Endometrial Cancer: Symptoms, Causes, Diagnosis, and PET-CT

Endometrial cancer is one of the most common gynecological cancers, particularly affecting postmenopausal women. It originates in the inner lining of the uterus, called the endometrium, and is usually detected early due to abnormal vaginal bleeding—a common symptom. The prognosis is often favorable with timely diagnosis and treatment.

Diagnostic tools like PET-CT scans play an essential role in detecting endometrial cancer, staging the disease, evaluating treatment response, and monitoring for recurrence. This article explains the symptoms, causes, types, and how PET-CT scanning contributes to comprehensive care for endometrial cancer.

What is Endometrial Cancer?

• Endometrial cancer refers to the abnormal and uncontrolled growth of cells in the endometrium, the inner lining of the uterus.
• It is most commonly found in women over the age of 50, particularly after menopause.
• Early detection significantly improves the chances of successful treatment.
• Surgery, radiation, hormone therapy, and chemotherapy are commonly used treatments depending on the stage.

What are the Symptoms of Endometrial Cancer?

• Abnormal vaginal bleeding, especially after menopause
• Bleeding between menstrual periods
• Pelvic pain or discomfort
• Pain during sexual intercourse
• Watery or blood-tinged vaginal discharge
• Unexplained weight loss
• Fatigue or general weakness

What Causes Endometrial Cancer?

• Hormonal Imbalance: Excess estrogen unopposed by progesterone increases the risk.
• Age: Most cases occur in women aged 50 and older.
• Obesity: Increases estrogen levels in the body.
• Diabetes: Elevated insulin and glucose levels may contribute to risk.
• Hormone Replacement Therapy (HRT): Especially estrogen-only therapies.
• Early Menstruation or Late Menopause: Prolonged exposure to estrogen.
• Family History: Genetic predisposition, particularly Lynch syndrome.
• Never Having Been Pregnant: Fewer hormonal changes may increase risk.
• Tamoxifen Use: A breast cancer medication that may affect the uterus.

What are the Types of Endometrial Cancer?

Endometrioid Adenocarcinoma

• Most common type
• Often associated with estrogen imbalance
• Typically detected early and responds well to treatment

Serous Carcinoma

• More aggressive, not hormone-related
• Less common but has a higher risk of spreading

Clear Cell Carcinoma

• Rare and aggressive form
• May require intensive treatment

Undifferentiated or Dedifferentiated Carcinoma

• Poorly differentiated cells
• Typically have a poorer prognosis

How is Endometrial Cancer Diagnosed?

• Pelvic Examination: Physical check of uterus and ovaries.
• Transvaginal Ultrasound: Evaluates the thickness and texture of the endometrial lining.
• Endometrial Biopsy: Gold standard test to confirm presence of cancerous cells.
• Hysteroscopy: Direct visualization of the uterine lining using a small camera.
• Dilation and Curettage (D&C): Surgical procedure for more thorough tissue sampling.
• PET-CT Scan: Detects cancer spread and metabolic activity in suspicious areas.
• MRI or CT Scan: Provides detailed anatomical images and assists in staging.

Role of PET-CT Scan in Endometrial Cancer

A PET-CT scan is one of the most advanced imaging tools in modern oncology. It combines functional imaging (via PET) with anatomical imaging (via CT), giving detailed information about both the size and metabolic activity of a tumor.

Uses of PET-CT in Endometrial Cancer:

• Detects metabolic activity of primary and metastatic tumors
• Assists in accurate staging of the disease
• Evaluates lymph node involvement
• Helps in treatment planning (surgery, radiotherapy, chemotherapy)
• Monitors treatment response and residual disease
• Identifies recurrence of cancer early
• Aids in choosing optimal biopsy sites
• Reduces the need for unnecessary exploratory procedures

Stages of Endometrial Cancer

• Stage I: Confined to the uterus
• Stage II: Spread to cervix
• Stage III: Invasion of pelvic area (vagina, ovaries, lymph nodes)
• Stage IV: Spread beyond pelvis (bladder, rectum, distant organs)

PET-CT is highly useful in assessing stages III and IV, where metastasis must be clearly understood for targeted treatment.

Treatment Options for Endometrial Cancer

• Surgery: Total hysterectomy with or without removal of ovaries and fallopian tubes
• Radiation Therapy: External beam radiation or brachytherapy
• Chemotherapy: Used in advanced or recurrent cases
• Hormone Therapy: For hormone-receptor-positive tumors
• Targeted Therapy or Immunotherapy: In select advanced cases

Treatment depends on stage, type, tumor grade, age, and overall health of the patient.

Conclusion

Endometrial cancer is a common and often treatable gynecological cancer when detected early. Symptoms like postmenopausal bleeding should never be ignored. Risk factors such as obesity, hormonal imbalance, and family history play a major role. Diagnosis involves a combination of pelvic exams, biopsies, and advanced imaging techniques.