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Medical statistics show that the highest number of cases is observed in women between 50 and 70 years of age. Women who have been taking oestrogens not in balance with progestogens for a long time belong to the higher risk group. Women who started menstruating early and those who entered menopause late, used hormone therapy for many years and did not give birth to children, are also at risk.
If endometrial cancer occurs in young women, it is usually associated with irregular or absent periods. Scientists explain this by increasing the amount of androgens – hormones that cause masculinization, i.e. facial hair, lowering the voice and increasing muscle mass. As a result of continuous anovulation, estrogen hyperstimulates the endometrium without the compensatory effect of progesterone, which is produced by the woman’s body after ovulation.
Excessive estrogen secretion and, consequently, a greater risk of developing endometrial cancer also applies to women with liver failure. Liver failure interferes with the conversion of estrogens. Overproduction of estrogen also affects obese women, as fat cells themselves raise the levels of these hormones in the body. In women who are 10-25 kg or more overweight, the risk of developing the disease is 10 times higher than in lean women. The risk of cancer is also greater in women suffering from high blood pressure and diabetes. Experts believe it’s probably because women with these conditions tend to be overweight. Another group of women at risk of developing the disease are those who have had breast or ovarian cancer.
Visible symptoms
The most common symptom of a developing cancer is bleeding or spotting in postmenopausal women. But any irregularities in menstruation – bleeding or spotting between periods should prompt the woman to visit her gynecologist to see if it is a sign of a developing cancer.
Another sign of endnometrial cancer may be a watery vaginal discharge. There is no pain in the first stage of the disease. It usually occurs when a tumor has closed the cervical opening and blood and pus are collected in the pelvis. Pain also accompanies metastases to other organs, such as the bladder or rectum.
Recognition of the enemy
The suspicion of endometrial cancer occurs in every postmenopausal woman who bleeds from the vagina or is in the pre-menopausal period and belongs to the group of increased risk, i.e. is obese. The doctor performs a gynecological examination, determines the size of the uterus and excludes other causes of abnormal bleeding. The basic test that confirms or excludes the suspicion of endometrial cancer is cytology. The material for the study is taken from the cervix. If the cytology does not give a definite answer, an endometrial biopsy is usually performed. Taking a fragment of the mucosa does not require anesthesia and can be performed in a gynecological office. If the woman is bleeding and the biopsy has not found the cause, curettage may be performed.
If the tests show the presence of cancer cells or the doctor determines that the cancer is advanced, it is necessary to see a gynecologist-oncologist so that he can choose the best treatment.
How is it treated?
When the stage of the cancer has been determined, surgery is required to remove the uterus and appendages – the ovaries and fallopian tubes. After assessing the risk of relapse, the doctor decides whether radiotherapy will be necessary. In patients with stage I cancer, the use of radiotherapy depends on the size of the tumor and the infiltration of the uterine muscle wall. If the disease is not advanced (Grade IA), radiation is not required.
In stage II endometrial cancer after surgery, radiation is usually used to reduce the risk of metastases to the lymph nodes.
When the cancer is stage III after hysterectomy, it is recommended to irradiate the tissues surrounding the uterus and the areas at risk of tumor cell transmission.
At stage IV, or when the disease has relapsed after previous irradiation, the woman must undergo hormone therapy or chemotherapy. Hormone therapy is based on taking a progestogen. In 3 out of 10 cases such therapy has the effect of inhibiting the division of cancer cells in the mucosa.
Can you prevent
So far, no screening method has been developed to help detect this cancer. Pap tests can be unreliable in endometrial cancer. Medical data show that in 4 out of 5 cases, despite obtaining the correct test result, there are cancerous cells in the mucosa.
The only thing recommended for women who are concerned about developing endometrial cancer is to avoid risk factors, such as: Maintaining a healthy body weight, although obesity alone has never been proven to be a decisive factor in the development of endometrial cancer.
Ladies who take estrogens for various reasons should know and remember about the need to supplement their therapy with progestins.
Text: Anna Jarosz