Endometrial Cancer
Risk: Endometrial cancer is the most common gynecologic malignancy and the fourth most common malignancy affecting women worldwide, behind only breast, colon, and lung cancer. Fortunately, the majority of women with endometrial cancer are diagnosed with early stage disease where the cancer is confined to the uterus. As a result, the majority of women with endometrial cancer can be expected to be cured with appropriate therapy. It is important to note that although 75% of endometrial cancers occur in women who are post-menopausal, 25% of cases occur in pre-menopausal patients. There are several risks identified through rigorous epidemiologic studies that are associated with the development of endometrial cancer in any age group. These risks include the use of unopposed estrogens, obesity, nulliparity, hypertension, diabetes, menopause after age 52, use of tamoxifen, and the development of complex atypical hyperplasia of the endometrium (a premalignant condition).
Diagnosis: As noted above women with endometrial cancer usually present early in the course of their disease. The majority of women, both pre and post menopausal, present to their physician with complaints of abnormal vaginal bleeding or discharge. 15% of all post menopausal patients with bleeding will ultimately be found to have endometrial carcinoma, while 80-90% of endometrial carcinoma patients will have noted an abnormal discharge prior to being diagnosed. Invariably, patients with carcinoma will have had some diagnostic procedure such as an endometrial biopsy or dilation and curettage (D&C) performed as a result of their bleeding. If endometrial cancer is present, these procedures will detect the carcinoma in approximately 95% of cases. The remainder of the cases are discovered incidentally during hysterectomy or workup of some other medical condition.
Treatment: Endometrial cancer is a surgically staged disease. Therefore, unless comorbid medical conditions preclude surgery or special conditions such as preservation of fertility is desired, all patients with endometrial cancer should undergo exploratory surgery and full hysterectomy. The vast majority of patients with endometrial cancer have their ovaries removed as well during the surgery as continued ovarian production of estrogens is thought affect outcome. This surgery is usually performed as an open procedure, however in select cases, a laparoscopic approach may be employed. During the surgery a full exploration is undertaken to not only diagnose the extent of tumor spread, but also to remove as much, if not all, visible tumor. This exploration may or may not include removal of pelvic and para-aortic lymphatic tissue, dependent upon risk factors for lymphatic spread determined during the surgical procedure. For most patients, surgical treatment is all that is necessary. However, if after pathologic review of the cancer, sufficient risk exists for recurrence of the cancer in spite of the surgery, patients may undergo pelvic or vaginal radiation therapy in order to decrease the risk of recurrence. For patients with advanced stage cancers (cancers with spread outside of the uterus), various chemotherapy or hormonal therapies have been employed in attempt to control the disease and provide for a prolonged and acceptable quality of life.
Prevention: Not surprisingly, the most effective way to prevent the development of endometrial cancer is to modify one’s risks. Maintaining a healthy lifestyle by maintaining ideal body weight, controlling hypertension and diabetes, monitoring diet and avoiding high fat intake, having chilDr.en, breastfeeding, and avoiding unopposed estrogens are the principle mechanisms by which risk may be modified. The use of oral contraceptives and tobacco use are also associated with a decrease in the risk of endometrial cancer, however tobacco use can not be supported in any setting. For more information on endometrial cancer, please visit the National Cancer Institute website.