Endometrial cancer is a frequently occurring malignancy among women who have reached menopause.

Can we say that cervical cancer incidence is decreasing while endometrial cancer incidence is increasing?

Recent data suggests that the incidence of cervical cancer has decreased due to the widespread use of the HPV vaccine. However, it is believed that cases of endometrial cancer are on the rise due to changes in diet and other factors. Under the “Hihy” program, experts from Hanyang University Medical Center answer questions about endometrial cancer and what symptoms may indicate that it may be occurring.

What is endometrial cancer?

Endometrial cancer is a condition where cancerous cells develop within the tissues of the uterine endometrium. There are two types of endometrial cancer: Type 1 and Type 2.

Type 1 of endometrial cancer is by one of the female hormones, estrogen, which causes abnormal overgrowth of endometrial tissue. This type of cancer includes adenocarcinoma, is the most common form of endometrial cancer, usually diagnosed in relatively young women. Patients with this type of cancer often have a more favorable prognosis.

Type 2 of endometrial cancer is not associated with estrogen exposure and usually has a lower degree of differentiation. This type of cancer usually occurs in postmenopausal women, has a less favorable prognosis, and is often associated to papillary serous adenocarcinoma.

What factors contribute to the development of endometrial cancer?

The most common cause of endometrial cancer is exposure to estrogen. The risk is especially increased with prolonged exposure to estrogen, such as in the case of polycystic ovary syndrome (PCOS) or long-term use of estrogen-only hormonal medications.

In addition, prolonged exposure to estrogen in the body, such as lack of pregnancy or late menopause, also increases the likelihood of developing endometrial cancer.

It’s important to note the risk of endometrial cancer is ten times higher if the body weight is more than 22 kilograms overweight, and about three times higher if a woman has diabetes. Furthermore, the risk of developing endometrial cancer is also 20 times higher with a genetic condition such as Lynch syndrome.

What symptoms indicate the possible occurrence of endometrial cancer?

The most common symptom is vaginal bleeding. Approximately 90% of patients with endometrial cancer have vaginal bleeding. However, in premenopausal women, can be difficult to detect because it resembles monthly menstrual bleeding.

Symptoms other than menstrual bleeding, such as vaginal bleeding, prolonged vaginal bleeding, or heavy discharge during your period, may indicate other medical issues. However, the possibility of endometrial cancer should also be considered. Other symptoms include increased discharge and pelvic pressure. It’s worth noting that around 5% of endometrial cancer cases can occur without any noticeable symptoms at all.

How is endometrial cancer treated?

The treatment of endometrial cancer typically involves surgical interventions. The surgery usually includes standard surgical procedures for cancer, such as hysterectomy (removal of the uterus), bilateral oophorectomy (removal of both ovaries and fallopian tubes), pelvic and aortic lymphadenectomy, and cytologic examination of the abdomen and pelvic cavity for further evaluation. Depending on the stage of cancer, maximal tumor resection may also be necessary to remove as many cancer cells as possible.

However, in low-risk endometrial cancer (defined as endometrial cancer of low malignancy limited to the endometrial layer or with shallow penetration into the myometrium that is less than 1/2 the thickness), removal of pelvic or aortic lymph nodes during surgery is not thought to affect overall recurrence rates or survival and therefore may not be performed.

Patients at low risk of endometrial cancer who strongly desire pregnancy may be prescribed progesterone-based hormone therapy without hysterectomy. This treatment is not standardized and should be discussed with a medical professional.

Following successful surgery, additional treatment such as radiation therapy, hormone therapy, or chemotherapy may be required depending on how far the disease has spread. Depending on the results of genetic testing, immunotherapy may also be considered.

Are there methods to prevent endometrial cancer?

Unfortunately, there are no known preventive methods for endometrial cancer similar to cervical cancer screening methods. However, it is possible to reduce the risk of this disease through lifestyle changes. If you are overweight or diabetic, it is essential to actively treat these conditions. If you are on hormone therapy with estrogen alone, it is recommended to switch to combination therapy with progesterone instead of estrogen alone.

If you are taking tamoxifen for breast cancer, you should have regular ultrasound scans to monitor changes in the endometrium. If you have been diagnosed with polycystic ovarian syndrome and have not ovulated for a long time, oral contraceptives may help prevent endometrial cancer.

Hanyang University Medical Centre

Professor of Obstetrics and Gynecology: Dr. Lee Won Moo

Field of medicine: Cervical Cancer, Ovarian Cancer, Endometrial Cancer, Uterine Sarcoma, Gestational Trophoblastic Disease, Uterine Fibroids, Uterine Adenomyosis, Endometriosis, Benign Ovarian Diseases, Laparoscopic Surgery, Robotic Surgery, Hysteroscopic Surgery.