Endometrial Cancer Treatment: Questions and Nutritional Support - Obstetrics and Gynecology

Dr. Zhang Tingzhang reply Obstetrics and Gynecology

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Dear devoted daughter: After reading your letter, I can feel your concern for your mother.
Due to uterine fibroids, she underwent laparoscopic hysterectomy, and subsequently, it was discovered that she has endometrial cancer.
This is a consultation we sometimes receive in our gynecologic oncology department.
Through Taiwan's e-learning platform, I can provide a more detailed response regarding this situation.
Endometrial cancer, also known as uterine corpus cancer, has shown an increasing trend in incidence according to the cancer registration report from the National Health Bureau of the Department of Health.
In 2003, there were 733 newly diagnosed cases compared to 682 cases in 2002 and 606 cases in 2001, indicating a yearly rise in the occurrence of endometrial cancer, similar to breast cancer.
The median age for diagnosis of endometrial cancer is 52 years, while for breast cancer, it is 49 years.
The rising incidence of these two cancers is likely related to the increasing population of middle-aged and elderly women in our country, as well as lifestyle westernization and declining birth rates.
Research has identified several risk factors for endometrial cancer, including an increase in body mass index (BMI) (obesity).
Women with obesity (BMI over 30) are approximately five times more likely to develop endometrial cancer compared to women with a BMI between 20 and 22.9 (normal range).
However, obesity during youth does not increase the risk of developing endometrial cancer later in life; rather, weight gain after the age of 20 (increased BMI) does raise the risk.
This is due to adipose tissue converting related hormones into estrogen, and obese individuals have lower levels of sex hormone-binding globulin, resulting in higher relative biological activity of estrogen.
Additionally, obese individuals are more likely to have: (1) polycystic ovary syndrome; (2) low physical activity; and (3) higher intake of saturated fatty acids.
European studies estimate that 26%-47% of endometrial cancer cases are attributable to being overweight.
Furthermore, women who experience menopause later and those who have an earlier onset of menstruation are at a higher risk for endometrial cancer.
Early menarche and delayed menopause extend the duration of a woman's menstrual years, thereby increasing the likelihood of developing endometrial cancer.
Women who begin menstruating before age 12 have a 60% higher incidence of endometrial cancer compared to those who start after age 12.
Women who experience menopause after age 52 have a 2.4 times greater risk than those who undergo menopause before age 49.
The average age of menopause in endometrial cancer patients is over six years later than in normal women.
Nulliparous women are also at a higher risk for endometrial cancer; those who have never given birth have double the risk compared to those who have had one child, and three times the risk compared to those who have had five or more children.
Endometrial cancer patients are three times more likely to experience menstrual irregularities and heavy bleeding compared to normal women.
These symptoms are often due to the ovaries not ovulating properly, leading to insufficient production of progesterone.
The lack of progesterone protection in the endometrium can result in hyperplastic changes, which may eventually lead to cancer.
Conditions such as polycystic ovary syndrome and functional ovarian tumors can cause prolonged estrogen stimulation of the endometrium.
For postmenopausal women, solely supplementing estrogen increases the risk of endometrial cancer by 4 to 8 times, with risk increasing with dosage and duration of use; however, adding progesterone can reduce this risk.
Women with significant anovulatory cycles before menopause also face an increased risk of endometrial cancer.
Members of families with hereditary nonpolyposis colorectal cancer, as well as women with a family history of endometrial, breast, colorectal, and ovarian cancers, have a significantly higher chance of developing endometrial cancer.
Preventive measures for endometrial cancer include regular exercise; women who engage in regular physical activity have a 38% lower risk of developing endometrial cancer compared to those who do not exercise.
Women who self-report exercising 90 minutes daily have a lower risk than those who exercise less than 30 minutes a day.
Additionally, this may be related to differences in weight.
Childbearing and breastfeeding can also reduce the risk of endometrial cancer, with women who have breastfed after age 30 or within the last 30 years having about a 50% lower risk.
For those not planning to become pregnant, considering the use of oral contraceptives containing progesterone can reduce risk by 10% for each year of use, and by 80% after 10 years; however, the benefits and drawbacks of contraceptives should also be taken into account.
Symptoms of endometrial cancer are not always clear, and some early cases present with menstrual irregularities, particularly prolonged bleeding (lasting more than a week) that does not respond well to medication.
During pelvic ultrasound examinations, a thickened endometrium may sometimes be observed.
In addition to surgery, radiation therapy is frequently used in the treatment of endometrial cancer, especially for patients at risk of local recurrence, as it can reduce the chances of local recurrence.
Side effects are generally mild, including slight abdominal pain and diarrhea.
Regular follow-up after treatment is necessary, which may include pelvic examinations, serum CA-125 markers, and X-ray assessments to monitor the disease status.

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Reply Date: 2006/11/14