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Endometrial Cancer: The Most Common Reproductive Cancer in Women
Yevgeniya Ioffe, M.D., Clinical Fellow, and Israel Zighelboim, M.D, Assistant Professor, are both in the Division of Gynecologic Oncology, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO.
The most common form of cancer of the female reproductive tract in the United States is endometrial carcinoma – cancer of the lining of the uterus, or endometrium. Endometrial cancer accounts for over 95% of uterine cancers, which themselves represented approximately 6% of all cancers diagnosed among U.S. women in 2010. It is estimated that 46,470 women will be diagnosed with uterine cancer and that 8,120 will die of this disease in 2011. The median age at which women are diagnosed with endometrial cancer is 63.(1)(2)
Traditionally, women with endometrial cancers have been divided into two groups, depending on the form of cancer they have. Type I tumors are estrogen-dependent, meaning their growth is stimulated by estrogen, like some breast cancers. Usually women with Type I tumors are younger and have a better prognosis. Type II tumors account for 10-20% of all spontaneously occurring endometrial cancers (those without a family history). The prognosis for Type II tumors, unfortunately, tends to be poor.(3)
In this article, we will discuss the risk factors, symptoms, diagnosis, and treatment options for endometrial cancer. We will also go over syndromes that are associated with a higher risk of endometrial cancer, like Lynch syndrome and Cowden syndrome, which also increase one’s risk of other forms of cancer, including breast, ovarian, thyroid, and intestinal. As doctors learn more and more about the genetics and behavior of endometrial cancer, they are better equipped to determine one’s risk of endometrial cancer, diagnose it earlier, and develop more effective means of treatment.
The risk factors for Type I endometrial cancer include obesity, diabetes, high blood pressure, taking medications like Tamoxifen (a breast cancer medication), estrogen replacement therapy without progesterone, chronic anovulation (lack of periods), never being pregnant, late menopause, and genetics.
Patients with Type II endometrial carcinomas are usually older when they are diagnosed and they typically haven’t had estrogen replacement therapy. The risk factors for Type II tumors are not as well defined as those of Type I endometrial carcinomas. The fact that Type II tumors are less common makes this cancer type more challenging for doctors to study and characterize. Several studies have reported that Type II cases are more likely to occur in older, normal weight women, and those who have been pregnant multiple times or African American women.(4)(5)
The Symptoms of Endometrial Cancer
A case history illustrates the risk factors and the symptoms associated with endometrial cancer:
A 45-year-old female who had been pregnant twice and given birth to one child came to her primary care physician complaining of worsening and excessive bleeding for the last six months. Five years earlier she had had her tubes tied in order to prevent further pregnancies. In the last ten years, the patient had gained weight, her BMI increasing from 29 to 37 (normal is 18.5–24.9), and she developed type II diabetes and high blood pressure.
Upon reviewing her family history, her doctor learns that the patient had family members with cancer: her brother was diagnosed with colon cancer at the age of 47, and her mother was diagnosed with colon cancer at the age of 44. In addition, the patient’s sister and maternal aunt were diagnosed with ovarian and endometrial cancer at the ages of 55 and 38, respectively.
After a thorough evaluation by an Ob/Gyn, the patient was found to have an enlarged uterus, a large fibroid, fluid in the endometrial cavity, and a growth in the lining of the uterus that was about an inch thick. An in-office biopsy revealed that it was indeed endometrial cancer.
One of the most common symptoms of endometrial cancer is abnormal vaginal bleeding, especially bleeding between periods or after menopause. Very long, heavy episodes of bleeding, abdominal or pelvic pain, and clear or white vaginal discharge after menopause are also regular symptoms. However, there can be other causes of any or all of these symptoms, so it is important to see your doctor if you experience any of them. As the case study above suggests, there can be a family or genetic predisposition for endometrial cancer if certain syndromes (like Lynch and Cowden) are present. These syndromes increase risk for a variety of cancers, and are discussed in detail later.