January 2019 www.womanthismonth.com 26 showcase DR MURAT WOMEN’S CLINIC UTERUS CANCER: Regular Screening and Prevention Endometrial cancer is a type of uterine cancer that involves the lining of the uterus (the endometrium). There are two types of endometrial cancer, which are classified by their relationship to oestrogen hormone stimulation. Endometrial cancer is the most common cancer of the organs of the female reproductive system. It usually occurs in women over the age of 50, and thus after menopause, but up to 25 per cent of cases may occur before the menopause. At diagnosis, about 75 per cent of women have a cancer confined to the uterus (stage I). For these women, the prognosis is very good. Today, it is not clear why endometrial cancer occurs. Some risk factors have been identified. There are several recognised pathologic and clinical factors that can identify if you are at an increased risk of relapse after surgery, or treatments which can help your doctor determine an appropriate treatment pathway. There are even genetic-related endometrial cancers, which account for up to five per cent of cases. Risk factors include: 1. Aging 2. Genes 3. Family history of endometrial cancer 4. Personal history of certain gynaecological diseases 5. Exposure to oestrogen 6. Overweight and obesity 7. Diabetes 8. Hypertension 9. Geographic factors 10. No pregnancy and total number of menstrual cycles Taking contraceptive pills containing both oestrogen and progesterone lower the risk of developing endometrial cancer. Other factors have been suspected to be associated with an increased risk (alcohol consumption, lack of physical activity) or a decreased risk (consumption of phytoestrogens found in soya food, coffee and vegetables) of developing endometrial cancer, but the evidence is inconsistent. Treatment for endometrial cancer depends on the risk for persistent or recurrent disease after surgical therapy: Low-risk disease The risk of relapse after surgery for low-risk endometrial cancer is very low, with estimates placed at five per cent or less. Given this, no further treatment is generally recommended. Intermediate-risk disease Women with low-intermediate risk disease can be observed without further treatment, since their risk of relapse after surgery alone is low (five per cent or less). Women with high-intermediate risk endometrial cancer benefit from adjuvant therapy to help reduce the chances of the cancer coming back in the pelvis (also known as a local recurrence). For most women with intermediate-risk disease, adjuvant vaginal or external beam radiation therapy is given. Of the two ways to give radiation, vaginal brachytherapy seems to be as effective as external beam radiation therapy, with fewer gastrointestinal side effects. These modes of radiation therapy are described below. High-risk disease Women with high-risk endometrial cancer are treated with adjuvant chemotherapy, especially if the disease is located outside DEMYSTIFYING FEMININE CANCERS Expert Dr Murat writes for WTM on an issue that is too frequently avoided.
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