What is uterine corpus cancer or endometrial cancer ?
Uterine tumors can originate from the cervix, which is the lowest part of the uterus, or from the body of the uterus, which includes the areas above the cervix. This text will focus solely on benign (non-cancerous) or malignant (cancerous) tumors of the body of the uterus.
TO REMIND YOU
The uterus is a pear-shaped organ. It is located in the small pelvis between the bladder in front and the rectum behind. In a woman of reproductive age, from puberty to menopause, the uterus measures 6 to 10 cm in length, 2 to 4 cm in thickness, and 5 cm in width.
The uterine cavity is lined with a special tissue called the endometrium . The main role of the endometrium is to receive the fertilized egg on the 7th day after fertilization. It then allows the pregnancy to continue its development. If a cycle is not followed by pregnancy, the endometrium is shed (desquamation) on average after 28 days. This shedding of the endometrium causes bleeding, which constitutes menstruation .
The outer layer of the uterus is made of muscular tissue or myometrium . This uterine muscle is considered the most powerful muscle in the female body. Its contractions help expel the baby during childbirth.
Benign uterine tumors are quite common. These are most often fibroids and, less frequently, polyps. Endometriosis is also a benign proliferation of the endometrium.
Uterine fibroids, uterine polyps and endometriosis
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Uterine fibroids are the most common benign tumors, particularly in women during their reproductive years. About 20% of women in their 30s, 20 to 40% of women in their 40s, and 40% of women in their 50s have them.
These fibroids do not transform into cancer. Women can have multiple fibroids at once.
In most cases, fibroids cause no abnormal symptoms and require no treatment. However, some fibroids may cause heavy menstrual bleeding ( menorrhagia ) or pain. In such cases, they are treated surgically, with the uterus not always needing to be removed entirely ( myomectomy ), depending on the patient’s age and desire for children. Medical treatment may also be proposed (oral progestins, LH-RH analogs).
Uterine polyps are benign tumors that may become malignant in 4% of cases (source: arcay.org).
Their treatment consists of removal through a uterine curettage .
Endometriosis is a common condition affecting 5 to 10% of women. It is defined by the presence of endometrial tissue outside the uterine cavity.
Endometriosis is always a benign proliferation, more commonly affecting women in their 30s or 40s. It can cause pain, which is typically cyclical, appearing in the second half of the menstrual cycle and during menstruation.
The treatment is hormonal, typically with oral contraceptives or LH-RH analogs to block estrogen production by the ovaries. Surgery via laparoscopy may sometimes be necessary.
At the boundary between benign and malignant tumors, endometrial hyperplasia is considered a precancerous condition.
Endometrial hyperplasia
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Endometrial hyperplasia may present with painful periods, menorrhagia (heavy bleeding), or metrorrhagia (bleeding that occurs outside of or between periods).
Sometimes, no symptoms are found. If left untreated, these lesions may, in some cases, progress to cancer. Treatment is most often surgical. Hormone therapy with progesterone (a female hormone) may also be considered.
Uterine cancers, commonly referred to as endometrial cancer, can be non-invasive (in situ cancers) or invasive.
In patients with in situ cancer, the cancer cells are confined to the endometrium, the tissue where they originated, and have not spread to the surrounding tissue.
In patients with invasive cancer, the cancer cells have spread beyond the uterus and have reached other organs, forming metastases.
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The formation of metastases is the real problem posed by cancer. Without metastasis, treating the primary tumor with local treatment , such as surgery or radiotherapy , would be enough to cure most cancers.
The presence of metastases results from the spread of cancer cells distant from the primary tumor and requires the use of treatments that also spread throughout the body (systemic treatments), such as chemotherapy, targeted therapies, hormone therapies, or immunotherapies .
This spread of cancer cells to form metastases is a complex phenomenon, as the cancer cells must leave the primary tumor, use lymphatic vessels and/or blood vessels to circulate through the body, and then exit these vessels to penetrate a new organ, where they multiply and form metastases.
Cancer cells originating from the endometrium can invade lymph nodes, which are immune system organs scattered throughout the body and connected by lymphatic vessels. The affected lymph nodes are initially located in the pelvis (pelvic lymph nodes) and then along the aorta, the large artery descending from the heart (para-aortic lymph nodes). Cancer cells can also spread to other organs. The most frequently affected are the peritoneum, liver, and lungs.
In France, in 2018, 8,224 cases of endometrial cancer were diagnosed.
In terms of incidence (number of new cases per year), endometrial cancer ranks as the fourth most common cancer in women, following breast, colon, and lung cancer. It accounts for approximately 13% of all cancers diagnosed in women (source: arcagy.org).
ts incidence increases after menopause, with more than three-quarters of cases diagnosed during this period. It often occurs between the ages of 60 and 70, with an average onset age of 69. The prognosis for these cancers is often favorable because symptoms, such as bleeding that occurs outside of menstrual periods or after menopause (metrorrhagia), typically appear at an early stage of the disease.
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Article updated on Jan 23, 2025
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