Endometrial CancerEndometrial cancer is a cancer that starts in the endometrium, the inner lining of the uterus (womb). The picture below shows where the uterus is located.
About the uterus and endometriumThe uterus is a hollow organ, about the size and shape of a medium-sized pear. The uterus is where a fetus grows and develops when a woman is pregnant. The uterus has 2 main parts (see picture above). The lower end of the uterus extends into the vagina and is called the cervix. The upper part of the uterus is called the body and is also known as the corpus. (Corpus is the Latin word for body.)
The body of the uterus has 2 layers. The inner layer or lining is called the endometrium. The outer layer of muscle is known as the myometrium. This thick layer of muscle is needed to push the baby out during birth. The tissue coating the outside of the uterus is the serosa.
Hormone changes during a woman's menstrual cycle cause the endometrium to change. During the early part of the cycle, before the ovaries release an egg (ovulation), the ovaries produce estrogens. The hormone called estrogen causes the endometrium to thicken so that it could nourish an embryo if pregnancy occurs. If there is no pregnancy, estrogen is produced in lower amounts and more of the hormone called progesterone is made after ovulation. This causes the innermost layer of the lining to prepare to shed. By the end of the cycle, the endometrial lining is shed from the uterus and becomes the menstrual flow (period). This cycle repeats throughout a woman's life until menopause (change of life).
Endometrial Cancer Risk FactorsWhen the balance of these two hormones shifts toward more estrogen — which stimulates growth of the endometrium — a woman's risk of developing endometrial cancer increases.
Factors that increase levels of estrogen in the body include: -
- Many years of menstruation. If you started menstruating at an early age — before age 12 — or you began menopause later, you're at greater risk of endometrial cancer than is a woman who menstruated for fewer years. The more years you have had periods, the more exposure your endometrium has had to estrogen.
- ever having been pregnant. Pregnancy seems to decrease the risk of endometrial cancer, although experts aren't sure exactly why this might be. The body produces more estrogen during pregnancy, but it produces more progesterone, too. Increased progesterone production may offset the effects of the rise in estrogen levels. It's also possible that not having been pregnant may be the result of infertility caused by irregular ovulation, which may be the reason why women who've never been pregnant are at an increased risk of endometrial cancer.
- Irregular ovulation. Ovulation, the monthly release of an egg from an ovary in menstruating women, is regulated by estrogen. Irregular ovulation or failure to ovulate increases your lifetime exposure to estrogen. Ovulation irregularities have many causes, including obesity and a condition known as polycystic ovary syndrome (PCOS). This is a condition in which hormonal imbalances prevent ovulation and menstruation. Treating obesity and managing the symptoms of PCOS can help restore your monthly ovulation and menstruation cycle, decreasing your risk of endometrial cancer.
- Obesity. Ovaries aren't the only source of estrogen. Fat tissue can produce estrogen. Being obese can increase the level of estrogen in your body, putting you at a higher risk of endometrial cancer and other cancers. Obese women have three times the risk of endometrial cancer and overweight women have twice the risk, according to the American Cancer Society. However, thin women can also develop endometrial cancer.
- A high-fat diet. This type of diet may add to your risk of endometrial cancer by promoting obesity. Or, fatty foods may directly affect estrogen metabolism, further increasing a woman's risk of endometrial cancer.
- Diabetes. Endometrial cancer is more common in women with diabetes, possibly because obesity and type 2 diabetes often go hand in hand. However, even women with diabetes who aren't overweight have a greater risk of endometrial cancer.
- Estrogen-only replacement therapy (ERT). Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking synthetic progestin, a form of the hormone progesterone, with estrogen — combination hormone replacement therapy — causes the lining of the uterus to shed and actually lowers your risk of endometrial cancer. However, this combination may cause other health risks, such as blood clots or breast cancer.
- Ovarian tumors. Some tumors of the ovaries may themselves be a source of estrogen, increasing estrogen levels.
Other factors that can increase your risk of endometrial cancer include: -
- Age. The older you are, the greater your risk of endometrial cancer. The majority of endometrial cancer occurs in women older than 55.
Endometrial Cancer CausesThe exact cause of endometrial carcinoma remains unknown, although several risk factors have been identified. Possessing one of these risk factors does not mean that a woman will develop endometrial cancer, but rather that her risk of developing endometrial cancer is higher than that of another woman without the risk factor.
Risk factors for endometrial cancer include the following: -
- Obesity: - Women who are more than 50 pounds over ideal weight have a 10-times greater risk of developing endometrial cancer than women of ideal weight. Body fat produces estrogen, and women with excess fat have a higher level of estrogen than women without excess fat. The higher level of estrogen is believed to increase the risk of cancer.
- No pregnancies: - Women who have never been pregnant have a 2- to 3-times higher risk than women who have been pregnant.
- Early puberty: - Women who begin their periods before age 12 years are at an increased risk. Early puberty increases the number of years that the endometrium is exposed to estrogen.
- Late menopause: - Women who go through menopause after age 52 years are at a higher risk of developing endometrial cancer than women who go through menopause earlier in life. Like early puberty, late menopause increases the number of years that the endometrium is exposed to estrogen.
- Treatment with unopposed estrogen: - The risk of developing endometrial cancer is increased by several times in women who take estrogen replacement therapy without added progesterone.
- High level of estrogen: - Women who have a high level of unopposed estrogen in the body are also at an increased risk. Several different conditions, such as polycystic ovarian disease, can cause a woman to have a high unopposed estrogen level.
- Treatment with tamoxifen: - Women who have been treated with tamoxifen, a drug used to prevent and treat breast cancer, may have a slightly increased risk of developing endometrial cancer.
- Other cancers: - Cancers of the breast, ovary, and colon are linked with an increased risk of endometrial cancer.
- Family history: - Women who have a close relative with endometrial cancer have an increased risk of the disease.
- Women who use oral contraceptives at some time have half the risk of developing endometrial cancer as women who have never used oral contraceptives.
- This protection occurs in women who have used oral contraceptives for at least 12 months.
Hormonal therapy Endometrial CancerHormone therapy used to be widely regarded as a very safe treatment for menopause. However, several major studies have shown that hormone therapy creates risks for certain medical conditions and problems, including heart disease, stroke, and cancer.
However, hormone therapy may help relieve some of the bothersome symptoms of menopause, such as hot flashes, vaginal dryness and pain with intercourse, and long-term complications of estrogen loss, such as osteoporosis.
BENEFITS OF HORMONE THERAPYPerhaps the largest benefit women receive from hormone therapy is relief from: -
- Hot flashes
- Night sweats
- Sleep difficulties
- Vaginal dryness
A woman's body produces less estrogen during and after menopause, which may affect her bone strength. Hormone therapy may also prevent the development of osteoporosis. For information on treating bone loss, see: Osteoporosis.
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