Endometrial cancer is the most common pelvic cancer, affecting 14 out of every 10,000 women yearly. Most women with this cancer are over 50 and past menopause; 10 percent are still menstruating. Your risk of uterine cancer is increased if you are heavy for your size, take synthetic estrogen without a progestogen, or have diabetes, high blood pressure, or a hormone imbalance that combines high estrogen levels with infrequent ovulation.
During the early 1970s, there was a sharp rise in the incidence of uterine cancer because of estrogens prescribed for menopausal women without any additional progestogen (progestin or progesterone) to reduce the chances of endometrial hyperplasia. Taking progestogens usually prevents the development of this condition in women taking estrogen.
Bleeding (including light staining) after menopause is the most common symptom of uterine cancer. However, most women who bleed do not have cancer. For women who are still menstruating, increased menstrual flow and bleeding between periods may be the only symptoms.
Unfortunately, the Pap test, while effective at detecting cervical cancer, is not reliable for detecting uterine cancer. If you have the above symptoms, your medical practitioner will probably recommend an aspiration or endometrial biopsy to sample the uterine lining—this is a simple office procedure. In some cases, a dilation and curettage (D&C) is preferred (performed with intravenous sedation or general anesthesia). Make sure that you have discussed the risks and benefits of these alternatives before making a decision.
Prevention and Self-Help
Because endometrial cancer appears to be influenced by factors such as obesity, hypertension, and diabetes, controlling these conditions with medications and self-help methods may prevent this type of cancer from developing. Exercise and a healthy diet with plenty of fruits and vegetables is the best strategy.
Medical Treatments for Uterine Cancer
When uterine cancer is found early, the success rate of conventional treatments is very high. Medical treatment for uterine cancer includes surgery, radiation, and chemotherapy. There is wide disagreement about which is best. Outside the United States, radiation is used frequently with good results.
Surgical treatment for uterine cancer is most commonly a hysterectomy. Follow-up radiation after surgery is possible if the tumor was large, if it is found or suspected to have spread to the lymph nodes, or if cellular changes suggest a fast-growing tumor. Hysterectomy can often be done laparoscopically (for more information, see Hysterectomy.) If the cancer comes back after one of these treatments, progestogen treatment may help slow it down.
In the past, many surgeons routinely removed women’s healthy ovaries when performing a hysterectomy, in order to prevent ovarian cancer from developing in the future. However, new research indicates that removal of healthy ovaries has adverse long-term health consequences for women and ovarian conservation should be encouraged. For more information, see Hysterectomy and Ovarian Conservation.