Updates in Gynaecology

Edited by Dr Roman

REDUCE YOUR RISKS FOR UTERINE CANCER (OR ENDOMETRIAL CANCER)

by Jose Roman

Uterine cancer (or endometrial cancer) is the cancer of the uterine body (“inside of the uterus” or lining) and NOT to be confused with the cancer of the cervix:

Endometrium = lining of the uterus

 

Endometrial cancer (or Uterine) cancer is the most common gynaecological cancer in women. Every year there are 315 new cases of endometrial cancer in New Zealand 

Age is a risk factor. Uterine cancer occurs in women over 50 and the average age at diagnosis is 60. There is however some evidence that endometrial cancer is increasing in younger women in New Zealand (less than 45).

Early warning signs of uterine cancer: Abnormal vaginal bleeding, especially after the menopause- Pelvic pain- Unusual vaginal discharge- Pain during sexual intercourse- unexplained weight loss

The period of higher risk to develop cancer of the uterus is after your periods have stopped (menopause). It does not matter if there is a heavy bleeding or just blood spotting. It is not normal to bleed after the menopause. You should communicate it to your GP. 

Cancer of the uterus is very different to cancer of the cervix. So, a normal smear provides no reassurance at all that you do not have cancer of the lining of the uterus (uterine cancer). Cervical screening does not screen for uterine cancer.

Obese and overweight women are 2-4 times as likely as normal-weight women to develop uterine or endometrial cancer. An easy way to have an idea of your weight is to calculate your Body Mass Index or BMI

 

BMI = weight ( Kg)/ (height)2

For example your weight is 100 Kg and your height is 172 cm

Then your BMI is 100/1722: 33.8 

So, in this case you should reduce your weight to reduce your risk of uterine cancer

 

BMI categories:

Underweight = <18.5
Normal weight = 18.5–24.9 
Overweight = 25–29.9 
Obesity = BMI of 30 or greater 

 

  • Contraception like the combined pill and the Progestin-secreting intrauterine device may reduce your risk. 
  • Never having been pregnant will increase your risk.
  • Late menopause will increase your risk. Your risk will increase the later the age your periods stop. 
  • A personal history of Polycystic Ovarian syndrome does increase the risk for endometrial or uterine cancer so if you notice any abnormality with your periods do notify to your GP.
  • Diabetes may also increase the risk of uterine cancer so adequate supervision from your GP is advisable
  • If you decide to take Hormone replacement therapy during menopause you should take Oestrogen PLUS progesterone as Oestrogen by itself would increase the risk of cancer
  • Your risk will increase If you need to take TAMOXIFEN which is a drug used for breast cancer. However, the benefits of Tamoxifen may outweigh the risks in your case, but you should discuss this issue with your doctor and design a plan of supervision.
  • Your risk will increase if a member of your family had uterine cancer or colorectal cancer. There is a genetic condition called “Lynch syndrome” that runs in some families and that will increase your risks of bowel, uterine and ovarian cancer at an earlier age. About 4-5% women with uterine cancer will have Lynch syndrome. So, know your family history.
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