Endometrial Cancer in India: An Emerging Health Challenge

Every year June is observed as Uterine Cancer Awareness Month. Endometrial cancer (EC) also commonly referred to as uterine cancer, originates from the inner lining of the uterus (endometrium). EC stands fourth in terms of gynecological cancer in India and according to the National Cancer Registry Programme (NCRP), EC accounts for about 1.5% to 2% of all cancers in women in India. In comparison to the West, India still has less number of endometrial cancer cases. It needs to be understood that EC is one form of uterine cancer. 95% of uterine cancers are endometrial cancers. On the contrary, cancer developing in the uterus other than the endometrium is termed uterine sarcoma.

Age is an important factor, but not the only factor

“One of the primary reasons why more cases have been reported in the West is because of increased life expectancy. India is doing well in terms of life expectancy and changing lifestyles. More often these cases are reported among elderly post-menopausal women. However, there have been exceptions emerging lately where women in the younger age groups are reporting EC. Increasing number of women in the younger age group are diagnosed with endometrial cancer during infertility evaluation and treatment,” says Dr. Roopesh N, Lead Consultant –Gynecologic Onco-Surgeon, Lap / Robotic Surgeon and Peritoneal Oncology Specialist at SPARSH Hospital, Bengaluru

5 Other factors contributing to endometrial cancer

1 Obesity: There is a strong link between obesity and endometrial cancer due to increased levels of estrogen produced by adipose tissue (high body fat)

2 Hormonal Factors: Prolonged exposure to estrogen without the balancing effect of progesterone, such as in PCOD, Hormone therapy for Breast cancer, hormone replacement therapy (HRT) or rarely certain ovarian tumors, increase the risk of endometrial cancer

3 Reproductive History: Women who have never been pregnant or have had fewer pregnancies are at higher risk

4 Genetics: A family history of endometrial or colorectal cancer, particularly in syndromes like Lynch syndrome, can elevate risk

5 Early age at menarche: Menarche is the first menstrual period, and when it occurs at a relatively younger age, it can increase the risk of developing endometrial cancer later in life.

Apart from these, sedentary lifestyle, diabetes, hypertension, infertility can also lead to endometrial cancer. Endometrial cancer generally has an excellent prognosis as it presents early and many of the subtypes are slow-growing. More than 70% of endometrial cancers present in stage 1 and hence are diagnosed early with highly successful outcomes.

Understanding the symptoms and diagnosis

Symptoms:

1. Bleeding after menopause
2. Irregular and heavy bleeding around menopause
3. Abnormal vaginal discharge
4. Lower abdominal pain (seldom)

Diagnosis:

1. Trans-vaginal ultrasound
2. MRI
3. Endometrial biopsy (PIPELLE office biopsy)

Treatment strategies for endometrial cancer depend on the stage and grade of the cancer:

1. Surgery – The primary treatment is usually a hysterectomy (removal of the uterus), often along with the removal of fallopian tubes and ovaries (salpingo-oophorectomy). This can also include sentinel lymph node dissection and complete lymph node dissection. In early cancers after proper selection, fertility-sparing surgeries are feasible too.
2. Cytoreductive surgery (CRS) – A major surgical procedure that aims to remove all visible cancer cells from the abdominal cavity and pelvis. This is considered only when the cancer is advanced but with limited peritoneal spread and is seldom considered.
3. Radiation – Used as an adjunct to surgery, particularly in advanced cases.
4. Chemotherapy – Utilized in advanced stages or when cancer has spread beyond the uterus.

Endometrial cancer is emerging as a notable public health challenge in India, necessitating enhanced awareness, early detection, and comprehensive management strategies. Efforts must be directed towards educating women about the symptoms and risk factors, promoting healthy lifestyles, and ensuring access to quality healthcare services. Through concerted public health initiatives and medical advancements, the impact of endometrial cancer can be mitigated, improving the prognosis and quality of life for affected women. Timely visit to the Gynecologic Oncologist instead of panicking about the disease would result in excellent outcomes and total cure in most women.