Risk Factors and Preventive Measures
Endometrial cancer is most common in women
over age 60. Unopposed estrogen therapy (estro-
gen without progestin, except in women who
have had hysterectomies) and long-term tamox-
ifen use are additional risk factors. OBESITY, INSULIN
RESISTANCE, and type 2 DIABETESalso increase the
risk for endometrial cancer because these condi-
tions result in higher levels of estrogens in the
blood circulation. Endometrial cancer follows a
predictable path of evolution from endometrial
HYPERPLASIAto full-blown cancer, a path that gen-
erally takes years or even decades to manifest.
This characteristic makes endometrial cancer fairly
easy to detect in women who have regular routine
medical examinations with pelvic examination.
See also BREAST CANCER; CERVICAL CANCER; HOR-
MONE-DRIVEN CANCERS; METASTASIS; OVARIAN CANCER;
PAP TEST; PREVENTIVE HEALTH CARE AND IMMUNIZATION.
endometrial hyperplasia An overgrowth of the
endometrium, the tissue that lines the UTERUS. The
thickened endometrium fails to slough during
MENSTRUATION, thus continuing to accumulate.
Often menstruation is minimal or intermittent.
Endometrial HYPERPLASIAin which cell DNAremains
normal nearly always remains benign (does not
become cancerous). Endometrial hyperplasia that
consists of both abnormal cells and abnormal cell
organization (architecture), though itself benign,
is precancerous.
There are four types of endometrial hyperpla-
sia:
- Simple endometrial hyperplasia (also called
cystic glandular or mild hyperplasia) is the ear-
liest stage of endometrial hyperplasia. There is
excessive growth of the cells of the
endometrium in confined locations though the
cells and their architecture (structure and
arrangement) are normal. The risk for progres-
sion to endometrial cancer is minimal; simple
endometrial hyperplasia often resolves (goes
away) without treatment. - Complex endometrial hyperplasia features
excessive growth of normal cells with irregular
architecture, presenting a somewhat higher,
though still relatively low, risk for developing
into endometrial cancer without treatment. For
most women, doctors recommend treatment
with progestin, a synthetic form of PROGES-
TERONE, to halt the actions of estrogen and
cause the endometrium to wither and slough.
The endometrium generally returns to normal
within two or three MENSTRUAL CYCLES.- Simple endometrial hyperplasia with atypia is a
moderate stage of endometrial hyperplasia in
which patches of endometrial cells are not only
replicating more frequently than normal but
have also become abnormal in their DNA
(called nuclear atypia). However, the cellular
architecture still follows the normal pattern for
endometrial tissue. Untreated simple endome-
trial hyperplasia with atypia progresses to
endometrial cancer in about 10 percent of
women. Treatment with progestin often
resolves the hyperplasia. - Complex endometrial hyperplasia with atypia is
the most serious stage of endometrial hyperpla-
sia. The endometrial cells have abnormal DNA,
instructing them to replicate in unstructured
and dysfunctional ways. As well, the endome-
trial tissue that contains the atypical cells is dis-
organized and erratic. Without treatment, this
stage of endometrial hyperplasia progresses to
endometrial cancer in a third or more of
women. Treatment with progestin usually,
though not always, resolves the hyperplasia.
Symptoms and Diagnostic Path
Symptoms of endometrial hyperplasia may
include bleeding between menstrual periods,
anovulatory periods (menstrual cycles without
OVULATION), heavy or prolonged menstrual periods,
and PAINduring SEXUAL INTERCOURSE. Some women
may experience AMENORRHEA (absence of men-
strual periods). Endometrial biopsy, as an inde-
pendent procedure or after DILATATION AND
CURETTAGE(D&C), confirms the diagnosis. Imaging
procedures are not usually helpful as they cannot
conclusively distinguish between noncancerous
and cancerous tumors in the uterus.Treatment Options and Outlook
In addition to progestin therapy, other treatment
options include the surgical operations D&C and
HYSTERECTOMY. In D&C the surgeon gently scrapesendometrial hyperplasia 275