Gynaecological cancers are among the most common cancers affecting women.Endometrial Cancer (EC) is one among them and ranks fourth among gynaecological cancers in India. EC, a malignancy originating in the in the tissues of the endometrium -a muscular inner layer of uterus is a significant subset of these cancers. Most EC cases are endometrioid adenocarcinomas arising due to uncontrolled cell growth, division and death. Since, uterus is an important organ in the female reproductive system, endometrial cancer poses potential threat to other organs within the female reproductive system.

Endometrial cancer develops due to a failure of normal cell regulatory
mechanisms, due to hormonal imbalances particularly triggered by
excessive oestrogen exposure. It stimulates unregulated proliferation
of endometrial cells. Mutations in tumour suppressor genes such as
PTEN and TP53, along with changes in oncogenes, lead to unregulated
growth. The PTEN gene is critical for regulating cell proliferation,
frequently mutated in such cases. Furthermore, 2-5 per cent of EC
cases arise from genetically inherited mutations, such as those
associated with Lynch syndrome. Globally, 95 per cent of uterine
cancers are endometrial cancers, making this the predominant form of
uterine malignancy.

Chronic conditions like hypertension and diabetes, increase the risk. New
evidence suggests that obesity, during childhood and adulthood in
particular, contributes to excessive oestrogen production,
exacerbating the risk.

Epidemiology in India

According to the National Cancer Registry Programme, endometrial cancer
accounts for 1.5–2 per cent of all cancers among Indian women,
which is lower than the prevalence in Western countries. However,
India faces some unique challenges, including poor cancer awareness
and inadequate cancer screening facilities, leading to late-stage
diagnosis. The majority of reported cases are detected only in
metastasis stages, demanding the immediate attention for improved
awareness and healthcare infrastructure development.

Risk Factors

Endometrial cancer is associated with several modifiable and non-modifiable risk
factors. Prolonged exposure to oestrogen alone, due to hormone
replacement therapy (HRT) after menopause increases the risk.
Similarly, endometrial cancer may develop in breast cancer patients
who have been treated with tamoxifen. However, the combination of
oestrogen with progesterone mitigates this effect.

Reproductive history plays a significant role in influencing the lifetime exposure
of a woman to endogenous (naturally occurring) oestrogen. Never
having given birth (Nulliparity), the onset of menstruation before
the usual age (early menarche) and late menopause contribute to
prolonged exposure to endogenous oestrogen, associated with a higher
risk of developing endometrial cancer.

In addition, reproductive factors such as infertility due to anovulation
or other reasons, may also contribute to prolonged oestrogen
exposure. Conditions like polycystic ovary syndrome (PCOS) further
increase this risk by disrupting regular ovulatory cycles.

Excess body fat (adipose tissue) contributes to heightened oestrogen
production and insulin resistance. Fat tissue is metabolically active
and converts androgens produced in the adrenal glands into oestrogen.
Higher oestrogen levels with insufficient levels of progesterone to
counteract the effects of oestrogen promote uncontrolled endometrial
proliferation, which increases the likelihood of mutations and
unregulated growths.

Families with multiple cases of endometrial or colorectal cancer may have
inherited genetic predispositions or environmental factors within
families linked to EC.

Women with Lynch syndrome have a 40-60 per cent lifetime risk of developing
endometrial cancer. Lynch syndrome is an inherited genetic condition
caused by mutations in the DNA.

Advancing age significantly amplifies the risk for endometrial cancer, as the
likelihood of developing cancer increases with age.

Symptoms

The symptoms of endometrial cancer are often non-specific, especially in
early stages. However, some common signs are:

1. Abnormal vaginal
   bleeding or discharge unrelated to menstruation.

2. Postmenopausal
   bleeding.

3. Pelvic pain.

4. Painful urination.

5. Discomfort during
   sexual intercourse.

Diagnosis

• Transvaginal
  Ultrasound is used to assess endometrial thickness.

• Endometrial Biopsy
  helps to test tissue samples and analysed it for malignancy.

• Hysteroscopy
  examine the uterine lining.

• Imaging Tests such
  as MRI, CT or PET scans help to diagnose and evaluate metastasis.

Treatment

Once the diagnosis is complete, patients often prefer allopathic
treatments. Some of them are;

1. Abdominal
   hysterectomy: The total removal of the uterus- together with removal
   of the fallopian tubes and ovaries on both sides, called a bilateral
   salpingo-oophorectomy.

2. Radiation Therapy:
   Employed to target residual cancer cells post-surgery or for
   advanced cases.

3. Chemotherapy:
   Typically used in cases of high-grade or metastatic EC.

4. Hormonal Therapy:
   Suitable for hormone-sensitive cancers, particularly in younger
   patients desiring fertility preservation.

5. Targeted Therapy:
   Focuses on specific molecular targets within cancer cells.

Limitations

The survival rate and recurrence are the significant limitations in
conventional cancer treatment. Early detection of endometrial cancer
provides a 5-year survival rate of over 90 per cent cases but
survival prospects are reduced in ‘advanced stages’ of EC. Many
women are diagnosed with EC at advanced stage in India, which
considerably reduces the overall survival rate.

Similarly, recurrence rate is also an undeniable concern in allopathic medicine
with metastatic cancers having the highest likelihood of recurrence.
To reduce recurrence and manage complexities associated with EC,
doctors recommend the total removal of uterus and fallopian tubes
based on the extent of metastasis. Despite these, they cannot
guarantee future protection from the disease.

Homoeopathic Remedy

Homoeopathy does not advise removing internal organs at any stages of EC because
homoeopathic remedies initially curtail the spread of diseased cells
whereby protect the affected parts by regenerating new healthy
tissues. As a result, organs in the reproductive system become fully
functional as the course of treatment advances. The central principle
of homoeopathy is to stimulate the natural healing processes of human
body by enhancing immunity system and helping the regeneration of
healthy tissues. Once the immunity boosting done through homoeopathic
remedies, it begins to identify harmful invading cells and recuperate
the deadly cells with new one.

Homoeopathic remedies fix the underlying imbalances in the body that
causes to the spread of cancerous cells in endometrium. It helps
regulating the proliferation of malignant cells by restoring
equilibrium to the immune system. When tumour suppressor genes become
inactive due to mutation these remedies influence epigenetic
mechanisms that allows gene expression. It also regulate uncontrolled
oestrogen exposure that directly caused to endometrial cancer
development.