Endometrial cancer is one of the most common female reproductive system tumors, with nearly 200,000 new cases each year, and its incidence ranks first among female reproductive system cancers in many European and American countries. In China, the incidence of EC is increasing year by year and is now second only to cervical cancer, and there is a trend of youthfulness. Most endometrial cancers are estrogen-dependent. The endometrium is affected by estrogen and progesterone, and progesterone plays an anti-estrogen role in endometrial tissues, and the lack of progesterone counteracting it is what makes endometrial lesions occur, initially as endometrial hyperplasia, and then gradually develop into endometrial cancer. What are the conditions that produce sustained estrogenic action in the absence of progesterone action? Which women are prone to endometrial lesions and even endometrial cancer? The following is a brief description of the risk factors for endometrial cancer.
Obesity is one of the high risk factors for endometrial cancer
Premenopausal obesity is mainly related to metabolic dysregulation and anovulation because patients do not ovulate and thus lack the secretion of progesterone, which makes the endometrium under the action of a single estrogen that lacks progesterone antagonism for a long time, and then cancer occurs. In postmenopausal obese women, androgens (androstenedione) secreted by adrenal glands can be converted into estrogens (estrone) by the action of enzymes (aromatase) in adipose tissues, and the more adipose tissues there are, the stronger the conversion ability, and the higher the plasma level of estrone, which is the main estrogen in the body of postmenopausal women, and the endometrium is under the influence of estrogen without progestin antagonism for a long time, which can also lead to endometrial carcinogenesis .
Increased risk of endometrial cancer in diabetes
Patients with diabetes have metabolic abnormalities, and the risk of endometrial cancer in these patients is three times higher than in those with normal blood glucose. Patients with hypertension have an increased chance of developing endometrial cancer and patients with hypertension have an increased chance of developing endometrial cancer. Obesity, diabetes and hypertension are called the “endometrial cancer triad”. Some scholars have suggested that coronary atherosclerotic heart disease is also related to endometrial cancer, which may be caused by hypothalamic-pituitary-adrenal dysfunction and metabolic abnormalities, as well as high-calorie and high-fat diet and lack of exercise and other lifestyles. Therefore, it has been suggested that endometrial cancer is a “disease of civilization” in contemporary society.
Reproductive endocrine disorder is a high risk factor for endometrial cancer
Reproductive endocrine disorders include amenorrhea, irregular vaginal bleeding, infertility, polycystic ovary syndrome (PCOS), etc. All these diseases and manifestations are related to abnormal ovarian endocrine function, focusing on abnormal ovulation (sporadic ovulation, anovulation). Some patients with reproductive endocrine disorders (e.g., PCOS, etc.) are also associated with lifestyle changes in recent years. Therefore, a healthy lifestyle is especially important to reduce the occurrence of endometrial cancer.
Estrogen abuse increases the risk of endometrial cancer
Exogenous estrogen: With the continuous improvement of people’s living standard and awareness of health care, many menopausal women go to hospitals for consultation and apply sex hormone supplementation therapy after getting relevant knowledge, but there are also women who apply estrogen drugs on their own. These women simply apply estrogen without doctor’s guidance and regular checkups, which will greatly increase the risk of endometrial cancer. In hormone supplementation therapy with combined estrogen and progestin, if the protective effect of progestin is sufficient, it is relatively safe for the endometrium even if applied for a long time.
Now that cervical cancer screening is well established and has yielded good results, the continued increase in the incidence of endometrial cancer makes endometrial cancer screening especially important and imperative!
Who needs to be screened for endometrial cancer?
1. Presence of the above-mentioned high-risk factors for endometrial cancer.
Endogenous estrogen increase: PCOS, recurrent anovulatory uterine bleeding, functional ovarian tumor
Exogenous estrogen increase: post-operative triamcinolone therapy for breast cancer, hormone replacement
Type II diabetes mellitus
Obesity: body mass index (BMI): >25
Hypertension
Genetic factors: first-degree relative with endometrial cancer, breast cancer, associated with hereditary non-polyposis colorectal cancer syndrome (Lynch syndrome), called Lynch syndrome-associated endometrial cancer.
2. Symptoms of abnormal vaginal bleeding and vaginal drainage.
Vaginal bleeding or vaginal drainage after menopause, long-term irregular vaginal bleeding
B ultrasound shows endometrial thickening: premenopausal endometrium >20mm; postmenopausal endometrium >5mm.