Uterine Cancer – A Life Style disease?

Sudha, (name changed) a 52 year old lady, went to the doctor with complaints of heavy and irregular menstrual bleeding. This problem had been troubling her for the last eight months, but she had kept it to herself thinking that she was going into menopause. Many friends had told her not to worry, saying that heavy bleeding was normal just before menopause. Sudha had only one son, who was well settled in life. She was also diabetic, hypertensive and slightly obese. When she reached the doctor finally, the problem had become so bad that she required blood transfusion for anaemia caused due to the blood loss. The doctor then did a diagnostic test on her, which showed that she had endometrial cancer.

Sixty years back, the incidence of endometrial cancer was much lower than what it is today. Its incidence has increased in the West and is increasing in developing countries like India. It is today the most common malignancy of the female genital tract in the Western world.

Endometrial cancer arises from the cells lining the uterine cavity. It is usually seen in pre-menopausal and post-menopausal age groups, but rare cases have also been reported in women from their early twenties. Endometrial cancer is increasing due to several reasons - longer life spans, increasing incidence of obesity and associated conditions like diabetes and hypertension, and excessive estrogen exposure.

Excessive estrogen exposure may be caused by early menarche, late menopause, hormone replacement therapy, having fewer children and anovulatory conditions with excessive estrogens like polycystic ovarian disease. Studies have shown the association between obesity, hypertension, diabetes and endometrial cancer. The presence of these three conditions with endometrial cancer is known as ‘corpus cancer syndrome.’

Endometrial cancer may also occur due to a genetic mutation that turns normal healthy cells to abnormal cells. Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of colon cancer and other cancers, including endometrial cancer. In HNPCC, the genetic mutation passes from parents to children.

Symptoms of uterine cancer include vaginal bleeding after menopause, heavy and or irregular bleeding from the vagina before menopause, abnormal watery discharge from the vagina and pelvic pain. The diagnosis can be made by simple tests like an endometrial biopsy or a dilatation and curettage (D and C).

The disease is highly curable in the early stages. The primary treatment is surgery removing uterus along with both ovaries. If not diagnosed early, endometrial cancer can spread to other parts of the body making it difficult to treat. Radiotherapy, chemotherapy and hormonal therapy are used to treat advanced cases along with surgery.

Prevention is always better than cure. Consulting a doctor when there is bleeding after menopause or when then there is heavy or irregular bleeding before menopause will help in detection of early stage cancer. Maintaining a healthy weight and regular exercise not only reduces the risk of endometrial cancer but also prevents obesity and its complications.

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