Sudden vaginal bleeding 'endometrial cancer' 4.7 times increase in obesity and elderly pregnancy, etc
Aug 20, 2024
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According to national cancer registration statistics, endometrial cancer occurred in 3.1 cases per 100,000 women in 1999, but increased by about 4.7 times to 14.6 in 2021.
Professor Park Joon-sik of obstetrics and gynecology at Soonchunhyang University Bucheon Hospital said "Endometrial cancer is caused by excessive exposure to the female hormone estrogen. Recently, endometrial cancer is increasing as the obese population increases due to westernized eating habits, low birth rates, and excessive exposure to estrogen due to aging pregnancy", he explained.
Endometrial cancer includes type 1 endometrial cancer, which is caused by excessive stimulation of estrogen, and type 2 endometrial cancer, which is less associated with estrogen. Type 1 accounts for the majority of endometrial cancers, usually arising from atypical endometriosis, is diagnosed early and has a relatively good prognosis. On the other hand, type 2 occurs in the atrophic endometrium and progresses quickly and has a poor prognosis.
Endometrial cancer is mostly caused by genetic variation that occurs during the proliferation of the endometrium. Major risk factors include estrogen replacement therapy, obesity, long ovulation cycle, and estrogen-secreting tumors. About 5% of all endometrial cancers are caused by genetic mutations and are characterized by developing before age 50.
The main symptom of endometrial cancer is vaginal bleeding, but it is also found at examination without symptoms. Postmenopausal women may suffer from vaginal bleeding, and premenopausal women may suffer from excessive menstruation or irregular bleeding outside the menstrual period.
In women with suspected endometrial cancer symptoms, the risk of endometrial cancer should be assessed by listening to a detailed medical history. If the endometrium is thicker than the normal range, it is suspected, and all suspected patients can be confirmed by endometrial biopsy and biopsy after endometrial scraping. Recently, as a screening test for genetic predisposition in endometrial cancer patients, additional tests are recommended to identify 'DNA mismatch repair (MMR)' that can occur during DNA replication and recombination in tumors.
Professor Park Jun-sik said "It is important to diagnose and treat early because if the disease progresses without treatment, vaginal bleeding may worsen and complications may occur due to invasion of organs around the pelvis."
Endometrial cancer is treated differently depending on the stage. The first and second stages of endometrial cancer involve only the uterus or cervix, and adjuvant radiotherapy is performed according to the risk factors for hysterectomy and postoperative recurrence. Radiation therapy may be performed in advance when a patient is difficult to treat surgically due to underlying diseases such as old age, obesity, diabetes, and high blood pressure. In addition, ectomy, bilateral ovarian ovarian resection, pelvic and aortic lymphadenectomy, pelvic and abdominal washing cell tests can be performed for staging.
For patients with endometrial cancer stage 3 and stage 4, the first treatment is to perform maximum tumor reduction such as electronic arthroplasty, bilateral tubular-ovascular resection, and pelvic and aortic lymphadenectomy. However, chemotherapy or radiation therapy is recommended if the imaging test makes it difficult to operate. Recently, chemotherapy including immune checkpoint inhibitors has improved in the initial treatment of advanced and recurrent endometrial cancer patients, and chemotherapy with immune checkpoint inhibitors is recommended as an initial treatment.
Professor Park Jun-sik said "The incidence of endometrial cancer in Korea is expected to continue to increase in the future. Since endometrial cancer is a disease that can be completely cured 100% at the time of initial diagnosis, if there are symptoms of vaginal bleeding, excessive menstruation, or irregular bleeding in postmenopausal women as well as regular obstetric checkups once a year, don't overlook it, and be sure to get an accurate diagnosis and appropriate treatment early on."
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