Obesity Is Leading Risk Factor
Cancer of the uterus (uterine cancer) is the most common gynecologic cancer in the United States. Although there are two types, endometrial cancer is the most common uterine cancer. Endometrial cancers arise from the inner lining of the uterus, while the second type — uterine sarcoma — occurs in the myometrium, or the muscle wall of the uterus.
Obesity and Endometrial Cancer
A number of cancers are associated with obesity, including endometrial cancer. In one study by American Institute for Cancer Research, for every increase of five BMI units, there was a 50% increase in risk of developing endometrial cancer. In fact, obese and overweight women are two to four times as likely as normal-weight women to develop endometrial cancer, and extremely obese women are seven times more likely to develop this cancer.
“The problem is not obesity as much as it is the issues that occur with that weight gain, such as high blood pressure, heart disease and stroke,” explains Director of Gynecologic Robotic Surgery at Northwestern Medicine Prentice Women’s Hospital, Edward J. Tanner III, MD, who has lectured nationally and internationally on surgical innovations in gynecologic cancer.
Obesity is also closely tied to hormonal changes, including estrogen levels. “Women who are overweight or obese have higher rates of circulating estrogen in their bloodstream. This estrogen stimulation can lead to the development of cancer,” says Dr. Tanner.
Menopause and Endometrial Cancer
Endometrial cancer typically occurs after menopause. During a woman’s menstrual cycle, estrogen stimulates the uterus. As you age, your ovaries release fewer hormones and you experience a natural decline in estrogen levels.
“It’s an imbalance of estrogen that leads to endometrial cancer. After menopause, those hormones are no longer produced,” says Dr. Tanner. “The ovaries are the only source of the hormone that counterbalances estrogen with progesterone.”
For those who use hormone therapy to ease menopause symptoms, studies have shown an increased risk of endometrial cancer when estrogen is taken without combination progesterone. Combination therapy is oftentimes a safe option if menopause symptoms are severe. Hormone replacement therapy should only be taken under the guidance of a women’s health provider.
Although the exact cause is unknown, other risk factors include:
- Using an intrauterine device (IUD)
- Advancing age (women age 50 and older)
- Family history of endometrial cancer or colorectal cancer
- Personal history of breast cancer or ovarian cancer
- History of endometrial hyperplasia
- History of polycystic ovary syndrome (PCOS)
- Certain genetic conditions, such as Lynch syndrome
Symptoms and Treatment
The most common symptom women experience is abnormal vaginal bleeding. However, for most women this is the only symptom they may experience. “Even if it’s one spot, women who have irregular bleeding, especially at or after menopause, should be evaluated,” Dr. Tanner urges.
Other symptoms can be very subtle and may include:
- Vaginal discharge
- Pain when urinating
- Pain during sex
- Unexplained weight loss
- Pain, pressure or a lump in the pelvic area or lower belly
According to Dr. Tanner, a conservative treatment approach may involve hormone therapy in the form of higher doses of progesterone to offset the levels of estrogen. However, a hysterectomy is typically a successful treatment option for most women, he says. Other forms of treatment may include radiation therapy, chemotherapy and immunotherapy.
The Bottom Line
If you notice irregular bleeding or spotting, get a medical evaluation right away, says Dr. Tanner. If you are diagnosed with endometrial cancer, seek out a specialist. “It’s really important for patients who have been diagnosed to see a gynecologic oncologist,” Dr. Tanner says. “They can offer the gold standard of care and leading-edge treatment.”
For those looking to reduce their risk for endometrial cancer, Dr. Tanner encourages a healthy diet and daily moderate physical activity.