1.Is endometrial cancer related to diet?
Although many studies have not confirmed a direct link between uterine cancer and diet, it is known that endometrium is very sensitive to hormones and responds to various changes in hormone levels in the body. Therefore, it is not difficult to imagine that endometrial cancer is associated with total dietary fat. In fact, the incidence of endometrial cancer is higher in overweight people than in those with normal weight.
2.What foods can reduce the chance of endometrial cancer?
Except for cancers directly related to diet such as liver cancer and esophageal cancer, various other cancers have not been proven to be directly related to diet. There are fewer studies on the relationship between diet and endometrial cancer, but despite this, the results are surprisingly similar in that consuming a diet low in saturated fat and high in fruits and vegetables reduces the risk of endometrial cancer.
Cancer originates in a single cell with abnormal proliferation capacity. This type of cell, which originates from tumors and invasive healthy tissue, often metastasizes and spreads to other parts of the body. Carcinogens are substances that promote the formation of tumor cells. They may originate from food, air or even the body itself. The effects of most carcinogens are not evident until the body undergoes significant malignancy. However, they often attack the genetic material (DNA) of the cell and cause it to change. This takes years to develop into a detectable tumor. During this time, compounds called inhibitors keep the cells growing normally. Some plant-based vitamin-like substances are often considered to be inhibitors of the above, while fats in food are considered to be promoters of abnormal cell growth.
(1) Fiber substances against cancer
In 1970, British physician Dennis Burkitt’s research showed that a high fiber diet reduced digestive tract diseases. He found that the incidence of colon cancer was reduced in countries with high fiber diets (mainly plant-based fiber). This finding is recognized globally. High-fiber diets tend to be found in non-industrial countries where meat is scarce and plant-based grains are a staple food. Animal foods do not contain fiber. The United States and other Western countries, where meat is a staple food, have the highest incidence of colon cancer in the world.
No one has yet identified how fibrin prevents digestive disorders, but there may be multiple mechanisms. Theoretically, fiber is often not digested in the early stages of digestion in the body. It moves quickly through the intestines and can help remove carcinogens. At the same time, it encourages more water to enter the digestive tract. The water and fibrous tissues increase the volume of stool, which dilutes the carcinogens. Fibrous substances are equally effective in preventing cancer in other cancers. Studies have shown that the incidence of stomach cancer and breast cancer, among others, is reduced in people on high fiber diets.
In the United States, fiber intake is 10 to 20 grams per day. The expert recommendation is 30 to 40 grams per day. The best sources of fiber are grains, legumes, vegetables and fruits. The closer the food is to its natural state, the higher the fiber content, such as with skin and unprocessed.
(2) Fats increase cancer risk
Multicultural studies show that people with high fat intake have the highest mortality rates from colon and breast and endometrial cancers. The opposite is true for populations with low fat intake. Studies using immigration can help exclude the influence of genetic factors.
Many studies have shown that fat can promote the development of a particular type of cancer and may also promote the risk of new cancer formation in patients who already have other types of cancer. While these have a large relationship with total fat intake, there is evidence that animal fats are more harmful than vegetable fats. Dr. Sheila, Bingham, a leading researcher at the University of Cambridge in England, found that meat was more strongly associated with colon cancer than any other factor. It also has a close relationship with prostate and ovarian cancer.
Fat has many roles in the body. It increases the production of hormones that promote the formation of breast and endometrial cancers. Likewise, it stimulates the production of bile acids, which provide the risk of colon cancer. The National Cancer Center recommends that people should reduce their fat intake to 30 percent. However, studies have shown that to achieve certain cancer prevention effects, the percentage of fat intake should be well below 30%, and 10% to 15% is perhaps the most appropriate.
(3) Soy foods prevent cancer
According to recent research, regular consumption of legumes will reduce the risk of endometrial cancer in women, and this effect is most pronounced in those who are overweight. Researchers? noted that estrogen produced in the female body plays a key role in the development of endometrial cancer. Soy foods contain isoflavones, which have both estrogen-like effects and anti-estrogenic activity. To investigate this issue, XiaoShu et al. from Vanderbilt University randomly selected 832 endometrial cancer patients and 846 non-endometrial cancer patients and compared the subjects’ intake of legumes. The results found that the higher the intake of legumes, the lower their risk of endometrial cancer. Compared with those women whose daily intake of legume protein was less than 5.9 g, the risk of endometrial cancer was 7%, 15%, and 33% lower in women whose daily intake of legume protein ranged from 6.0 g to 10.2 g, 10.3 g to 16.0 g, and 16.0 g or more. This reduction in risk of endometrial cancer was even more pronounced when the analysis was limited to women who were overweight. The researchers noted that although the results of this study suggest that soy foods have an anti-endometrial cancer effect, further studies are needed to confirm that this effect is more pronounced in overweight women.
(4) Green tea also protects against cancer
A special study recently reported by the Shanghai Institute of Oncology showed that drinking tea, especially green tea, may have a preventive effect on endometrial cancer, but this preventive effect may be limited to premenopausal women. The results of the study showed that tea drinkers, especially green tea drinkers, had a lower risk of endometrial cancer than non-drinkers. The more often tea was consumed, the more significantly the risk of endometrial cancer was reduced. Those who drank tea seven times a week or more reduced the risk of endometrial cancer by about 20%. Those who drink green tea and have no history of alcohol consumption or smoking have about 23% lower risk of endometrial cancer; those who drink >200 grams of green tea per month have about 30% lower risk of endometrial cancer.
The researchers analyzed that endometrial cancer is a hormone-dependent tumor, and excessive estrogen exposure is its main cause. Green tea may reduce the risk of endometrial cancer by lowering estrogen levels in the body. In addition, tea polyphenol complexes may enhance lymphocyte proliferation and strengthen the body’s immune function. Since no other studies on tea consumption and endometrial cancer have been reported, further epidemiological studies, especially cohort studies, are expected to confirm this.
3.Does hormone replacement therapy increase the incidence of endometrial cancer?
Hormone replacement therapy is very good, which is a sign of social progress and a good requirement for women to pursue quality of life. However, hormone replacement therapy had a long exploration period in western countries from the 1950s to the 1970s. During this period, hormone replacement therapy was not very standardized in western countries at the beginning, and after a rush, it caused a parallel rise in endometrial cancer. At that time, the amount of prescriptions increased four times, and the incidence of endometrial cancer also increased four times. In our country, the use of hormone replacement therapy gradually began after the 1990s, and at first estrogen replacement therapy alone was used in many places, but it increased the incidence of two types of cancer, one being endometrial cancer and the other being breast cancer. The increase in the incidence of these two types of cancers has attracted widespread attention. Since then, hormone replacement therapy has changed from simple estrogen replacement therapy to cyclic combined estrogen-progestin replacement therapy. Knowing these theories and increasing the amount of hormone replacement therapy, the incidence of endometrial cancer has not increased.
Nowadays, hormone replacement therapy is suitable for women with menopausal syndrome and women with poor postmenopausal status of life, who have their own requirements, who do not have any contraindications, who do not have a family history of cancer, and who are not particularly obese or have cholecystitis. This treatment allows women with severe menopausal symptoms or premature ovarian failure to go through menopause smoothly or to reduce the occurrence of menopause-related osteoporosis. However, the prerequisite is to find a hospital and doctor who can guide the patient to perform hormone replacement therapy. Only in this way is it safe and beneficial to the health of patients.
4.Can endometrial cancer patients use hormone replacement to relieve symptoms after surgery?
Several retrospective studies have concluded that the use of estrogen replacement therapy in early-stage endometrial cancer patients after regular surgery and treatment and after a period of stabilization has not been found to increase the recurrence rate of tumor or tumor-related death. However, evidence-based medical evidence from large sample and prospective studies is still needed. At present, the clinical use of hormone replacement therapy for patients after endometrial cancer treatment needs to be cautious and closely followed up.
5.Can oral contraceptives prevent endometrial cancer?
It is indisputable that oral contraceptives have obvious protective effect on the endometrium of premenopausal women, and the application of 21 days of oral contraceptives combined with estrogen and progestin for patients with 28 days per cycle is a common method of administration, and it is found that endogenous estrogen can still be maintained at a low level in the days after stopping the pill. The risk of endometrial cancer is reduced by almost 40% with the use of oral contraceptives, and this protective effect on the endometrium persists for at least 15 years even after discontinuation of oral contraceptives. Numerous clinical studies have confirmed that the protective effect of oral contraceptives on the endometrium increases with the duration of use and that the risk of endometrial cancer decreases with the duration of oral contraceptive use. In conclusion, the risk of endometrial cancer decreases by 56% after 4 years of oral contraceptive use, by 67% after 8 years of use, and by 72% after 12 years of use. At the same time, oral contraceptives can also reduce the incidence of ovarian cancer.
6.Are obese people prone to endometrial cancer?
Many studies have found that the risk of endometrial cancer increases with the increase of body mass index and weight. These studies have measured obesity in many ways, such as weight, body mass index (BMI), waist-leg circumference ratio, waist-hip circumference ratio, etc. The main reason for the increased chance of endometrial cancer in obese women may be related to higher levels of estrogen in the blood, which happens to be a very clear cause of endometrial cancer.
Obesity is often associated with several risk factors that increase the risk of endometrial cancer, such as centripetal obesity, polycystic ovary syndrome, low activity and high saturated fat diet. A study conducted in Europe found that 26%-47% of endometrial cancers may be associated with excess weight and obesity, and similar trials have yielded the same results, that is, endometrial cancer is associated with excess weight, and the relative risk of endometrial cancer from obesity is 2-10. Some studies have found that the risk of endometrial cancer from centripetal obesity is higher than that from peripheral obesity. Some studies have even found that late obesity is more closely related to endometrial cancer than early obesity.
The etiological basis of obesity leading to endometrial cancer is not fully understood, and many have proposed mechanisms related to it. According to the estrogen theory, the main source of estrogen in the plasma of postmenopausal women is the aromatization of androstenedione in the body, and this process occurs mainly in the subcutaneous fat. This may explain why late onset of obesity is associated with the development of endometrial cancer. In addition, some people think that centripetal obesity is prone to endometrial cancer may be related to hyperinsulinemia.
Since many studies have found that obesity is related to the occurrence of endometrial cancer, can physical exercise change the risk of endometrial cancer?
There are many studies on the risk of endometrial cancer and physical activity, and the results prove that there seems to be a negative correlation between the two. A large Dutch study found that postmenopausal women who exercised for more than 90 minutes per day had a 46% reduction in the risk of endometrial cancer compared to those who exercised for less than 30 minutes per day. In another study that compared 822 patients with endometrial cancer to 1,111 normal subjects, the risk of endometrial cancer was reduced by 38% when women who exercised regularly during the 2 years prior to the development of endometrial cancer were compared to those who did not exercise at all. Therefore, it is proposed that physical exercise can reduce the risk of endometrial cancer in obese women because the risk of endometrial cancer in obese patients is modified by weight loss (a known risk factor for endometrial cancer) or by reducing the level of estrone in the serum.
8.What is the relationship between childbirth and breastfeeding and endometrial cancer?
Endometrial cancer mostly occurs in patients who have not given birth or are infertile, and 66.4% of patients under 40 years old are not giving birth. The incidence of endometrial cancer is 3 times higher in unborn women than in menstruating women. While childbirth reduces the risk of endometrial cancer, breastfeeding also reduces the risk of endometrial cancer by suppressing ovulation.
A study in Mexico found that prolonged breastfeeding reduced the risk of endometrial cancer by 58%-72%. The same pattern exists for the number of children breastfed. A study on the relationship between breastfeeding and endometrial cancer in the United States pointed out that breastfeeding over the past 30 years has reduced the risk of endometrial cancer, and if the first breastfeeding is done after the age of 30, the risk of endometrial cancer will drop by 50%.
9.Can patients with endometrial cancer still keep their uterus?
Endometrial cancer occurs in the endometrium and gradually invades the muscular layer and plasma layer of the uterus as the disease progresses and starts to metastasize to the outside of the uterus. In general, patients with endometrial cancer cannot keep their uterus. Only a few special cases can be considered for uterine preservation, and the following conditions must be met: the endometrial cancer pathology must be highly differentiated and there is no evidence of myometrial infiltration, and the patient must be young and childless and willing and able to follow up closely for observation.
10.How to treat and follow up patients who have preserved their fertility?
(1) First, a high dose of progestin should be given, equal to more than 100 times the contraceptive dose, and an endometrial biopsy should be performed three months after treatment;
(ii) If the pathological results three months after treatment suggest no change in the lesion, another three months will be used and endometrial biopsy will be performed again, then if the pathology suggests improvement, progesterone can continue to be applied for three months, followed by pathological examination, if the pathological results do not reveal that the endometrium has been transformed into normal, then consideration should be given to preserving the fertility function; if the pathological endometrium has been transformed into normal endometrium, then assisted conception should be started;
③. If the disease has progressed after three months of treatment, give up preserving the fertility function.
11.What should be examined in the follow-up of endometrial cancer patients?
No matter what adjuvant examinations are done, seeing the doctor is the first important thing, and pelvic examination should be the most important part of all follow-up examinations. Since endometrial cancer is prone to recurrence in the lungs and liver, liver and kidney ultrasound and chest X-ray at each postoperative follow-up is extremely valuable. If ultrasound reveals abnormalities, further additional tests such as CT or MRI will be performed. In addition, postoperative serum CA125 test is important, and persistent elevation after surgery often indicates intra-abdominal recurrence. Special types of endometrial cancer are followed up in the same way as ovarian cancer, with more emphasis on serum CA125. If CA125 is significantly elevated preoperatively, postoperative follow-up will be the best indicator. Generally speaking, if CA125 is continuously elevated during postoperative follow-up, recurrence should be considered. Of course, other imaging examinations are also necessary. Initially, a comprehensive CT examination should be performed once a year and ultrasound examination every three months, etc.
12.Is postmenopausal bleeding endometrial cancer?
Postmenopausal bleeding should be given enough attention, but it should not be overly exaggerated. Postmenopausal bleeding is often considered as one of the important clinical manifestations of endometrial cancer. According to this symptom, timely attention and early examination and treatment can lead to early diagnosis and treatment of many endometrial cancers. However, people often equate postmenopausal vaginal bleeding with endometrial cancer, and whenever this symptom occurs, patients and even some clinicians first think that they are suffering from cancer, which causes great psychological pressure for patients and their families and seriously affects patients’ life, which is actually over-exaggerated. Studies have found that only 8.1% of patients with postmenopausal bleeding have the possibility of endometrial cancer, 18.8% have the possibility of benign endometrial lesions, and the majority or nearly 3/4 of patients do not have endometrial abnormalities at all, so there is no need to talk about tigers. Then, in the clinical encounter with postmenopausal bleeding patients, doctors should first pay enough attention to them and provide adequate information and explanation to patients, as well as carry out related knowledge and further relevant examinations to clarify the diagnosis.
13.Is endometrial thickening endometrial cancer?
The cause of endometrial cancer is unknown, but there are many factors related to the development of this disease, and endometrial thickening is one of them. However, there are many causes of endometrial thickening, including: endometrial cancer, endometrial complex hyperplasia, endometrial simple hyperplasia, endometrial polyps, etc.
In order to better define the risk factors for endometrial cancer, a study conducted a multifactorial analysis of each traditional risk factor and found that only the thickness of the endometrium and the occurrence of endometrial cancer were closely related. In the ovarian cycle, when follicles develop and mature in the ovary, under the effect of ovarian secretion of estrogen, the endometrium appears to proliferate, i.e. the proliferative endometrium; after ovulation, under the effect of ovarian corpus luteum secretion of progesterone and estrogen, the proliferative endometrium is secreted, i.e. the secretory endometrium; after the corpus luteum degenerates in the ovary, due to the decrease of estrogen and progesterone, the endometrium loses its support and becomes necrotic The endometrium loses its support and becomes necrotic and exfoliates, which manifests as menstrual flow, which is called menstrual endometrium. The menstrual phases are proliferative, secretory and menstrual phases. After menstruation to ovulation is the proliferative phase and the thickness of the endometrium is usually <0.8 cm, after ovulation to menstruation is the secretory phase and the thickness of the endometrium is about 0.8-1.2 cm. The thickness of the endometrium before menstruation is 1.1cm or more. The results of statistical data from our small sample showed that the thickness of the endometrium in the endometrial cancer group was 14.4±7.2 mm, while the thickness of the endometrium in benign endometrial lesions (simple hyperplasia, compound hyperplasia) and normal endometrium was 7.0±3.8
mm, with a significant difference between the two groups (P<0.001). If we try to divide the endometrial thickness into three groups: <5 mm, 5-15 mm and >15 mm, using the current international trend of 5 mm as a unit, the chances of cancer were found to be 0, 6.4% and 19.3%, respectively, which is consistent with the results of the current international studies. According to the results of this study, if the endometrial thickness is <5 mm, the chance of endometrial cancer is 0. Therefore, it should be said that if the patient's endometrial thickness is <5 mm on vaginal ultrasound, diagnostic scraping can be avoided and close observation and follow-up can be performed. This will allow many patients to avoid undergoing diagnostic scraping and reduce unnecessary trauma. Vaginal ultrasound is now considered very effective in monitoring the thickness of the endometrium, especially in patients with postmenopausal bleeding, and is very useful in assessing the patient's condition.
14. Can endometriosis and fibroids turn into endometrial cancer?
Many people are worried whether endometriosis and fibroids, which are benign diseases, will turn into endometrial cancer. Uterine fibroids are benign tumors occurring in the myometrium, and the incidence of malignancy is relatively low (0.4-0.6%), and they do not turn into endometrial cancer. The problem of endometriosis is also malignant, endometriosis ectopic to the ovary, it becomes ovarian cancer, clear cell carcinoma of the ovary is relatively common, which has nothing to do with endometrial cancer.
15.Should people with obesity, diabetes and hypertension pay special attention to prevent endometrial cancer?
The incidence rate of diabetes, hypertension and obesity in our country is increasing year by year, and these factors are also high-risk factors for the development of endometrial cancer, so the issue of medical examination or screening for high-risk groups is also receiving increasing attention. The high-risk groups of endometrial cancer are hypertension, obesity, diabetes, women who have never had children, young anovulatory women, and women with ovarian tumors that secrete estrogen, etc. All those who have been exposed to estrogen for a long time and have these related factors should be the targets of close monitoring and screening. What should be the frequency of screening? The frequency should be the same as for other aspects of gynecologic physical examinations, which should be performed at least once a year. The gynecologic physical examination should also include at least a gynecologic physical examination, cervical cytology and gynecologic ultrasound to detect abnormalities for further examination in a timely manner. At the same time, internal diseases related to endometrial cancer should be treated and controlled in time to reduce the risk factors for its development.
16.How should I face the disease after having endometrial cancer?
Endometrial cancer is a relatively mild malignant tumor. Although its incidence rate is increasing, it has a relatively good recovery. Although its incidence is increasing, it has a relatively good outcome. The five-year survival period of early stage patients is generally more than 90%. Therefore, first of all, don’t be afraid, and you must relax your spirit. Because any malignant tumor requires not only a series of professional medical treatments such as surgery, radiotherapy and chemotherapy, but also the patient’s mental state, immune status, diet and living habits have an impact on the recurrence of the tumor and the treatment of the tumor. Any doctor’s treatment for tumor is to remove the lesions and eliminate the residual lesions in the body through chemotherapy and radiotherapy, but these treatments alone cannot eliminate the tumor 100%. Therefore, it is necessary to rely on the patient’s own resistance to kill the residual cancer cells or the awakened cancer cells afterwards, and then it is possible to prevent the tumor from recurring to the greatest extent. Therefore, medical treatment is of course very important and indispensable, but the role of patients themselves should not be underestimated. Therefore, I hope every patient can face their disease correctly, so that they can have more motivation and better confidence to overcome the disease and regain their health together with doctors.
Secondly, it should be emphasized that endometrial cancer has a good prognosis because most of the patients are in the early and middle stage. However, after the completion of surgery and other treatments, it is important to come to the hospital for checkups on time and follow the doctor’s instructions. In this way, if the disease recurs, it can be detected early and the treatment effect can be best, so that surgery or chemotherapy and radiotherapy can be performed again. If you don’t come to the hospital on time for checkups and only find out to seek medical help when the symptoms are serious in late stage, you will lose the best time for treatment and the survival rate will be greatly reduced. Therefore, as a patient with malignant tumor, one should neither be too worried nor too relieved. This is something that can be achieved only with the efforts of doctors, patients and family members.
17.When should endometrial examination be performed?
Endometrial examination should be done immediately if one of the following conditions is encountered.
①Postmenopausal bleeding or bloody leucorrhea, after excluding cervical cancer and vaginitis, endometrial cancer should be highly alerted and scraping should be considered.
②Patients who are over 40 years old and have irregular vaginal bleeding that cannot be stopped despite hormonal treatment or recurrence after once stopping bleeding.
③Patients who are younger but have long-term uterine bleeding, infertility, or ovulation disorders.
④Patients with persistent vaginal fluid discharge.
⑤ Patients with atypical endometrial hyperplasia, bleeding or those with repeated malignant cells found on vaginal smear.
It should be emphasized that the only early symptom of endometrial cancer in postmenopausal women is vaginal bleeding. Vaginal bleeding in early stage endometrial cancer is often a small amount of bleeding, some of which may appear as dripping or even just a faint bit of pink. This very small amount and light-colored bloody discharge is really hard to be detected. Some women who find a small amount of bloody discharge on their underwear or hand paper often ignore it because of the small amount of blood or light color due to the lack of awareness of cancer prevention, allowing endometrial cancer or precancerous lesions to easily slip past under their eyes. Women often prefer to wear underwear with color, and it is difficult to detect light pink secretion stained on the underwear. The situation is different with white or light-colored underwear, especially white underwear, which is not difficult to be detected as long as one pays attention to it frequently, which creates a very favorable situation for early detection of endometrial cancer or precancerous lesions.
18.After hysterectomy because of endometrial pre-cancer, will there be cancer cells? Will people age after hysterectomy?
Precancerous lesions, which have not reached cancer, only have a malignant tendency in cell morphology, and the cells have not yet become malignant cancer cells. If the results of pathological examination are correct, there will be no cancer cells in the body of patients with precancerous lesions.
In patients who undergo simple hysterectomy for endometrial precancerous lesions and keep both ovaries, the surgery does not have much impact on the function of ovaries, so the endocrine system will not be greatly changed by the surgical removal of the uterus. The role of the uterus is mainly the reproductive function, as well as the monthly menstrual flow that also results from the cyclic shedding of the endometrium. After hysterectomy, although you don’t get your period, the endocrine function of the ovaries is still similar to that before surgery, so it doesn’t cause menopause or so-called aging, and it doesn’t cause “sex change” after hysterectomy as some people say.