Endometrial cancer

The most common female reproductive cancer is endometrial cancer - a cancer of the lining of the uterus. The disease has both genetic and environmental risk factors and kills thousands of women a year in the U.S. The cancer appears to be caused, at least in part, by increased estrogen exposure in the uterus, and the environmental risk factors for this cancer tend to revolve around this hormonal balance.

Endometrial cancer progression and diagnosis

The cancer starts in the uterus (stage 1), the spreads to the cervix (stage 2), the surrounding pelvic area and/or lymph nodes (stage 3), and then to the abdomen and bladder (stage 4). Hysterectomy (removal of the uterus) is usually pursued during stage 1 to prevent spread of the cancer. According to PubMed Health, surgeons generally go in through the abdomen in order to biopsy surrounding tissue and confirm complete removal and lack of spread. Radiation therapy is often used to ensure the cancer doesn't return, and chemotherapy is used in later stages.

Survival and treatment

Survival when diagnosed in stage 1 is very good, with more than 90% of patients surviving beyond 5 years. However, 5-year survival for cancer that has spread is less than 25%. Regular pelvic screenings and Pap smears can help diagnose the cancer early! The effects of estrogen therapy on your risk should also be discussed with your doctor, who will likely suggest regular screenings to monitor your cancer risk.

Are you at risk for endometrial cancer?

Endometrial cancer is the most common female reproductive cancer, affecting more than 42,000 women and being attributed to more than 7,700 deaths in 2009 according to the National Cancer Institute. Endometrial cancer affects the uterus, beginning from cells in the endometrium, the interior uterine lining. Most endometrial tumors are adenocarcinomas.

This specific type of cancer is thought to be caused by increased estrogen exposure in the uterus.

Endometrial hyperplasia

Women who are diagnosed with uterine cancer tend to have had endometrial hyperplasia. Hyperplasia is an increase in the number of cells, in this case the cells lining the uterine wall. Endometrial hyperplasia occurs most often in women over the age of 40. If hyperplasia is caught early, the physician may recommend hysterectomy to eliminate the risk of cancer, in addition to hormone treatment with progesterone as it has shown to be protective in the uterus against the effects of estrogen.

The symptoms of endometrial hyperplasia include various forms of abnormal vaginal bleeding (heavy menstrual bleeding, bleeding between periods, and menstrual bleeding after menopause).

Genetic risk factors for endometrial cancer

A genetic component exists for most cancers because of how neoplastic changes occur within cells. Women with a personal history of female reproductive cancer, such as breast and ovarian, are at a higher risk of endometrial cancer. Also, women with a family history of inherited colorectal cancers are at an increased risk for this cancer.

In addition, race plays a role in the risk of uterine cancer. Though Caucasian women are more likely to get this cancer compared to African American women, African-American women tend to have higher mortality rates associated with endometrial cancer compared to Caucasian women, 7.3 deaths per 100,000 cases vs. 3.8 deaths per 100,000 cases.

Environmental and lifestyle risk factors for endometrial cancer

Women who undergo estrogen replacement therapy tend to have a higher risk of this cancer. Combined estrogen-progesterone therapy does not appear increase the risk because of progesterone’s effect on the uterus.

Tamoxifen treatment also appears to increase the risk of disease. Usually used to prevent breast cancer, tamoxifen has estrogen-like effects on the uterus that have to be monitored to avoid trading one female reproductive cancer for another.

Obesity, hyperlipidemia (increased lipid levels in the blood), a high-fat diet, and diabetes are also considered to contribute to increased estrogen levels via production in the fat tissue, thus increasing the risk of endometrial cancer.

Other risk factors for uterine cancer

Age is an important risk factor for this cancer. Three-quarters of diagnosed women are post-menopausal, with most patients between the ages of 50 and 59 years. Only roughly 5% of endometrial cancer cases occur before the age of 40. Women who began menstruating before the age of 12, have never been pregnant, and who have irregular ovulation patterns also tend to have a higher rate of uterine cancer, potentially due to the associated estrogen fluctuations and exposure.