Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T19:12:36.297Z Has data issue: false hasContentIssue false

18 - Endometrial cancer: prevention, screening, and early detection

from Part IV - Cancer prevention

Published online by Cambridge University Press:  21 August 2009

By
Ellen Sakornbut
Edited by
Jo Ann Rosenfeld
Ellen Sakornbut
Affiliation:
University of Iowa
Jo Ann Rosenfeld
Affiliation:
The Johns Hopkins University
Get access

Summary

Case: T.H. is a 48-year-old woman who has not had a menstrual period in seven months, when she comes into the office with a sudden heavy menstrual period that has already lasted ten days. She has had to use three boxes of pads, and up to one pad an hour at its most heavy flow. She has had no pain but wonders what is happening to her. She does not smoke, is moderately overweight (body mass index (BMI) 31.0), and had normal thyroid tests three months ago.

Introduction

Endometrial carcinoma is one of the most common cancers in women, with an incidence of 2.6%. It ranks behind breast cancer and colon cancer in incidence, but it is seen more commonly than ovarian cancer. Endometrial carcinoma may be preceded by endometrial hyperplasia. Hyperplasia, as a potentially precancerous condition, and endometrial carcinoma meet criteria for conditions that benefit from early detection. Effective, reasonably tolerated treatments of endometrial hyperplasia and early-stage endometrial carcinoma are available. Early treatment has a significant impact on outcome.

Endometrial carcinoma and hyperplasia present most frequently with abnormal uterine bleeding, either in the premenopausal and perimenopausal age group, or in postmenopausal women. This is a common complaint in mid-life women. The presence of vaginal bleeding is also monitored in many women during mid life by clinicians concerned with the side effects of hormonal therapy or in high-risk women, such as those undergoing treatment with tamoxifen following breast cancer diagnosis.

Keywords

endometrial biopsyendometrial carcinomaendometrial hyperplasiahormonetherapyPipellesalpingoophorectomyunopposed estrogenhysterectomy
Type
Chapter
Information
Women's Health in Mid-Life
A Primary Care Guide
 , pp. 293 - 310
Publisher: Cambridge University Press
Print publication year: 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kurman, R. J., Kaminski, P. F. and Norriss, H. J.The behavior of endometrial hyperplasia. A long-term study of “untreated hyperplasia” in 170 patients. Cancer 1985; 56:4033.0.CO;2-X>CrossRefGoogle Scholar
Dietel, M.The histological diagnosis of endometrial hyperplasia. Is there a need to simplify?Virchows Arch. 2001; 439:604–8CrossRefGoogle Scholar
Horn, L. C., Bilek, K. and Schnurrbusch, U.[Endometrial hyperplasias: histology, classification, prognostic significance, and therapy.]Zentralbl. Gynakol. 1997; 119:251–9Google Scholar
Anastasiadis, P. G., Koutlaki, N. G., Skaphida, P. G., et al.Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur. J. Gynaecol. Oncol. 2000; 21:180–83Google ScholarPubMed
Sherman, M. E.Theories of endometrial carcinogenesis: a multidisciplinary approach. Mod. Pathol. 2000; 13:295–308CrossRefGoogle ScholarPubMed
Sung, J., Zheng, Y., Quddus, M. R., et al.p53 as a significant prognostic marker in endometrial carcinoma. Int. J. Gynecol. Cancer 2000; 10:119–27CrossRefGoogle ScholarPubMed
Effects of hormone replacement therapy on endometrial histology in postmenopausal women The Postmenopausal Estrogen/Progestin Interventions Trial. The Writing Group for the PEPI trial. J. Am. Med. Assoc. 1996; 275:370–75CrossRef
Woodruff, J. D. and Pickar, J. H.Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens only. Am. J. Obstet. Gynecol. 1994; 170:1213–23CrossRefGoogle ScholarPubMed
Hachisuga, T., Fukada, K., Iwasaka, T., et al.Endometrioid adenocarcinomas of the uterine corpus in women younger than 50 years of age can be divided into two distinct clinical and pathologic entities based on anatomic location. Cancer 2001; 92:2578–843.0.CO;2-V>CrossRefGoogle ScholarPubMed
Duska, L. R., Garrett, A., Rueda, B. R., et al.Endometrial cancer in women 40 years of age and younger. Gynecol. Oncol. 2001; 83:388–93CrossRefGoogle Scholar
Ricci, E., Moronia, S., Parazzini, F., et al.Risk factors for endometrial hyperplasia: results from a case-control study. Int. J. Gynecol. Cancer 2002; 12:257–60CrossRefGoogle ScholarPubMed
Anderson, K. E., Anderson, E., Mink, P. J., et al.Diabetes and endometrial cancer in the Iowa women's health study. Cancer Epidemiol. Biomarkers Prev. 2001; 10:611–16Google ScholarPubMed
Ricci, E., Moroni, S., Parazinni, F., et al.Risk factors or endometrial hyperplasia: results from a case–control study. Int. J. Gynecol. Cancer 2002; 12:257–60CrossRefGoogle ScholarPubMed
Weidepass, E., Persson, I., Adami, H. O., et al.Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 2000; 11:185–92Google Scholar
Bernstein, L., Deape, D., Cerhan, J. R., et al.Tamoxifen therapy for breast cancer and endometrial cancer risk. J. Natl. Cancer Inst. 1999; 91:1654–62CrossRefGoogle ScholarPubMed
Pukkal, E., Kyyronen, P., Sankila, R. and Holli, K.Tamoxifen and toremifene treatment of breast cancer and risk of subsequent endometrial cancer: a population-based case–control study. Int. J. Cancer 2002; 100:337–41CrossRefGoogle Scholar
Neven, P., Lunde, T., Benedetti-Panici, P., et al.A multicentre randomized trial to compare uterine safety of raloxifene with a continuous combined hormone replacement therapy containing oestradiol and norethisterone acetate. Br. J. Obstet. Gynaecol. 2003; 110:157–67CrossRefGoogle ScholarPubMed
Lynch, H. T. and Lynch, J.Lynch syndrome: genetics, natural history, genetic counseling, and prevention. J. Clin. Oncol. 2000; 18(21 supp):19–31SGoogle Scholar
Watson, P., Vasen, H. F., Mecklin, J. P., Jarvinen, H. and Lynch, H. T.The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am. J. Med. 1994; 96:516–20CrossRefGoogle ScholarPubMed
Wild, S., Pierpoint, T., Jacobs, H. and McKeigue, P.Long-term consequences of polycystic ovary syndrome: results of a 31 year follow-up study. Hum. Fertil. (Camb.) 2000; 3:101–5CrossRefGoogle ScholarPubMed
Yamazawa, K., Matsui, H., Seki, K. and Sekiya, S.A case–control study of endometrial cancer after antipsychotics exposure in premenopausal women. Oncology 2003; 64:116–23CrossRefGoogle ScholarPubMed
Farquhar, C. M., Lethaby, A., Sowter, M., Verry, J. and Baranyai, J.An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am. J. Obstet. Gynecol. 1999; 181:525–9CrossRefGoogle ScholarPubMed
Anastasiadis, P. G., Skaphida, P. G., Koutlaki, N. G., et al.Descriptive epidemiology of endometrial hyperplasia in patients with abnormal uterine bleeding. Eur. J. Gynaecol. Oncol. 2000; 21:131–4Google ScholarPubMed
Thomas, D. E.The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries. Contraception 1991; 43:695–710CrossRefGoogle ScholarPubMed
Balen, A.Polycystic ovary syndrome and cancer. Hum. Reprod. Update 2001; 7:522–5CrossRefGoogle ScholarPubMed
Feeley, K. M. and Wells, M.Hormone replacement therapy and the endometrium. J. Clin. Pathol. 2001; 54:435–40CrossRefGoogle ScholarPubMed
Pickar, J. H., Yeh, I., Wheeler, J. E., Cunnane, M. F. and Speroff, L.Fertil. Steril. 2001; 76:25–31CrossRef
Lethaby, A., Farquhar, C., Sarkis, A., et al. Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev 2000; CD000402
Sendag, F., Terek, M. C. and Karadadas, N.Sequential combined transdermal and oral postmenopausal hormone replacement therapies: effects on bleeding patterns and endometrial histology. Arch. Gynecol. Obstet. 2001; 265:209–13CrossRefGoogle ScholarPubMed
Mount, S. L., Wegner, E. K., Eltabbakh, G. H., Olmstead, J. I. and Drejet, A. E.Significant increase of benign endometrial cells on Papanicolaou smears in women using hormone replacement therapy. Obstet. Gynecol. 2002; 100:445–50Google ScholarPubMed
Karim, B. O., Burroughs, F. H., Rosenthal, D. L. and Ali, S. Z.Enodmetrial-type cells in cervico-vaginal smears: clinical significance and cytopathologic correlates. Diagn. Cytopathol. 2002; 26:123–7CrossRefGoogle ScholarPubMed
Chhieng, D. C., Elgert, P. A., Cangiarella, J. F. and Cohen, J. M.Clinical significance of atypical glandular cells of undetermined significance. A follow-up study from an academic medical center. Acta Cytol. 2000; 44:557–66CrossRefGoogle ScholarPubMed
Vhin, A. B., Bristow, R. E., Korst, L. M., Walts, A. and Lagasse, L. D.The significance of atypical glandular cells on routine cervical cytologic testing in a community-based population. Am. J. Obstet. Gynecol. 2000; 182:1278–82Google Scholar
Chhieng, D. C., Elgert, P., Cohen, J. M. and Cangiarella, J. F.Clinical implications of atypical glandular cells of undetermined significance, favor endometrial origin. Cancer 2001; 93:351–6CrossRefGoogle ScholarPubMed
Nakagawa-Okamura, C., Sato, S., Tsuiji, I., et al.Effectiveness of mass screening for endometrial cancer. Acta Cytol. 2002; 46:277–83CrossRefGoogle ScholarPubMed
Gol, K., Saracoglu, F., Ekici, A. and Sahin, I.Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women. Gynecol. Endocrinol. 2001; 15:63–7CrossRefGoogle ScholarPubMed
Korhonen, M. O., Symons, J. P., Hyde, B. M., Rowan, J. P. and Wilborn, W. H.Histologic classification and pathologic findings for endometrial biopsy speci-mens obtained from 2694 perimenopausal and menopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 Study). Am. J. Obstet. Gynecol. 1997; 176:377–80CrossRefGoogle Scholar
Archer, D. F., Mc-Intyre Seltman, K., Wilborn, W. W. Jr, et al.Endometrial morphology in asymptomatic postmenopausal women. Am. J. Obstet. Gynecol. 1991; 165:317–20CrossRefGoogle ScholarPubMed
Barakat, R. R., Gilewski, T. A., Almadrones, L., et al.Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: a prospective study using office endometrial biopsy. J. Clin. Oncol. 2000; 18:3459–63CrossRefGoogle ScholarPubMed
Epstein, E. and Valentin, L.Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women. Ultrasound Obstet. Gynecol. 2002; 20:486–91CrossRefGoogle ScholarPubMed
Andolf, E., Dahlander, K. and Aspenberg, P.Ultrasonic thickness of the endometrium correlated to body weight in asymptomatic postmenopausal women. Obstet. Gynecol. 1993; 82:936–40Google ScholarPubMed
Fleischer, A. C., Wheeler, J. E., Lindsay, I., et al.An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms. Am. J. Obstet. Gynecol. 2001; 184:70–75CrossRefGoogle ScholarPubMed
Langer, R. D., Pierce, J. J., O'Hanlan, K. A., et al.Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease. Postmenopausal Estrogen/Progestin Interventions Trial. N. Engl. J. Med. 1997; 337:1792–8CrossRefGoogle ScholarPubMed
Gerber, B., Krause, A., Muller, H., et al.Ultrasonograhic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding. Eur. J. Cancer. 2001; 37:64–71CrossRefGoogle Scholar
Neven, P. and Vernaeve, J.Guidelines for monitoring patients taking tamoxifen treatment. Drug Saf. 2000; 22:1–11CrossRefGoogle ScholarPubMed
Love, C. D., Muir, B. B., Scrimgeour, J. B., et al.Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening. J. Clin. Oncol. 1999; 17:2050CrossRefGoogle ScholarPubMed
Gerber, B., Krause, A., Muller, H., et al.Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J. Clin. Oncol. 2000; 18:3464–70CrossRefGoogle ScholarPubMed
Giorda, G., Crivellari, D., Veronesi, A., et al.Comparison of ultrasonography, hysteroscopy, and biopsy in the diagnosis of endometrial lesions in postmenopausal tamoxifen-treated patients. Acta Obstet. Gynecol. Scand. 2002; 81:975–80CrossRefGoogle Scholar
Cohen, I., Perel, E., Flex, D., et al.Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynecologically symptomatic and asymptomatic breast cancer patients. J. Clin. Pathol. 1999; 52:278–82CrossRefGoogle Scholar
Dove-Edwin, I., Boks, D., Goff, S., et al.The outcome of endometrial carcinoma surveillance by ultrasound scan in women at risk for hereditary nonpolyposis colorectal carcinoma and familial colorectal carcinoma. Cancer 2002; 94:1708–12CrossRefGoogle ScholarPubMed
Gull, B., Carlsson, S., Karlsson, B., et al.Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy?Am. J. Obstet. Gynecol. 2000; 182:509–15CrossRefGoogle ScholarPubMed
Karlsson, B., Granberg, S., Wikland, M., et al.Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding – a Nordic multicenter study. Am. J. Obstet. Gynecol. 1995; 172:1488–94CrossRefGoogle ScholarPubMed
Weber, G., Merz, E., Bahlmann, F. and Rosch, B.Evaluation of different transvaginal sonographic parameters in women with postmenopausal bleeding. Ultrasound Obstet. Gynecol. 1998; 12:265–70CrossRefGoogle ScholarPubMed
Randelzhofer, B., Prompeler, H. J., Sauerbrei, W., Madjar, H. and Emons, G.Value of sonomorphological criteria of the endometrium in women with postmenopausal bleeding: a multivariate analysis. Ultrasound Obstet. Gynecol. 2002; 19:62–8CrossRefGoogle ScholarPubMed
Epstein, E. and Valentin, L.Rebleeding and endometrial growth in women with postmenopausal bleeding and endometrial thickness <5 mm managed by dilation and curettage or ultrasound follow-up: a randomized controlled study. Ultrasound Obstet. Gynecol. 2001; 18:499–504CrossRefGoogle ScholarPubMed
Goldstein, R. B., Bree, R. L., Benson, C. B., et al.Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. J. Ultrasound Med. 2001; 20:1025–36CrossRefGoogle ScholarPubMed
Medverd, J. R. and Dubinsky, T. J.Cost analysis model: US versus endometrial biopsy in evaluation of peri- and postmenopausal abnormal uterine bleeding. Radiology 2002; 222:619–27CrossRefGoogle Scholar
Deckardt, R., Lueken, R. P., Gallinat, A., et al.Comparison of transvaginal ultrasound, hysteroscopy, and dilation and curettage in the diagnosis of abnormal vaginal bleeding and intrauterine pathology in perimenopausal and postmenopausal women. J. Am. Assoc. Gynecol. Laparosc. 2002; 9:277–82CrossRefGoogle Scholar
Clark, T. J., Gupta, J. K., Hyde, C., Song, F. and Khan, K. S.Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. J. Am. Med. Assoc. 2002; 288:1610–21CrossRefGoogle Scholar
Dijkhuizen, F. P., Mol, B. W., Brolmann, H. A. and Heintz, A. P.The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89:1765–723.0.CO;2-F>CrossRefGoogle Scholar
Larson, D. M. and Broste, S. K.Histopathologic adequacy of office endometrial biopsies taken with the Z-sampler and Novak curette in premenopausal and postmenopausal women. J. Reprod. Med. 1994; 39:300–303Google ScholarPubMed
Livengood, C. H. 3rd, Land, M. R. and Addison, W. A.Endometrial biopsy, bacteremia, and endocarditis risk. Obstet. Gynecol. 1985; 65:678–81Google ScholarPubMed
Trolice, M. P., Fishburne, C. Jr. and McGrady, S.Anesthetic efficacy of intrauterine lidocaine for endometrial biopsy: a randomized double-masked trial. Obstet. Gynecol. 2000; 95:345–7Google ScholarPubMed
Cicinelli, E., Didonna, T., Schonauer, L. M., et al.Paracervical anesthesia for hysteroscopy and endometrial biopsy in postmenopausal women. A randomized, double-blind, placebo-controlled study. J. Reprod. Med. 1998; 43:1014–18Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×