Endometrial cancer is also known as uterine cancer. The cancer occurs in the innermost lining of the uterus. In addition, the uterus is a pear-shaped organ. It is hollow and lies inside the pelvic region. It is a part of the female reproductive organ where the fetus grows and nourishes.
The uterus has two parts. The upper part is the uterine cavity and the bottom part is the cervix. The cervix then continues into the vagina. The uterine cavity is where the endometrium layer forms a glandular, thick tissue layer rich in blood vessels to conceive the baby.
When the pregnancy does not occur, the endometrium layer then sheds. This phenomenon is what we call menstruation. When the cells of the endometrium layer inside the uterus develop the change (mutation) in its DNA (genetic material), they become cancerous. These cells start multiplying rapidly and form a tumor.
Endometrial or uterine cancer is one of the most common cancers that females develop. Endometrial cancer is one of the fatal diseases among women in African countries. With the rise in cancer cases in Africa, a lot of people are unable to receive the proper diagnosis and early treatment due to a lack of cancer awareness, inadequate diagnostic and screening facilities, and a shortage of specialized oncologists and medical staff. In addition to this, the cost of vaccination and treatment is high with the low capacity of the hospitals to take the patients.
Studies show that by the year 2030, there will be a 70% rise in cancer cases due to-
All the above reasons lead to high mortality rates and morbidity rates. The low and middle-income countries are slow growing in the healthcare sector. That is why, a lot of women from African countries like Kenya, Ghana, Tanzania, and Rwanda visit India every year for the correct diagnosis and treatment of uterine cancer.
Indian cancer hospitals have the most up-to-date treatment protocols and diagnostic tools for high-quality treatment at very cost-effective rates. India is the most affordable country to receive endometrial cancer treatment.
The hospitals in India have the most innovative and modern technologies for early diagnosis and treatments with high success rates. The oncologists in Indian cancer hospitals are experienced in handling complex cancer cases. They have been in medical practice for many years and acquired ample knowledge.
Endometrial cancer commonly known as uterine cancer is one of the common cancers that occurs in females. The uterine cancer begins when the DNA change (mutation) occurs in the healthy cell which makes the cells grow and multiply rapidly.
As these cells grow, they form a mass of cells known as a tumor. Now, this tumor can be cancerous or non-cancerous. If the tumor is non-cancerous, then it does not spread elsewhere in the body. It does not cause major health problems in the body. On the other hand, if the tumor is cancerous, it can spread to nearby organs and tissues to distant organs in the body through the bloodstream or the lymph nodes.
Following are the cancerous and non-cancerous conditions that can arise in the uterus. The non-cancerous conditions in the uterus include:
■ Fibroids: These are the tumors that grow in the uterus which are non-cancerous. They don't usually become cancerous. If it is not causing you pain, discomfort, bleeding, etc. then it is not necessary to remove them.
■ Uterine Polyps: These are the abnormal growth of cells that include the blood vessels, glands, stroma, etc. that project from the uterine lining which is known as endometrium and occupies the space in the uterine cavity. A woman can develop these non-cancerous tumors during the reproductive phase as well as during the post-menopausal phase.
■ Endometriosis: This is a disease in which the tissues that form the lining inside the uterus, start to grow outside of the uterus. This condition can develop when a woman starts getting her menstrual cycle and it can last until a woman gets her menopause. It can cause severe pelvic pain and it often interferes with the pregnancy.
■ Endometrial Hyperplasia (EH): It is a condition where the lining of the uterus (endometrial lining) becomes too thick. It is also known as Endometrial Intraepithelial Neoplasia (EIN) which is a precancerous condition where the uterine lining grows too much that it becomes thick. It contains the normal cells, glandular structures, and the abnormal cells. The EH generally is a precancerous condition that can develop into cancer when it contains complex glands and atypical cells.
When we talk about the types of cancer that can occur in the endometrial lining or the uterus, they are majorly of two types. There are different stages of these cancers depending upon how severe they are and whether they have spread to the surrounding tissues of any organs of the body. The two major types of uterine cancer along with their subtypes are listed below.
This is the uterine cancer that the majority of females develop. About 80% of uterine cancer is adenocarcinoma. It starts from the cells that line the uterus, commonly known as endometrium. It is also known as a type 1 uterine cancer. There are a few subtypes of this category which are mentioned below.
■ Serous Adenocarcinoma: It is a cancer that starts in the endometrial lining of the uterus and then spreads to the lymph nodes and other parts of the body.
■ Adenosquamous Carcinoma: It is a rare type of uterine cancer that develops in the outer layer of the uterus.
■ Uterine Carcinosarcoma: This type of cancer resembles the adenocarcinoma and sarcoma but there is a high chance of them spreading to the lymph nodes and other parts of the body.
This is a type of uterine cancer that starts from the supporting tissues of the uterus which is known as a myometrium. The myometrium is the muscle of the uterus. This is a rare type of uterine cancer, about 2 to 4 percent of people develop this type of cancer. It is also known as type 2 uterine cancer. There are a few subtypes of this category also, which are mentioned below.
■ Uterine Leiomyosarcoma: It is the most common type of sarcoma that occurs in the myometrium (muscular wall) of the uterus. About 2% of uterine cases are of this type.
■ Endometrial Stromal Sarcoma: This is a type of uterine cancer that develops in the connective tissues supporting the uterus and they usually grow slowly. It is a very rare type of uterine cancer. About less than 1% of uterine cancer cases are of this type.
■ Undifferentiated Sarcoma: It is a type of cancer that spreads rapidly (unlike endometrial stromal sarcoma) but only occurs in about less than 1 percent of uterine cancer cases. Like endometrial stromal sarcoma, it develops in the connective tissues of the uterus.
The exact cause of endometrial cancer is still unknown. However, due to a genetic mutation of the cells in the endometrium, the abnormal cell growth begins. These abnormal cells grow and multiply at a very fast rate. These cells also kill the healthy cells. When these abnormal cells accumulate, they form a thick mass of cells which is called a tumor. These cancer cells may or may not spread in the nearby tissues and organs. They can even spread to other distant organs in the body which is called metastasis (spread of cancer). Some risk factors that increase the chance of developing uterine cancer, are:
■ Specialists believe that uterine cells develop mutation when there are changes in the level of female reproductive hormones such as estrogen and progesterone. When reproductive hormones' level fluctuates, they directly affect the endometrial lining of the uterus. When the level of estrogen increases, it causes the endometrial cells to multiply and divide. When there is a mutation in these cells, it forms cancer and develops a tumor.
■ Another factor that leads to a genetic mutation in the endometrial cells is the family history or the heredity of uterine cancer. If your close relatives have a family history of endometrial or Lynch syndrome (colorectal cancer), then you are at risk of developing uterine cancer.
■ Women with obesity can also develop cancer of the uterus. What happens is that women who are overweight produce more estrogen which can cause the uterine wall to make the cells multiply rapidly. About 70% of uterine cancers have a direct link to obesity.
■ Females who have any of these types of cancer such as breast cancer, ovarian cancer, or colon cancer, have a chance to spread (metastasize) from that particular organ to the uterus, the lining of the uterus, or around the uterus.
■ Exposure to radiation or any other carcinogens can also increase the risk of developing cancer in the uterus. If you had a previous radiation treatment near the pelvic area then you have a high risk of developing cancer in the uterus or nearby organs.
■ A woman suffering from hormonal imbalance has a high risk of developing cancer in the uterus. The imbalanced hormones mess with the endometrial lining of the uterus, which makes the cells in the endometrium multiply and divide, these cells can develop mutations in their DNA and thus become cancerous.
■ Uterine cancer can often occur in women who are more than 45 or 50 years of age. It is common in women after 50 years of age whereas it is uncommon in women below 45.
■ Women who are suffering from type 2 diabetes and are obese, have a higher chance of uterine cancer. Obesity and diabetes are conditions that mess up the whole body, they also decrease our immunity which is very important for the body.
■ If you have some other medical conditions such as PCOS (polycystic ovarian syndrome), you will have higher estrogen levels in the body and the progesterone level will be low, this can interfere with the endometrial lining of the uterus and can result in the formation of cancer or tumor.
You must consult your gynecologist if you have any of the endometrial cancer symptoms mentioned above. The specialists who diagnose and treat the cancers of the female reproductive organs are known as gynecologic oncologists. They will then recommend the tests to examine the signs of the possible diseases. These diagnostic tests help diagnose the presence of the cancer, its current stage, type, and spread extent. They guide specialists to choose the best treatment procedure for you. Following are the diagnostic tests that your doctor recommends.
Medical history is important as it plays a major role in determining the cause of the medical condition you have. Your doctor may also ask you about your family history. If someone in your close family has a history of cancer or uterine cancer, then there are chances that you will also develop the cancer. Your doctor will also ask about your overall health, any present medical conditions, etc.
The pelvic exam is done to see any signs of lumps or other abnormalities in the pelvic area and the organs lie in the pelvic area. Your doctor may inspect your reproductive organs such as the vagina, vulva, cervix, uterus, etc. The doctor may examine the vagina of a patient to feel any abnormalities present there.
The blood test is an important test that helps your doctor to know whether you have an infection in the body. If there is any infection in the body, then the blood test will show it. If a woman has cancer of the uterine lining, then the blood will contain increased levels of some significant compound.
This is a test in which the cervical tissue sample is collected for laboratory testing. The Pap test helps to find the cancer cells and the cells in their pre-cancerous stage. The doctor may suggest some limitations for about 48 hours before the Pap test.
A small tissue sample is taken from the uterus with the help of a suction that is applied through a thin tube. This tissue sample. Then, the sample is sent to the laboratory for testing. A specialist known as a pathologist will examine this tissue under a microscope and check for the presence of any abnormal cells.
This is a procedure that is similar to the biopsy. In this procedure, the patient is given anesthesia for a painless procedure. The doctor inserts the thin flexible tube in the uterus through the vagina and cervix. Then, the doctor collects the tissue from the uterus and sends it to a lab for testing.
Imaging tests like transvaginal ultrasound use sound waves to create images of the uterus for checking the condition of the uterus. Another imaging technique is a CT Scan which uses X-rays to take pictures of the organ under examination from different angles. Your doctor will see this image to check for any abnormalities present in the uterus. An imaging test known as an MRI Scan uses the magnetic field to create images from different angles and merge the images to create a detailed image. Some of the similar tests known as PET scans are also used in the same manner.
This test is generally used to determine whether the tumor is cancerous or non-cancerous. Biomarkers are the molecules that are specific to the cells the doctor examines. In case of cancer cells biomarkers such as proteins, specific genes, and other factors are checked for. These materials are unique in the cancer cells and are not present in the normal and healthy cells. So we can easily differentiate between cancer cells and healthy cells.
The hysteroscope has an attached camera and lighting device that helps in visualizing the inside cavity of the uterus. This procedure helps collect a sample of the uterine lining to send it to the lab for further testing.
A multidisciplinary medical team provides the treatment of uterine cancer. It means a group of doctors work together to provide the treatment. The doctor who treats the cancer is known as an oncologist, and the doctor who treats the cancer of the reproductive organs is known as a gynecologic oncologist.
The type of treatment that is selected for your treatment depends on many factors like the stage and type of uterine cancer, the patient’s overall health, age, personal preferences, etc. Many times, cancer is treated with a combination of treatments for example, a lot of time chemotherapy is combined with radiotherapy or surgery. This is done to provide effective treatment if the cancer has spread and started affecting other tissues. The different types of treatments for uterine cancer are as follows:
Surgery is done when the cancer is localized. That means, it is present in one organ only and has not spread anywhere else in the body. The surgery is done to remove the tumor from the affected organ. Along with the tumor, some of the surrounding tissue is also removed which is called a margin to prevent the recurrence of the cancer from this site. There are different types of surgery depending upon how much portion is to be removed. The common surgical procedures that are used for removing the tumor from the uterus are as follows:
■ Hysterectomy: This is a procedure that involves removing the uterus (reproductive organs). The hysterectomy is of two major types depending upon the organ removed from the uterus. A simple hysterectomy involves the removal of the cervix along with the uterus whereas a radical hysterectomy involves the removal of the cervix, the upper portion of the vagina, and the nearby tissues along with the uterus. Sometimes the fallopian tubes and the ovaries are also removed along with the uterus. It is known as salpingo-oophorectomy hysterectomy.
■ Lymphadenectomy: This surgery is performed to remove the lymph nodes present near the tumors. This is to make sure that cancer does not spread through the lymph nodes to the other parts of the body. Sometimes, a similar procedure known as a lymph node biopsy is performed in which a dye is injected into the uterus which gets collected in the lymph nodes that contain cancer, these lymph nodes that take up the dye are then removed surgically.
The surgery is performed either laparoscopically /robotically which involves making a few tiny incisions in the abdomen. Laparoscopic surgery is also known as keyhole surgery. The open surgery involves making a large incision in the abdomen.
The doctor who performs this treatment is a specialist known as a radiation oncologist. This method of treatment involves using a high beam (high energy) of radiation (X-rays) and focusing it directly on the cancerous tissue to destroy and kill the cancer cells. This can be done internally or externally. The radiation therapy delivered internally is known as brachytherapy. It is performed by placing the applicators inside the uterus through the vagina and cervix. The radiation delivered externally is known as external-beam radiation therapy. It is performed by using the radiation machine outside the body and focusing the radiation on the pelvic area.
Sometimes the treatment is done through medication which can be given to the patient either orally, intravenously, or intramuscularly. There are many different types of drug therapies which are sometimes combined, and sometimes they are often used with other treatments like surgery and radiation therapy. The drug therapies such as chemotherapy and targeted therapy target the cancer cells and destroy them whereas the drug therapies like hormone therapy and immunotherapy work in different ways. The different types of drug therapy for uterine cancer are listed below.
■ Chemotherapy: Chemotherapy uses drugs/medicines that stop the cancer cells from growing and multiplying. Chemotherapy is often used after surgery to remove any remaining cancer cells in the body.
■ Hormone Therapy: This treatment is most commonly used to treat adenocarcinomas and grade 1 or 2 cancers. The main goal of hormone therapy is to reduce the estrogen hormone and increase the progesterone levels in the body. Hormone therapy is used in combination with radiation therapy and surgery.
■ Targeted Therapy: As the name suggests, targeted therapy involves the use of drugs that target the cancer cells to stop them from growing and multiplying, and then destroy them. These drugs target the specific compounds present in the cancer cells and are absent in the normal healthy cells. These compounds can either be the proteins, genes, or the other factors of the cancerous cells. These drugs identify the cancer cells and start the process of killing them.
■ Immunotherapy: This treatment helps make the patient’s immune system strong enough to fight against the cancer cells. The cancer cells hide from the immune cells by using the proteins known as checkpoints. This protein of the cancer cells stops the immune cells from attacking the cancer cells. Immunotherapy makes our immune system capable of finding these cancer cells and destroying them.
It is crucial to get regular checkups and screening in order to keep track of the health and any signs of recurrent cancer. Almost all cancer has a chance of recurring. However, if you maintain a healthy lifestyle and follow the guidelines provided by your doctor, you can minimize the cancer recurrence chances.
The cancer is most likely to reoccur within the first 2 years. Hence, must attend follow-up visits after the treatment ends. Your doctor will suggest follow-up appointments for the screening of cancer. For the first 2 years, you will be given appointments every 3 to 6 months and after that, you will be given appointments every 6 to 12 months.
During these appointments, physical exams, CT Scans, Pap tests, and X-rays are done to make sure you are cured. It is also important to take care of yourself by maintaining healthy lifestyle choices like regular exercise, a balanced diet, proper rest and sleep, and maintaining a healthy weight. Along with these, try to avoid alcohol and tobacco products as much as possible.
The total cost of endometrial uterine cancer treatment in India is influenced by many factors such as the chosen hospital and its infrastructure, selected treatment approach, diagnostic tests performed, medications, location of the hospital, surgeon’s fees, travel and stay cost, etc. However, on average, the endometrial or uterine treatment cost in India can range between 4,500 USD to 6,000 USD. The cost of endometrial cancer treatment in the USA, UK, and Australia can range between 5,000 to 15,000 USD, 16,500 to 25,500 USD, and 13,300 to 33,200 USD respectively.
For a better understanding, the costs of different treatments for womb cancer are listed below.
The cost of the complete treatment including the follow-up sessions is much lower in India as compared to many other countries. India has the most experienced gynecologic oncologists who provide the best possible treatment considering the patient’s health condition, stage and type of cancer, and minimum invasion. With the affordability of the treatments, the quality of the medical care remains supreme with modern infrastructure and facilities and highly cooperative medical staff.
Endometrial cancer is a condition that many women are suffering from due to the modernized lifestyle in most countries. The diagnosis and treatment procedures are easily available in high-income countries. However, low and middle-income countries lack proper diagnostic and therapeutic approaches for uterine cancer.
In addition to this, there is a shortage of medical experts who provide the correct diagnosis and treatment. It is very difficult for the patient to be mentally and emotionally strong once they are diagnosed with the advanced stage of cancer. Hence, an early diagnosis must be made so the treatment is possible and also when the cancer is in its early stage.
Seeking the correct diagnosis and high-quality treatment options at cost-effective prices many women from these countries visit India. It is because India is the only country where they can receive supreme quality treatment at a very affordable cost. In other countries, high-quality treatment can be received, but the cost is too high that they cannot afford it. Due to this, India has become a medical hub and a boon for international patients.
Yashoda Hospital (Somajiguda) 
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Dr. Kumardeep D Choudhary 
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Dr. Suvyl Fernandes Rodricks 
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Dr. Sanjeev Kumar Sharma 
Dr. Kapil Kumar 
Dr. Satya Prakash Yadav 
Dr. Prerna Lakhwani 
Dr. Rayaz Ahmed 
Dr. Gaurav Dixit 
Dr. Mukesh Patekar 
Dr. Biswajyoti Hazarika 
Dr. Pawan Kumar Singh 
Dr. Harish Verma 
