Endometrial cancer

Endometrial cancer is the most common type of gynecological cancer in developed countries. It originates in the endometrium, which is the mucous layer that lines the interior of the uterus, where cells begin to grow in an uncontrolled manner. Its prevalence is low (8.4 cases/100,000 inhabitants) and, in general, it has a good prognosis due to early symptomatology that allows early detection.

The exact cause of endometrial cancer is unknown, however, certain risk factors have been identified that increase the likelihood of its occurrence. Among them are:

  • Hormonal imbalances. Abnormal fluctuations in estrogen and progesterone levels cause changes in the endometrium, especially if this involves an increase in estrogen levels and a decrease in progesterone. This can occur in polycystic ovary syndrome and in obese women.
  • More years of menstruation. Women with earlier menarche and/or later menopause have a higher risk of this type of neoplasm.
  • Pregnancies: Women who have had at least one pregnancy have a lower risk of endometrial cancer.
  • Use of the contraceptive pill. Women who take contraceptive treatment for a long time have a lower risk of endometrial cancer.
  • More than 90% of endometrial cancer cases are diagnosed in women over the age of 50.
  • Hereditary cancer syndromes, such as Lynch syndrome or hereditary non-polyposis colorectal cancer, increase the risk of endometrial cancer. Possessing mutations in the BRCA1/2 genes also increases predisposition.

Endometrial cancer is the most commonly diagnosed cancer of the female reproductive system in developed countries. In a meta-analysis including almost 13,000 cases and more than 100,000 controls, a total of 15 loci associated with endometrial cancer were identified. Among the genes identified, CDCA8, previously associated with ovarian cancer, and the SH2B3 and NF1 genes encoding negative regulators of oncogenic signal transduction proteins, stand out. These findings may explain up to a quarter of the heritability of endometrial cancer. These findings provide important insights into the biology of the disease.

Symptoms

Endometrial cancer usually presents symptoms even in its early stages, which facilitates its early detection. Among the symptoms, the most common are:

  • Unusual vaginal bleeding, spotting or other vaginal discharge: approximately 90% of patients diagnosed with endometrial cancer have abnormal vaginal bleeding, such as a change in their menstrual periods or bleeding between periods or after menopause.
  • Pelvic pain and/or loss of mass and weight: A pain in the pelvis, feeling a mass (tumor) and/or unexpected weight loss can also be symptoms of endometrial cancer. These symptoms are usually more common in the later stages of the disease.

Although any of these can be caused by conditions other than cancer, it is important to consult with your doctor for any of these symptoms.

Prevention

Most cases of endometrial cancer cannot be prevented, but there are some actions that can reduce the risk of developing this disease. The best way to reduce the risk is to try to avoid or minimize the risk factors. General recommendations would be:

  • Healthy lifestyle, with a balanced diet, practicing regular physical exercise and promoting weight loss in obsessive or overweight women.
  • Combining estrogen with progesterone to treat menopausal symptoms. This combination may increase the risk of breast cancer, so it is recommended to consult your doctor.
  • Taking birth control pills. The use of this type of drug reduces the risk of uterine neoplasia and may be useful in women at high risk.
  • In the case of hereditary predisposition syndromes such as those mentioned above (Lynch syndrome, etc.) in which patients have a very high risk of endometrial cancer, hysterectomy may be considered as a preventive measure.

Number of observed variants

13.5 million variants

Number of risk loci analyzed in the study

15 loci

Bibliography

O'Mara TA, Glubb DM, Amant F, et al. Identification of nine new susceptibility loci for endometrial cancer. Nature Communications. 2018 Aug;9(1):3166.

Spanish Society of Medical Oncology [April 2022]

Mayo Clinic [April 2022]

American Cancer Society [April 2022]

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