Endometrial Cancer

ENDOMETRIAL CANCER

• Cancer of the uterine endometrial lining

• Most common female reproductive
cancer
– 40,000 new cases/year
– 7,000 deaths/year
• Most of these malignancies are
adenocarcinoma
 Incidence and Prevalence
• Most common gynecologic cancer
• 4th most common in women (US)
• 2nd most common in women (UK)
• 5th most common in women (worldwide)
• Western developed > Southeast Asia
• Increase in the 1970’s
– Increased use of menopausal estrogen therapy
 RISK FACTORS FOR
ENDOMETRIAL CANCER
• Early menarche
(<age 12)
• Late menopause
(>age 52)
• Infertility or nulliparous
• Obesity
• Treatment with tamoxifen
for breast cancer
• Estrogen replacement
therapy (ERT) after
menopause
• Diet high in animal fat
• Diabetes
• Age greater than 40
• Caucasian women
• Family history of
endometrial cancer or
hereditary nonpolyposis
colon cancer (HNPCC)
• Personal history of breast
or ovarian cancer
• Prior radiation therapy for
pelvic cancer
 Endometrial Carcinoma
Etiology
• Unnoposed estrogen
hypothesis: exposure to
unopposed estrogens
Pathology
• Spreads through uterus,
fallopian tubes, ovaries
and out into peritoneal
cavity
– Metastasizes via blood and
lymphatic system
 SYMPTOMS OF
ENDOMETRIAL CANCER
• Symptoms
– Non-menstrual bleeding or discharge
• Especially post-menopausal bleeding
– Heavy bleeding
– Dysuria
– Pain during intercourse
– Pain and/or mass in pelvic area
– Weight loss
– Back pain
 ENDOMETRIAL CANCER

• Diagnosis • Treatment
– Pelvic examination – Surgery
– Pap smear (detect cancer • Hysterectomy
spread to cervix)
• Salpingo-oophorectomy
– Endometrial biopsy
• Pelvic lymph node
– Dilation and curettage dissection
– Transvaginal ultrasound • Laparoscopic lymph node
sampling
– Radiation therapy
– Chemotherapy
– Hormone therapy
• Progesterone
• Tamoxifen
 Prevention and Survival
• Early detection is best prevention
• Treating precancerous hyperplasia
– Hormones (progestin)
– D&C
– Hysterectomy
– 10 ~ 30% untreated develop into cancer
• Average 5 year survival
– Stage I => 72 ~ 90%
– Stage II=> 56 ~ 60%
– Stage III => 32 ~ 40%
– Stage IV => 5 ~ 11%
 Potentially modifiable risk factors

Dietary factors
Isoflavones:
Phytoestrogens that
have properties
similar to selective
estrogen receptor
modulators

Soy, beans, chick peas…

 Dietary fiber
Increases estrogen
excretion and
decreases estrogen
reuptake: whole
grains, vegetables,
fruits, and seaweeds
 Summary points
• Endometrial cancer is one of the leading
gynecological cancers in the US
• Obesity is one of the key factors involved
in Endometrial cancer development
• More research is needed to explore
modifiable risk factors in endometrial
cancer development