Endometrial cancer has a reputation for being one of the most treatable and least-lethal gynecological cancers that women face. But as Ifill’s case shows, a significant minority of cases can be aggressive and fast-paced ― and they’re more likely to be concentrated among black women.
For women who have recurrent endometrial cancer, doctors have few medications that can specifically target growth.
“We don’t have as many tools as [we do with] other cancers,” said Dr. Ursula Matulonis, director of the gynecologic oncology program at Dana-Farber Cancer Institute and an associate professor of medicine at Harvard Medical School.
“This is a significant problem for women, and we need to do a better job treating our patients. We need more research around it.”
How most women experience endometrial cancer
Endometrial cancer is the most common kind of pelvic cancer in women and is typically diagnosed at an early stage, which results in overall five-year survival rates of about 82 percent (in contrast, cervical cancer has a 68 percent five-year survival rate, while ovarian cancer’s is 46 percent).
It refers to cancerous growths in the endometrial cells, which make up the inner lining of the uterus. In premenopausal women, that endometrial lining is shed monthly during menstruation, but endometrial cancer usually strikes postmenopausal women, perhaps because of the shift in hormones that happens after a woman stops getting her period.
Specifically, a rise in estrogen can encourage the growth of endometrial cancers. Estrogen can rise too high after menopause because progesterone levels go down, but it can also rise in obese women because fat tissue can drive estrogen higher.
“These types of cancer that are estrogen-induced are usually less aggressive, the stakes are lower and they’re highly curable,” said Dr. Linus Chuang, a gynecological oncologist at the Icahn School of Medicine at Mount Sinai.
“[In] patients where it’s not obesity related, they’re genetically more aggressive and related to mutations in their entire oncogene. Unfortunately, even if these patients are detected early, sometimes it’s difficult for [the cancer] to be treated.”
While endometrial cancer and uterine cancer are terms that are sometimes used interchangeably, endometrial cancers are actually just a subset of cancers that start in the uterus. Of the 60,050 new cases of uterine cancer that will be diagnosed this year, about 1,600 of them will be rare uterine sarcomas, which start in the muscle layers, while the rest will be endometrial cancers. In total, about 10,500 women will die of uterine cancer every year, but black women are more likely to die of the disease than white women.
Treatment options for endometrial cancer
Most cases of endometrial cancer can be resolved with surgery in which doctors remove all or part of the cervix, uterus, fallopian tubes, ovaries and lymph nodes. More serious cases may also require chemotherapy and radiation, but Matulonis points out that beyond these options, the only targeted medication for endometrial tumors are anti-estrogen medicines that slow the growth of cancer cells.
“There’s only one FDA-approved drug for endometrial cancer for recurrence, and it’s progesterone,” said Matulonis. “We need more basic science researchers working on this cancer, we need well done clinical trials [and] we need new therapeutic targets to be tested in uterine cancer.”
Another problem with endometrial cancer treatment is that the way doctors traditionally classify and grade tumors doesn’t seem to have any relationship to the way those tumors are driven by genetic factors that can influence growth and aggressiveness. In 2013, scientists analyzed tumors from 373 patients and were able to break down endometrial cancer into four basic genetic groups. Understanding which of these four groups a patient’s tumor falls into, Matulonis argues, may be a better way to guide cancer treatment than the usual way doctors decide how to pursue treatment.
“We’re at a crossroads for endometrial cancer research right now, because what you see under the microscope doesn’t necessarily translate into the true nature of that cancer,” said Matulonis.
How to prevent endometrial cancer
Because endometrial cancer growth is driven in part by the hormone estrogen, there are a few ways to lower your risk of the disease. The primary one, according to both Matulonis and Chuang, is to maintain a healthy weight and avoid obesity. Endometrial cancer is twice as common in overweight women than in normal weight women, while obese women have more than three times the risk of the disease, notes the American Cancer Society.
“The incidence of endometrial cancer has really been rising very quickly, and it’s because we’re all putting on weight,” said Chuang. Other reasons for the rise in endometrial cancer include rising life expectancy and use of the breast cancer drug Tamoxifen, which can increase a woman’s risk of endometrial cancer.
For the same reasons, women who try to treat the symptoms of menopause with estrogen therapy can also increase their risk. Endometrial cancer risk is also higher in women who have diabetes or a hormonal condition called polycystic ovary syndrome, both of which can cause hormone imbalances.
Other protective factors include long-term use of the birth control pill, IUDs and pregnancy, as they all introduce more progesterone into the body.
Women with endometrial cancer can save their own lives if they go to the doctor as soon as they experience any unusual vaginal bleeding. For postmenopausal women, this means painless, abnormal bleeding from the vagina at any time, as they’ve already stopped getting their monthly period. For premenopausal women, the first symptoms of endometrial cancer includes spotting in between periods.