of Uterine Cancer
Irregular vaginal bleeding is the most common presenting sign of endometrial cancer. It generally occurs early in the disease process, and is the reason why most patients are diagnosed with highly curable early stage cancer.
Uterine cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells. Most endometrial cancers develop sporadically, which means for no known reason.
A risk factor is anything that increases a person’s chance of developing cancer. Risk factors can influence the development of cancer but most do not directly cause cancer. Many individuals with risk factors will never develop cancer and others with no known risk factors will. Some cancers however are more likely to develop in individuals with certain risk factors that increase an individual’s chance of developing cancer. The following factors may raise a person’s risk for developing endometrial cancer.1,2
Risk factors for endometrial cancer include the following:
- Endometrial hyperplasia.
- Hormone therapy.3,4
- Tamoxifen therapy.5,6
- Polycystic Ovarian Syndrome
- Never having children/
- Early menarche and late menopause.
- Family history/genetic predisposition.7,8
- Lynch Syndome
Prolonged, unopposed estrogen exposure has been associated with an increased risk of endometrial cancer.3,4 However, combined estrogen and progesterone therapy prevents the increase in risk of endometrial cancer associated with unopposed estrogen use.5,6
Tamoxifen, which is used for both the treatment and prevention of breast cancer is associated with an increased risk of endometrial cancer related to the estrogenic effect of tamoxifen on the endometrium.5,6 It is important that patients who are receiving tamoxifen and experiencing abnormal uterine bleeding have follow-up examinations and biopsy of the endometrial lining.
1 American Cancer Society: Cancer Facts and Figures 2017. Atlanta, Ga: American Cancer Society, 2017.
2 Ward KK, Shah NR, Saenz CC, et al.: Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol 126 (2): 176-9, 2012.
3 Ziel HK, Finkle WD: Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med 293 (23): 1167-70, 1975.
4 Jick SS, Walker AM, Jick H: Estrogens, progesterone, and endometrial cancer. Epidemiology 4 (1): 20-4, 1993.
5 van Leeuwen FE, Benraadt J, Coebergh JW, et al.: Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet 343 (8895): 448-52, 1994.
6 Fisher B, Costantino JP, Redmond CK, et al.: Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 86 (7): 527-37, 1994.
7 Lynch HT, Lynch J, Conway T, et al.: Familial aggregation of carcinoma of the endometrium. Am J Obstet Gynecol 171 (1): 24-7, 1994.
8 Lu KH, Schorge JO, Rodabaugh KJ, et al.: Prospective determination of prevalence of lynch syndrome in young women with endometrial cancer. J Clin Oncol 25 (33): 5158-64, 2007.
9 Nead KT, Sharp SJ, Thompson DJ, et al.: Evidence of a Causal Association Between Insulinemia and Endometrial Cancer: A Mendelian Randomization Analysis. J Natl Cancer Inst 107 (9): , 2015.