Editorial
Endometrial Cancer
S. Chhabra*
Department of Obstetrics Gynecology, Mahatma Gandhi Institute of Medical Sciences, India
Akanksha Shishugruha, Kasturba Health Society, Sevagram, India
Dr. Sushila Nayar Hospital, Utavali, Melghat, Amravati, India
*Corresponding author: S Chhabra, Department of Obstetrics Gynecology, Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India
Published: 02 Jan, 2018
Cite this article as: Chhabra S, Endometrial Cancer. Clin
Oncol. 2018; 3: 1389.
Editorial
Endometrial Cancer (EC) is fourth most common cancer. It contributes to 6% of cancers in
women and one of the most frequently diagnosed gynecologic cancers. EC have been divided
into two types, because of differences in risk factors, presentation, histopathology and behavior.
Type I Adeno carcinoma, most common variety associated with Endometrial Hyperplasia (EH),
unopposed estrogenic stimulation without adequate opposition by progestin and Type II, serous
carcinoma, clear cell carcinoma, anaplastic carcinoma in atrophic endometrium in older women,
high risk histologic types. Over the years researchers have recognized many risk factors for EC.
They include elderly age, nulliparity, infertility, early menarche, late menopause: obesity, diabetes,
hypertension, Insulin resistance, dyslipidaemia, Polycystic Ovary Syndrome (PCOS), unopposed
estrogen therapy, animal origin nutrients, families with hereditary non polyposis of colon cancer and
so on. Long-term Tamoxifen therapy in breast cancer is another risk factor. However observations
linking blood pressure, glucose metabolism, and insulin resistance to EC have come mostly from
retrospective studies and planned research is needed. Earlier obesity and insulin resistance were not
fully recognized as potential risk factors for EC. Now DM has been found to be a risk factor for Type
I EC, however the association was not found in Type II EC. Further about endometrial hyperplasia
neither all EH are precancerous, nor associated with EC, so division has been made for appropriate
diagnosis and management.
A typical EH is precursor for most endometrioid type adenocarcinomas. It should be considered
and ruled out in all the cases of heavy, prolonged, frequent, or irregular uterine bleeding in women
of any age, especially older than 30 years. The high cancer risk conferred by an endometrial
intraepithelial neoplasma (EIN), must be carefully considered in deciding upon appropriate
therapy. Oral use of progestins, such as megestrol acetate and medroxyprogesterone acetate are
the most commonly used methods. The most notable studies are about the treatment of EH using
levonorgestrel-releasing intrauterine system. Total hysterectomy is curative for AEH / EIN and
provides a definitive standard for assessment of a concurrent carcinoma. Birth control pills, plant
origin nutrients, dietary fiber, retinol, β-carotene, vitamin C, E, may decrease the risk. In PCOS cases
there seems to be impact of metformin on EC outcomes, recurrence or overall survival. Weight loss
and exercise, the most effective steps, women could take to prevent developing metabolic syndrome,
which has linkage could reduce EC also. Although certain factors increase risk for development of
EC, they do not always cause the disease. Many women with one or more risk factors never develop
EC others with EC do not have any known risk factors. Even if there is one or more risk factor, there
is no way to know which, if any, of factors was responsible.
At present, various methods used for diagnosing and staging the EC include- cervical/vaginal
cytology, endometrial cytology, endometrial biopsy, transvaginal ultrasonography histopathology,
immune histochemistry magnetic resonance imaging, hysteroscopy, and dilatation and curettage.
Total hysterectomy with adnexectomy and bilateral pelvic lymphadenectomy, and total
lymphadenocolpo hysterectomy with bilateral adnexectomy. Despite potential for either synchronous
or metachronous ovarian cancer, several researchers report safety of ovarian preservation during
hysterectomy in young women with EC. In advanced cases adjuvant radio chemotherapy have
definite place. Hormone therapy depends upon immune histochemistry for hormone receptors.
While medical as well as surgical extra uterine spread is poor prognostic factor in EC, conservative
management in young women is possible when EC is limited to endometrium. Despite a long
history of disease and great efforts in research, there is no practical and accurate system to know
true precancerous lesions. So there is a limitation to prevention of EC. Screening is controversial.
Diagnosis is possible only after curettage and histopathology. Therapy is varied. Researchers have
recommended gynaecological examination, transvaginal ultrasound,
aspiration biopsy from 30 to 35 years in mutation carriers. As per the
consensus among experts, periodic health examination, screening for
EC by any tool are not recommended because there is no scientific
evidence to support benefit of such examinations in menopausal
and postmenopausal women who have no identified risk factors.
EC, common genital tract cancer is surrounded by controversies in
screening and therapy. Prognosis is good even beyond early disease. A
lot of more research is needed about prevention, various associations
and best therapy.