Endometrial cancer

Endometrial cancer (Endometrial cancer)

1) Disease description (Causes and symptoms)

• Definition: A malignant tumor arising in the endometrium, which lines the inside of the uterus. It is usually found confined to the uterine corpus, and the prognosis varies according to the stage and grade of differentiation.
• Major causes and risk factors:
  • Prolonged exposure to endogenous (including exogenous) estrogen (anovulation, increased peripheral estrogen due to obesity, estrogen-only hormone therapy, etc.)
  • Atypical endometrial hyperplasia
  • Early menarche / late menopause, nulliparity (infertility)
  • Obesity, diabetes, hypertension, thyroid abnormalities
  • Use of certain medications such as tamoxifen (a breast cancer treatment)
  • Family history (endometrial cancer or breast cancer) — hereditary cancers (e.g., Lynch syndrome) may be associated
• Brief pathophysiology: Endometrial hyperplasia due to excess estrogen → atypical hyperplasia followed by malignant transformation. The cancer may cause myometrial invasion, metastasis to the cervix, ovaries, or peritoneal cavity, and lymph node metastasis.
• Main symptoms:
  • Postmenopausal vaginal bleeding (most common)
  • Abnormal uterine bleeding (irregular menstruation, heavy menstrual bleeding)
  • Pelvic pain, abdominal pain, abnormal vaginal discharge, etc.

2) Treatment methods and precautions

• After the diagnosis is confirmed, treatment principles take into account the stage (surgical stage), pathological grade of differentiation, the patient’s age, and desire for pregnancy.
• Standard treatment
  • Surgical treatment (standard treatment for most stage I cases)
    • Total hysterectomy + bilateral salpingo-oophorectomy (BSO)
    • Pelvic and para-aortic lymph node dissection may be considered according to pathological and clinical risk factors
  • Radiation therapy
    • Adjuvant radiation therapy (intravaginal brachytherapy or external pelvic-beam radiation) is used when the risk of recurrence is high or specific pathological findings are present
    • Be aware of acute and chronic radiation side effects (myelosuppression, diarrhea, vaginal atrophy and sexual dysfunction, bladder problems, intestinal obstruction, etc.)
  • Chemotherapy
    • Used for high-risk, advanced, or recurrent lesions (e.g., carboplatin + paclitaxel)
  • Hormone therapy
    • In young patients with low-grade (endometrioid, grade 1) disease confined to the uterus, progestins (such as medroxyprogesterone or megestrol) or an LNG-IUS (levonorgestrel-releasing intrauterine system) may be considered for fertility preservation, but strict selection and follow-up are required
  • Targeted and immunotherapy
    • Pembrolizumab (an immuno-oncology drug) may be used in cases that are MSI-H/dMMR or TMB-high
    • Combinations such as lenvatinib + pembrolizumab may be used in patients with advanced MSS (microsatellite-stable) disease (the indications and usage criteria must be confirmed)
• Lifestyle management and precautions
  • Visit a medical institution immediately if postmenopausal bleeding or abnormal bleeding occurs
  • Regular gynecological examinations are recommended while taking tamoxifen
  • Prevention of infection and thrombosis (deep vein thrombosis) after surgery, and management of bowel and bladder side effects after radiation, are necessary
  • If pregnancy is desired, discuss the appropriateness of conservative treatment and the risk of recurrence carefully with the medical team

3) Outpatient visit checklist (Examples of items to prepare, records, and questions)

• Organize the following items and information in advance
  • A list of medications currently being taken (hormonal drugs, anticoagulants, anticancer drugs, etc.)
  • Menstrual history: age at menarche and menopause, characteristics, timing, frequency, and amount of recent bleeding (clearly indicate whether postmenopausal bleeding occurred)
  • Medical history (breast cancer, diabetes, thyroid disease, etc.) and surgical history (ovarian or uterine surgery)
  • Family history (cancers of the uterus, colon, ovaries, breasts, etc.) and whether there are hereditary diseases
  • Weight and height (degree of obesity) and lifestyle habits (smoking, alcohol use)
  • Results of previous tests (ultrasound, endometrial biopsy, blood tests, MRI, etc.) — printouts or electronic files if possible
  • Whether pregnancy is desired (if pregnancy is desired, the possibility of conservative treatment should be discussed)
• Recording the following items during the outpatient visit can facilitate consultation:
  • The date bleeding began and its duration, and related symptoms (pain, discharge, etc.)
  • Recent weight changes, fever, and changes in urination or bowel movements

4) Examples of general questions to ask the doctor

• "What does my stage mean, and what is my prognosis?"
• "What treatment options do you recommend, and what are the advantages and disadvantages (side effects) of each treatment?"
• "If surgery is not possible or the risk is high, what alternative treatments are available?"
• "How will recurrence testing and follow-up be conducted after treatment?"
• "What aspects of my lifestyle should I improve (weight management, exercise, etc.)?"

5) Examples of disease-specific questions

• "I want to become pregnant. Based on my pathological results, is fertility-preserving (hormonal) treatment possible for me? If so, what follow-up tests are needed, and how often should they be performed?"
• "There is cancer in my family. Do you recommend genetic testing to assess for hereditary predisposition (e.g., Lynch syndrome)? If so, what test should I have and when would be the best time to undergo it?"

Additional information: The diagnosis and treatment plan vary depending on the stage, histological grade of differentiation, molecular test results (MSI/MMR, etc.), the patient’s general condition, and the patient’s wishes (including pregnancy). Consult your treating specialist regarding specific treatment and test selection.