometriosis with:
Top modern and advanced machine system The laparoscopic surgery methods are performed by a team of highly skilled doctors, providing good treatment effect while still ensuring the accuracy of the treatment. Aesthetics Always update the most optimal and effective methods in screening and treatment of endometrial cancer: cancer screening through genetic testing, robotic surgery with a success rate of up to 95%. Thanks to good medical quality, customers can completely trust the results of examination and treatment at the hospital.