Endometrial Cancer
Endometrial Cancer — part of gynaecology and women’s health at Dr. Najeeb Layyous's clinic in Amman.
In short: Endometrial cancer is one of the most curable cancers in women, because its symptoms appear early and most cases are diagnosed at the first stage. The main symptom is abnormal bleeding, especially after the menopause. Risk factors are obesity, diabetes, high blood pressure, no children, polycystic ovaries and taking oestrogen without progesterone. It is diagnosed by vaginal ultrasound and biopsy.
It is one of the most curable gynecological cancers because it usually causes abnormal bleeding early in its course, which leads to early detection and treatment with good outcomes.
Risk factors:
- Obesity
- Diabetes
- Hypertension
- Nulliparity
- Early menarche
- Late menopause
- Polycystic ovary syndrome
- Estrogen supplementation without progesterone
- Family history, especially Lynch syndrome (hereditary colon and endometrial cancer syndrome)
- Use of tamoxifen (a breast cancer medicine)
Symptoms:
- Abnormal vaginal bleeding
- Heavy cycles
- Irregular cycles
- Intermenstrual bleeding
- Postmenopausal bleeding
- Pelvic pain
- Pain during sex
Diagnosis:
- Thickened endometrium on transvaginal ultrasound
- Endometrial biopsy (outpatient pipelle sampling or hysteroscopy with directed biopsy), which is the only way to confirm the diagnosis; any postmenopausal bleeding needs assessment even if the lining looks thin
- Using MRI imaging to determine disease stage
Stages of the disease:
Stage one: confined to uterus
Stage two: reaches cervix
Stage three: spreads outside uterus but confined to pelvis
Stage four: spreading to bowel, bladder or distant organs
Today, the stage is combined with the tumour type and molecular tests on the tissue (POLE, mismatch-repair/MMR and p53 status), which help predict how the cancer will behave and whether extra treatment is needed. All women with endometrial cancer should be tested for mismatch-repair deficiency, which can also point to Lynch syndrome in the family.
Most cases are found at stage one, which is why it is one of the most curable gynecological cancers.
Treatment depends on:
- Fertility desires
- Stage of disease
Treatment options:
- Surgery: removal of the uterus, cervix, both tubes and ovaries (total hysterectomy with bilateral salpingo-oophorectomy), usually by laparoscopy, often with sentinel lymph node biopsy
- Radiation therapy
- Hormonal therapy (high-dose progestogens, often a levonorgestrel IUD) for fertility preservation, only in selected young women with early, low-grade disease limited to the lining of the uterus, with repeated biopsies and hysterectomy once childbearing is complete
- Chemotherapy in advanced or recurrent stages, now often combined with immunotherapy (such as dostarlimab or pembrolizumab), especially when the tumour is mismatch-repair deficient
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
We’re grateful for dealing with such a physician — he’s very caring and deals with each case separately. We would’ve loved to spend more time with him, however he was never in a hurry during our given time.