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Uterine Cancer
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Uterine cancer - endometrial cancer

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WOMEN'S HEALTH

Cancer

Uterine (endometrial cancer) is one of the most common cancers in women. The uterus is made up of different tissue types that can give rise to different kinds of uterine cancer.

Endometrial cancer begins in the lining of the uterus (endometrium). The uterus is a hollow, pear-shaped organ where a baby develops during pregnancy. Endometrial cancer most often occurs after the reproductive years, in women between the ages of 50 and 70.

Endometrial cancer is often detected at an early stage because it frequently produces vaginal bleeding between periods or after menopause. If discovered early, this slow- growing form of cancer is likely to be confined to the uterus. Removing the uterus surgically often eliminates the cancer. In fact, early-stage endometrial cancer is successfully treated more than 80 percent of the time. However, the death rate from endometrial cancer has increased over the past 10 years. Researchers aren't sure why.

Signs and symptoms

Endometrial cancer often develops over a period of years. Your first clue that something is wrong may be vaginal bleeding that's uncommon for you.

Most cases of endometrial cancer develop in postmenopausal women whose periods have stopped. However, about 20 percent of cases affect younger women. Signs and symptoms may include:

  • Heavy periods or bleeding between periods

  • Vaginal bleeding or spotting during perimenopause (the time just before menopause) or after menopause

  • A pink, watery or white discharge from your vagina

  • Pelvic pain, especially late in the disease

  • Pain during intercourse

  • Weight loss

Some endometrial cancers may reach an advanced stage before signs and symptoms are present. But this is rare.

Causes

Healthy cells grow and divide in an elegant and orderly way to keep your body functioning normally. But sometimes this growth gets out of control — cells continue dividing even when new cells aren't needed.

In endometrial cancer, cancer cells develop in the lining of the uterus. Why these cancer cells develop isn't entirely known. However, scientists believe that the levels of estrogen in a woman's body play a role in the development of endometrial cancer. Factors that can increase the levels of this hormone and other risk factors for the disease have been identified and continue to emerge. In addition, ongoing research is devoted to studying changes in certain genes that may cause the cells in the endometrium to become cancerous.

Risk factors

The female reproductive system consists of two ovaries, two fallopian tubes and a uterus. The ovaries produce two main female hormones — estrogen and progesterone. The balance between these two hormones changes each month, helping the endometrium thicken in case pregnancy occurs or shed tissue if it doesn't.

When the balance of these two hormones shifts toward more estrogen — which stimulates growth of the endometrium — a woman's risk of developing endometrial cancer increases. Factors that increase levels of estrogen in the body include:

  • Many years of menstruation. If you started menstruating at an early age — before age 12 — and continue to have monthly periods into your 50s, you're at greater risk of endometrial cancer than a woman who menstruated for fewer years. The more years you have a monthly period, the more exposure your endometrium has had to estrogen.

  • Never having been pregnant. The body produces more progesterone during a pregnancy, helping protect you from endometrial cancer by lowering levels of estrogen. If you've never been pregnant, you don't get the benefit of this protection.

  • Irregular ovulation. Ovulation, the monthly release of an egg from an ovary in menstruating women, is regulated by estrogen. Irregular ovulation or failure to ovulate can increase your lifetime exposure to estrogen. Ovulation irregularities have many causes, including obesity and a condition known as polycystic ovary syndrome (PCOS). This is a condition in which hormonal imbalances prevent ovulation and menstruation. Treating obesity and PCOS can help restore your monthly ovulation and menstruation cycle, decreasing your risk of endometrial cancer.

  • Obesity. Ovaries aren't the only source of estrogen. Fat tissue can change some hormones into estrogen. Being obese — defined roughly as being 30 pounds or more overweight — can increase levels of estrogen in your body, putting you at risk of endometrial cancer and other cancers. A high-fat diet also can add to your risk by promoting obesity. Some scientists even think that fatty foods may directly affect estrogen metabolism, further increasing a woman's risk of endometrial cancer.

  • Diabetes. This is a risk factor for endometrial cancer mainly because obesity and type 2 diabetes (formerly called adult-onset or noninsulin-dependent diabetes) often go hand in hand. However, some data suggest that women who have diabetes, whether they're obese or not, are at greater risk of endometrial cancer.

  • Estrogen replacement therapy (ERT). Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of endometrial cancer. However, taking synthetic progestin, a form of the hormone progesterone, with estrogen — combination hormone replacement therapy — causes the lining of the uterus to shed and actually lowers your risk.

  • Ovarian tumors. Some tumors of the ovaries may themselves be a source of estrogen, increasing estrogen levels.

Other factors that can increase your risk of endometrial cancer include:

  • Age. Most endometrial cancers develop over many years. Therefore, the older you are, the greater your risk. Endometrial cancer most often occurs in women between the ages of 50 and 70.

  • Family history of endometrial cancer. Endometrial cancer can run in some families, especially those who have an inherited risk of certain types of colon cancer. If colon cancer and endometrial cancer run in your family, you may have an inherited risk of these cancers.

  • Personal history of breast cancer or ovarian cancer. Some of the same risk factors for breast cancer and ovarian cancer also increase your risk of endometrial cancer.

  • Prior pelvic radiation treatment. Radiation of the pelvic region to treat ovarian cancer or another cancer can damage cells, sometimes increasing the risk of developing a second cancer such as endometrial cancer.

  • Tamoxifen treatment. Endometrial cancer has been found in two out of every 1,000 breast cancer patients who have been treated with the hormonal drug tamoxifen. The drug acts like an estrogen, causing the uterine lining to grow. If you're being treated with this hormone, see your doctor for an annual pelvic examination and be sure to report any unusual vaginal bleeding.

  • Hereditary nonpolyposis colorectal cancer (HNPCC). This inherited disease is rare and results in colon cancer at a young age. The cause is an abnormality in a gene important for DNA repair. Women with HNPCC are at high risk of uterine cancer.

Having risk factors for endometrial cancer doesn't mean you'll get the disease. It means that you're at risk and should be alert to possible signs and symptoms of the disease. Conversely, some women who develop endometrial cancer — and often a more aggressive form — appear to have no risk factors for the disease.

 

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