Essay Example on Obstetric and Gynea: Introduction and Definition

Introduction

Endometrial cancer (also called corpus cancer or corpus uterine cancer) is a type of malignancy that affects the uterus. It results from abnormal and uncontrollable growth of cells in the inner lining of the uterus (endometrium). In the developed world, this condition is the most prevalent female genital cancer. The National Cancer Institute (2020) estimates that about 23 in 100 women in America will have endometrial cancer in their lifetime. Depending on how the cells appear microscopically, this condition can occur in six different types, including adenoma, uterine, squamous cell, small cell, transitional, or serous carcinoma. Endometrial cancer has a high rate of good prognosis compared to other malignancies. The National Cancer Institute (2020) estimates that 80% of all patients live for five or more years after this diagnosis. Early diagnosis and treatment increase the risk of going to remission.

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Etiology and Risk Factors

There is no known definite cause of endometrial cancer. It results from mutations in the genetic material of cells in the endometrium. Old age is a risk factor, as women aged over 55 years have the highest incidence of this type of cancer (Board, 2019). Additionally, conditions like obesity, diabetes, polycystic ovarian syndrome, endometrial hyperplasia, and lynch syndrome increase the risk. Endometrial cancer is more prevalent in women who have early menstruation, late menopause, hormonal replacement therapy, or taxomifen therapy for breast cancer (National Cancer Institute, 2019). These conditions prolong exposure to estrogen, which in turn increases the risk of malignancy. Genetics also play a role. According to Board (2019), this disease runs in the family and is common in those with Lynch syndrome, a hereditary condition.

Clinical Manifestations

Three-quarters of all patients with this type of cancer are post-menopause (National Cancer Institute, 2019). As such, the first sign is vaginal bleeding that is similar to the one that usually occurs after menopause, but heavier and frequent. The symptoms are subtler in 25% of those who peri or pre-menopausal (National Cancer Institute, 2019). The most common is irregular menses, bleeding between periods, and spotting. In advanced endometrial cancer, pain in the pelvis, abdomen, and during sex, changes in bladder or bowel habits and bloating may occur. Some women with endometrial cancer are asymptomatic.

Pathophysiology Changes

DNA mutations in the endometrium turn healthy calls abnormal. They divide uncontrollably and do not die after the set period to leave room for new ones. As a result, they accumulate in the uterus, forming a mass referred to as a tumor (Casey et al., 2019). The malignant cells invade neighboring tissues and can break off and spread, a process called metastasis. The presence of these unhealthy cells changes the dynamics of the uterus leading to abnormal bleeding, pain, and other complications.

Investigations

Women suspected to have endometrial cancer undergo a pelvic examination. The pelvis may appear normal since bleeding usually occurs from the endometrium. At the same time, the cervix may show no gross evidence of disease, and the uterus may have a standard size (National Cancer Institute (2019). The patient may also undergo laboratory tests to exclude pregnancy. The doctor then performs a pelvic ultrasound to examine the texture and thickness of the endometrium to detect abnormalities. If the endometrium is more than 4 mm, thickened, more tests follow.

Some doctors may perform hysteroscopy to examine the endometrium for any physical abnormalities. The recommended method of diagnosing endometrial cancer is biopsy or Dilation and Curettage (D&C) to obtain tissue samples for histological analysis (Casey et al., 2019). After an endometrial cancer diagnosis, the patient undergoes a routine evaluation to assess if she is fit to start therapy. The most frequent tests include blood studies, chest radiography, and electrocardiography. Accurate staging is not possible at this stage because doctors need more information from the study of tumor after surgery.

Treatment

The most common treatment modality for endometrial carcinoma is the surgical removal of the malignant tissue (Casey et al., 2019). It can involve the removal of the uterus, fallopian tubes, cervix, and ovaries. The operation may also involve the removal of lymph nodes (lymphadenectomy) for staging to determine the need for additional treatment. Surgery does not guarantee the removal of all cancer. Therefore, the doctor may prescribe adjuvant therapy with radiation or hormones to kill remaining malignant cells and lower the risk of recurrence.

Radiation uses high-energy beams over a given period to destroy cancerous cells. This procedure can happen before surgery to make it simpler to remove the tumor or after to lower the risk of recurrence. In certain occurrences, such as when the patient is not healthy enough for surgery, radiation may be the only therapy administered. It has low effectiveness on its own, but it reduces the rate of growth of malignant cells. There are two ways of administering radiotherapy, depending on the type and stage of cancer. First, it can be externally where a machine outside the body sends radiation waves to the uterus (National Cancer Institute, 2019). The other method is internally placing radioactive substances such as seeds, needles, catheters, or wires near or directly into cancer.

The next treatment option is chemotherapy, which involves the use of drugs to kill abnormal cells. It can either be systemic (delivered through the bloodstream) or regional (placed directly on a body cavity like the abdomen). The patient may receive one drug or a combination, orally, or intravenously in a specific number of cycles depending on the type and stage (Board, 2019). Just like radiation, chemotherapy can happen before or after surgery. The doctor may prescribe it if cancer has advanced and spread beyond the uterus.

Another adjuvant treatment is hormone therapy. The doctor can prescribe agents that block or lower the levels of some hormones in the body, causing the cancer cells that rely on them to stop growing and die. In most cases, the prescription includes high doses of progesterone in pills or intrauterine devices (National Cancer Institute, 2019). Another choice is aromatase inhibitors that reduce the production of estrogen. The doctor can prescribe hormone therapy if the cancer is advanced or metastatic, or the patient cannot undergo surgery or radiotherapy (Board, 2019). In most cases, it has to be in combination with other therapies.

The patient can also undergo targeted therapy. It involves the use of substances that attack specific weak areas of malignant cells, without harming healthy cells. This form of treatment can destroy proteins, genes, or the environment that supports the growth of cancer. Usually, it treats advanced cases in combination with chemotherapy (Board, 2019). There are three forms of targeted therapy currently. Monoclonal antibodies such as bevacizumab kill or block the growth of cancer cells or inhibit substances that support them. In addition, doctors can use agents like everolimus that inhibit Target of Rapamycin (mTOR), to control the growth of malignant cells (National Cancer Institute, 2019). The third method is the use of signal transduction inhibitors like metformin to block cellular communication. These therapies are still under investigation and are mostly available through clinical trials.

The last method of treating endometrial carcinoma is immunotherapy. This biological therapy boosts the body’s natural immunity and is often in combination with other forms of treatment. It includes the use of substances made in a laboratory or the body, which restores or strengthens the immune system. For instance, advanced endometrial cancer responds well to a combination of pembrolizumab and lenvatinib (National Cancer Institute, 2019). Immunotherapy is suitable in cases where systemic therapy is impossible or radiation, and surgery fail.

In conjunction with these curative treatments, cancer patients need palliative care to relieve the pain and symptoms of a severe illness. (Casey et al., 2019) showed that physical, emotional, and social support improves prognosis and the quality of life, mainly when administered along with treatment. Such supportive care reduces the severity of the symptoms and improves patients’ satisfaction with care, which improves the chances of survival.

Complications

The most common complication of endometrial cancer is anemia due to excess bleeding (National Cancer Institute, 2019). This condition results in fatigue, loose bowel movement, skin reactions, and upset stomach. In the case of metastasis, other forms of cancer may occur in the body. Surgery causes short-term effects like tiredness, pain, nausea, vomiting, and difficulties in bowel and bladder movement. Hysterectomy leads to an immediate inability to conceive or menstruate. Furthermore, the removal of ovaries accelerates the onset of menopause as the body stops producing sex hormones (Piovano et al., 2014). Lymphadenectomy can cause lymphedema, increased bleeding, and thromboembolism, particularly in older and obese patients.

Chemical therapies can have several side effects depending on the dose and the individual. The most common ones include skin reactions, nausea, vomiting, loss of appetite, diarrhea, loose bowel movement, fatigue, and hair loss (Piovano et al., 2014). With recent advances, new drugs have components, such as growth factors and antiemetic to prevent some of the side effects. Chemotherapy also affects the fertility of patients who have had a hysterectomy and causes early menopause. At the same time, most of the drugs used have high toxicity damaging the liver, kidney, and the hearing ability (Piovano et al., 2014). Hormone therapy may upset the body’s homeostasis, causing weight gain, insomnia, fluid retention, and increased appetite.

Bibliography

Board, PATE, 2019. Endometrial Cancer (PDQ®). (Online): National Cancer Institute (US), p. 30

Casey, M.J., Summers, G.K. and Crotzer, D. (2019). Cancer, Endometrial. (Online): StatPearls Publishing, p. 35

National Cancer Institute (2019). Endometrial cancer treatment (PDQ®): patient version. PDQ cancer information summaries. (Online) Available at: https://www.cancer.gov/types/uterine/hp/endometrial-treatment-pdq (Accessed 13 July. 2020).

National Cancer Institute (2020). Cancer Stat Facts: Uterine Cancer. (Online) Available at: https://seer.cancer.gov/statfacts/html/corp.html (Accessed 13 July. 2020).

Piovano, E., Fuso, L., Poma, C.B., Ferrero, A., Perotto, S., Tripodi, E., Volpi, E., Zanfagnin, V. and Zola, P. (2014). Complications after the treatment of endometrial cancer: a prospective study using the French-Italian glossary. International Journal of Gynecologic Cancer, (online) Volume 24(3), p.418-426. Available at: https://doi.org/10.1097/igc.0000000000000094 (Accessed 13 July. 2020).