What are the symptoms of endometrial cancer and how is it treated? Be careful about "abnormal bleeding" before and after menopause
Ask the Experts
Convener of the Women’s Cancer Prevention and Treatment Committee of the Taiwan Obstetrics and Gynecology Association
Dr. Hong Yaoqin, Vice President of Women’s Medical Center, Ajou University Hospital
What is endometrial cancer? What factors are related to it?
The endometrium is the lining of the uterine cavity and is where the fertilized egg implants during pregnancy. Endometrial cancer occurs when the endometrium thickens abnormally, develops cancer cells, and produces tumors and hard lumps. Early-stage endometrial cancer is limited to the uterine cavity. As the tumor progresses, it may invade the muscle layer, cervix, ovaries, fallopian tubes and surrounding lymph glands, spread outside the uterus and even metastasize to distant places.
Endometrial cancer is most common in those over 60 years of age, and risk factors include obesity, diabetes, hypertension, and polycystic ovaries. Excessive hormonal stimulation of pure estrogen (without progesterone) can also increase the risk of endometrial cancer. Women with irregular menstruation, early menstruation, late menopause (over 52 years old), and those who have never had children are more likely to develop endometrial cancer.
In addition, taking Tamoxifen for breast cancer may increase the risk of endometrial cancer by 2-9 times. Women with a family history of breast cancer and colorectal cancer should also pay attention to their own genetic risks.
What are the common symptoms of endometrial cancer? Should I pay attention to abnormal bleeding?
One of the common symptoms of endometrial cancer before menopause is abnormal bleeding, including irregular menstruation, excessive bleeding, and prolonged menstruation. If bleeding recurs more than one year after menopause, you should pay close attention to endometrial lesions, such as the growth of fibroids, polyps, or severe inflammation in the endometrium. Endometrial cancer also accounts for a large proportion of postmenopausal bleeding. Be sure to Consult a gynecologist promptly and perform ultrasound and internal examination or endometrial biopsy sampling to confirm whether it is benign or malignant.
It is now recommended that women undergo Pap smears every 1 to 3 years, and may be evaluated by a gynecologist whether to undergo ultrasound examination of the uterine lining at the same time. In addition, women are reminded to develop the habit of recording their menstrual cycles to understand whether they often have menstrual periods lasting more than 8 days, menstrual blood volume exceeding 80cc, whether menstrual periods are irregular or take too long, and if they have related symptoms, they should seek medical attention as soon as possible to avoid delayed diagnosis.
How is endometrial cancer treated? Must I have a hysterectomy?
Endometrial cancer has different treatments depending on the patient’s age and fertility needs, but surgery is still the first choice. The scope of resection includes simple hysterectomy (including cervix), both ovaries and fallopian tubes. Patients with deeper invasion and larger tumors require (extensive) hysterectomy and removal of pelvic and para-aortic lymph nodes. When cancer cells invade deeply and spread outside the uterus, hysterectomy must be followed by electrotherapy or chemotherapy to reduce the recurrence rate.
If the endometrial cancer is in the early stage (stage 1) and the cancer cells are well differentiated and have not invaded the muscle layer (or are very superficial), hysteroscopic surgery can be used to remove the cancer while considering preserving fertility. Cells, combined with a large amount of progesterone treatment, there will be a chance to preserve the uterus after 3-6 months of evaluation. However, progesterone treatment must be continued for more than 1-2 years after surgery.
In recent years, for advanced endometrial cancer, genetic screening can be performed to confirm whether corresponding target drugs (such as Lenvatinib) are available, and combined with Anti PD-L1 immunotherapy drugs, it can improve the 5-year survival rate and prolong disease-free survival.
Is the chance of recurrence of endometrial cancer high? How to reduce recurrence?
The recurrence rate of endometrial cancer in stages 1-2 is about 5%-20%; for endometrial cancer in stages 3-4, the recurrence rate will increase to 30%-50%. According to statistics, the 5-year survival rate of stage 1 endometrial cancer is between 86% and 95%. Therefore, the earlier it is detected, the recurrence rate is lower, and there is a chance that radiotherapy and chemotherapy will be unnecessary, which helps to improve the prognosis.
The correct way to reduce recurrence after treatment can be divided into two levels. The first is “self-health adjustment”. It is recommended to go to bed early and get up early, maintain a normal work and rest, maintain adequate immunity, absorb enough vitamins and other nutrients, and do not take hormonal drugs indiscriminately. Proper exercise and walking every day can also help reduce recurrence. If you have problems such as high blood pressure, diabetes, obesity, etc., you should adjust and improve them as soon as possible.
Second, “regular follow-up visits”, including internal pelvic examination, smears, and ultrasound examinations every 3 to 6 months after surgery, to track whether there are abnormal increases in CEA and CA125 tumor indicators, and to monitor liver and kidney function and other values. Also pay attention to whether there are recurrence symptoms in the body, such as loss of appetite, weight loss, pain, shortness of breath or vaginal bleeding, which may be signs of recurrence or metastasis of endometrial cancer.
Is endometrial cancer the leading cause of gynecological cancer? What methods can help with prevention or early detection?
In the past 5-10 years, endometrial cancer has become the number one major malignant cancer among gynecological cancers. There are approximately 2,500-3,000 new cases every year. The standard incidence rate is 15-16 per 100,000 people, resulting in 260 to 280 women every year. die. With the westernization of living habits, diet, and poor exercise habits, the incidence of endometrial cancer is increasing year by year, even surpassing cervical cancer and ovarian cancer, becoming the gynecological cancer with the largest number of new cases.
Although endometrial cancer is more likely to occur around the age of 60, there are still many young cases diagnosed in their 30s. These patients often have heavy menstrual flow, irregular menstruation, or prolonged menstruation as the main symptoms. After ultrasound examination, , Endometrial cancer was found after scraping and tissue testing of endometrial tissue. Therefore, young women should not take it lightly.
To prevent endometrial cancer, you should pay attention to whether you have genetic inheritance. If you have breast cancer, endometrial cancer, colorectal cancer, or ovarian cancer in your family, you may belong to a high-risk group. Or if you have breast cancer and take Tamoxifen, it may also increase the risk of endometrial hyperplasia or cancer.
In addition, reducing risk factors is also very important to prevent endometrial cancer. Obesity, hypertension, and diabetes should receive appropriate treatment. Women who have not yet given birth should pay attention to the fact that the ovaries are not properly rested and overworked, which may lead to an increased risk of endometrial cancer. When taking hormones, you should be careful not to supplement estrogen alone. You can use drugs combined with progesterone. Taking combined oral contraceptives may reduce the risk of endometrial cancer. Diets high in calories and fat should be avoided. People with polycystic ovary syndrome are advised to lose weight as early as possible.
Among them, obesity not only increases the risk of endometrial cancer by 3 to 10 times, but is also related to diabetes, hypertension, menstrual disorders, and polycystic ovary syndrome. It is recommended that women should maintain a healthy weight to reduce related lesions and avoid the risk of endometrial cancer.
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