Endometrial cancer is the most prevalent gynaecological cancer in developed countries, especially after menopause.
Its incidence has increased by more than 40% in the last two decades. The prevalence of this type of cancer tends to increase with age, being more frequently diagnosed in women over 50 years of age, typically post-menopausal.
In terms of risk factors, women who are overweight, have high blood pressure, diabetes, and have a history of using oestrogen hormone therapy are more likely to develop this type of cancer. Furthermore, women with a history of early menarche, late menopause, nulliparity, polycystic ovary syndrome, and genetic syndromes, such as Lynch syndrome (a hereditary disease that leads to an increased risk of colorectal cancer), are at an increased risk of developing endometrial cancer.
One of the most common symptoms is abnormal uterine bleeding, which is associated with more than 75% of cases. This is vaginal blood loss, similar to menstruation, but occurs when women have already reached menopause. In premenopausal women, irregular or excessive menstrual bleeding may also be a symptom. Additionally, symptoms such as abnormal vaginal discharge (not associated with infection or other common causes), pelvic pain, increased abdominal volume, or dyspareunia (pain during sexual intercourse) may occur, although they are not common in the early stages of the disease.
Menopause plays an important role in both the diagnosis and treatment of endometrial cancer and can contribute to early detection and create some complications. On the one hand, since one of the main warning symptoms of endometrial cancer is abnormal vaginal bleeding, which is much less common after menopause, this usually leads to earlier investigation.
On the other hand, with menopause, increased exposure to oestrogen, especially if associated with factors such as obesity, diabetes, hypertension, and the use of hormone replacement therapy, increases the risk of developing endometrial cancer. These risk factors can increase the complexity of patient management.
Regarding treatment, this mainly involves total hysterectomy (removal of the uterus). In postmenopausal women, surgery may be more complex if there are other associated comorbidities, such as heart or lung disease, that make anaesthesia or recovery more difficult.
The treatment of endometrial cancer depends on the stage at which the disease was diagnosed, the tumour subtype, and the patient’s clinical condition. As around 80% of endometrial cancers are diagnosed in early and localized stages, surgery is the main treatment, and survival rates are over 90% at five years.
However, in more advanced stages, when the disease affects lymph nodes or other distant organs, or in more aggressive subtypes, treatment may involve chemotherapy and/or radiotherapy, and the prognosis is worse. Early detection and a personalized therapeutic approach are key to improving survival rates and quality of life.
Although there is no way to completely guarantee the prevention of this type of cancer, it is possible to adopt strategies that reduce known risk factors, such as practicing healthy lifestyle habits.
There is currently no evidence to support screening for endometrial carcinoma in the general population. Screening is recommended only for asymptomatic women carrying mutations associated with Lynch syndrome. This involves gynaecological examination, suprapubic and transvaginal gynaecological ultrasound, and annual endometrial biopsy starting at age 35 until they undergo hysterectomy and bilateral adnexectomy.
Article submitted by the HPA Group
