Endometrial Cancer
Two Major Women’s Health Groups Call Attention to a Leading Reproductive Cancer
Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) and the Society of Gynecologic Oncologists (SGO) today issued guidance to physicians for diagnosing, managing, and treating endometrial cancer, the most common female genital tract malignancy. In the US, more than 40,000 women will be diagnosed with endometrial cancer this year; it is the fourth most common cancer in women, behind lung, breast, and colon cancer. Approximately 7,310 women die annually from the disease. Because it is the most common cancer of the female reproductive system, nearly all ob-gyns will encounter the disease sometime in their career.
Written in partnership with the SGO, the new ACOG Practice Bulletin, “Management of Endometrial Cancer,” provides information on the epidemiology, the cause(s) and effects of the disease, and the management strategies, that will allow ob-gyns to identify women at increased risk, help diagnose cases early, and recommend treatment options. The document also outlines instances in which patients may benefit from referral to a gynecologic oncologist.
“This important collaboration between ACOG and SGO is another step we have taken together to improve care for women with gynecologic cancers,” says James W. Orr, Jr, MD, ACOG Fellow and immediate past president of SGO. “The comprehensive guidance offered for the management of women with endometrial cancer will contribute to improving patient outcomes.”
The most common cause of endometrial cancer is an excess of estrogen unopposed by progestogen; it is more common in women who take estrogen therapy alone, without a progestin hormone, after menopause. Women who take combination birth control pills (estrogen plus progestin) appear to have a lower risk. Women are at a higher risk of endometrial cancer if they:
- Do not ovulate regularly and often miss periods
- Began menstruating before age 12
- Have never been pregnant
- Have a history of infertility
- Are 50 or more pounds overweight
- Have endometrial hyperplasia (abnormal thickening of the endometrium)
- Have late menopause (on average, around age 51)
It is important to identify women at risk for endometrial cancer in order to provide them with counseling and appropriate screening. In addition, women with anovulatory disorders or problems with ovulation should be counseled about their long-term risk of endometrial cancer, and ways they can prevent or reduce their risk of the disease.
There is no standard screening test to detect endometrial cancer and routine screening is not recommended because of the lack of an appropriate, cost-effective, and acceptable test that reduces mortality. Fortunately, most women (90%) with endometrial cancer develop symptomatic vaginal bleeding or discharge that leads to an early diagnosis and results in an increased opportunity for cure, notes ACOG. Other symptoms include pelvic pressure or discomfort. A biopsy is the accepted first step in evaluating a patient with abnormal uterine bleeding or if endometrial cancer is suspected.
According to ACOG, most women with endometrial cancer should undergo complete systematic surgical staging to help determine appropriate management. Surgery is the most common treatment for women with endometrial cancer. In the unusual instance when a patient is deemed an exceptionally poor surgical candidate, radiation treatments alone may be considered in an attempt to treat the uterine disease. Women with atypical endometrial hyperplasia or very small endometrial cancer who want to maintain their fertility may be treated with progestin therapy.
ACOG also recommends that to detect any recurrent disease, patients should undergo pelvic exams every three to four months for two to three years, then twice a year, after surgical treatment of the cancer.
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The American College of Obstetricians and Gynecologists is the national medical organization representing over 49,000 members who provide health care for women.
The Society of Gynecologic Oncologists is a national medical specialty organization of physicians who are trained in the comprehensive management of women with malignancies of the reproductive tract