Why does it occur
The most common type of endometrial cancer is associated with the long-term influence of estrogen on the uterine lining without the counterbalance of progesterone. The endometrium grows, goes through the stages of hyperplasia, then atypical hyperplasia, and eventually a tumor develops.
From here the whole logic of risk factors becomes clear: everything that creates an excess of estrogen or lack of ovulation increases the likelihood of disease. And it follows from this that timely treatment of endometrial hyperplasia prevents the development of cancer.
- Obesity is a leading factor; adipose tissue converts androgens to estrogens
- Diabetes mellitus type 2
- Arterial hypertension
- PCOS and chronic lack of ovulation
- Taking estrogen without progesterone
- Taking tamoxifen
- Late onset of menopause and early onset of menstruation
- Absence of childbirth
- Age after 50 years
- Lynch syndrome is a hereditary predisposition; with it the disease occurs earlier
- Endometrial hyperplasia with a history of atypia
Symptoms
- Bleeding or spotting after menopause is the main and earliest sign
- Heavy, prolonged or irregular periods in women before menopause
- Bleeding between periods
- Watery or bloody discharge
- Pain in the lower abdomen - usually in later stages
- Abdominal enlargement
- Weight loss, weakness with a common process
- In the early stage, there are usually no other symptoms other than bleeding
It is important to understand the balance of probabilities: most bleeding during menopause is not caused by cancer, but by mucosal atrophy or polyp. But this can only be determined by examination, and that is why such a symptom requires a visit to the doctor without delay.
Diagnostics
- Transvaginal ultrasound measuring endometrial thickness is the first step in case of bleeding
- Pipelle endometrial biopsy - outpatient tissue sampling without anesthesia
- Hysteroscopy with targeted biopsy is the most accurate method
- Diagnostic curettage of the uterine cavity with histology
- Histological examination is the only way to confirm the diagnosis
- Determination of tumor type and degree of differentiation
- MRI of the pelvis - assessment of the depth of invasion into the uterine wall
- CT scan of the abdomen and chest
- Tumor marker CA-125 for suspected widespread process
- Molecular genetic research of the tumor - influences the choice of treatment
- Screening for Lynch syndrome at an early age and a family history
Treatment
- Surgical treatment - basis: removal of the uterus with appendages
- Laparoscopic access in early stages - less trauma, faster recovery
- Lymph node removal or sentinel node biopsy to determine stage
- Radiation therapy, including brachytherapy, for certain stages and risk factors
- Chemotherapy for advanced disease and aggressive tumor types
- Hormonal therapy - for certain types of tumors and for widespread processes
- Organ-sparing hormonal treatment is an exceptional option for young women with early, well-differentiated tumors who wish to preserve fertility; carried out according to strict indications with repeated biopsies
- Observation after treatment according to the established schedule
Prevention
- Maintaining normal body weight is the most important measure
- Compensation for diabetes mellitus
- Regular physical activity
- Ensuring regular endometrial shedding in the absence of ovulation - with PCOS and irregular cycles
- Taking a progestogen component when using estrogens
- Timely treatment of endometrial hyperplasia
- Monitoring while taking tamoxifen
- Combined hormonal contraceptives and intrauterine hormonal system reduce the risk
- Testing for any menopausal bleeding
- Genetic counseling for suspected Lynch syndrome
Where to get examined in Tashkent
An ultrasound with evaluation of the endometrium, the ability to perform a pipel biopsy or hysteroscopy with a biopsy, and a histological laboratory are required.
In Tashkent, such an examination is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic; Once the diagnosis is confirmed, treatment is determined together with gynecological oncologists.
The main thing to remember is that bleeding after menopause, even once and scantly, is a reason to see a doctor this week. It is thanks to this symptom that endometrial cancer is most often detected early and successfully treated. Clinic contacts are below.
