Posted on: March 15, 2016
Endometrial Cancer: Reducing Your Risk
By Dr. Iris Wertheim
Unlike breast cancer, endometrial cancer is not often the focus of media
attention, and is rarely cited as a health consequence of obesity. So you may be surprised to learn that endometrial cancer – cancer of the lining of the uterus – is the most common gynecological cancer in the U.S, and that there is a known link between obesity and this disease. Here, I raise your awareness of endometrial cancer, and offer empowering advice to every woman about reducing her risk.
Endometrial cancer arises in the glands of the lining of the uterus. It is the most prevalent gynecological cancer in the United States, affecting 50,000 women annually.
The major risk factor for developing endometrial cancer is age: onset is most commonly seen in post-menopausal women between the ages of 55 and 64. Another major risk factor is any condition that produces excess estrogen. Throughout a woman’s life, estrogen receptors in the uterine lining make the uterus highly reactive to estrogen. This is completely normal. However, that very responsiveness can cause problems when there exists an elevated level of circulating estrogen in the bloodstream. When excess estrogen overly stimulates those highly receptive uterine cells, they can start to undergo uncontrolled growth and transform into a cancer.
By far the largest cause of elevated estrogen in American women is obesity. Let me explain: A woman who carries extra weight has more fat cells. These cells store a hormone called androstenedione, which is converted into estrogen. As a result, obesity puts women at risk for endometrial cancer. As obesity among American women has risen, so has the incidence of endometrial cancer. Equally disturbing is that the increase in obesity among children and teens has made endometrial cancer more common in young women, in whom the cancer is usually estrogen-related. Other risk factors for endometrial cancer include Tamoxifen use, hypertension, familial cancer syndromes (such as Lynch Syndrome), and diabetes.
By contrast, exposure to progesterone seems to lower the risk of developing endometrial cancer. Women are often are exposed to progesterone by taking birth control pills (virtually all of which contain progesterone) or by using progesterone-containing IUDs. Women are also exposed to progesterone throughout pregnancy: women with many children have a lower risk of endometrial cancer than women who have never been pregnant.
Because obesity increases the risk for endometrial cancer, women need to accurately understand the definition of obesity. A formula called the Body Mass Index (BMI) calculates body fat based on your height and weight. Obesity is defined as a BMI greater than 30. However, you should be concerned earlier than that. A BMI of 25-30 indicates that you are overweight, and thus that your risk for endometrial cancer is elevated. An ideal BMI is under 25. It is very easy to learn your BMI: Simply google “Calculate BMI” for online calculators that let you plug in your height and weight, instantly provide your BMI, and show where that number falls on the spectrum.
The most common symptom of endometrial cancer is bleeding after menopause. For women who are have not gone through menopause, it is important to notice an irregular bleeding pattern. Irregular bleeding means heavy bleeding or bleeding in between periods. For both groups, endometrial cancer should be on your radar.
At the first symptom, see your gynecologist. You will typically have an endometrial biopsy and a pelvic ultrasound. If the biopsy reveals endometrial cancer, you should see a gynecologic oncologist, the specialist who has a thorough understanding of the disease, is able to do a complete staging procedure, and can refer appropriately if other treatment is needed.
The primary treatment for endometrial cancer is hysterectomy – surgery to remove the uterus. During the procedure, the surgeon decides whether to sample nearby lymph nodes for cancer. Today, robot-assisted hysterectomy is mainstream, making surgery safer and more precise, while providing faster recoveries. Because endometrial cancer is frequently discovered at an early stage, post-surgical outcomes are good.
In light of the link between endometrial cancer and obesity, I urge all women to reduce your risk by maintaining a healthy weight and getting regular exercise. The overwhelming health benefits can’t be overstated. In addition, every woman needs to be vigilant. Women who see a gynecologist at the first sign of abnormal bleeding have better outcomes.
Robotic Surgery Offers Special Benefits
At Northern Westchester Hospital (NWH), robot-assisted surgery is performed on the vast majority of patients with endometrial cancer. Robotic visualization is enhanced and outstanding, and the instruments are very sophisticated, all of which permits very precise surgical movements. Benefits to patients include decreased blood loss and risk of infection, and far faster recoveries, with shorter hospitals stays. The technology’s tiny incisions are a boon for obese patients, who are at greater risk for wound infection. In addition, robotic surgery allows the surgeon unrestricted access to the pelvis regardless of body weight. What is more, the small incisions enable patients to be mobile the very next day, thereby decreasing their post-surgical risk for blood clots and infection.
Dr. Iris Wertheim is Director of the Gynecologic Oncology Program at the Cancer Treatment & Wellness Center, Northern Westchester Hospital.