Understanding gynecologic cancers is extremely important for women, their families and their communities.
When I gave a lecture on gynecologic cancers in 2013, I spoke from an academic and scientific understanding. Now, this story involves my own endometrial cancer diagnosis, and it is personal. (Read my story, "Magical thinking and denial: learning to think about cancer.")
All gynecologic cancers are extremely personal because they involve intimate areas of our bodies. It is difficult for many of us to acknowledge problems we experience with our female anatomy. I frequently have discussions with women who tell me they have been denying their abnormal bleeding for months. Ladies, we delude ourselves when we refuse to face reality. Just say "no" to the fear of facing your personal myths about cancer.
What is endometrial cancer?
Endometrial cancer is a cancer that starts in the endometrium, the inner lining of the uterus (womb).
Endometrial cancer is the most common gynecologic cancer in the United States. If the signs are recognized early, the cure rate may be vastly improved. The emotional, psychological and physical details of these diseases may often prevent us from sharing our symptoms and discussing unusual symptoms, such as excessive vaginal bleeding. When we understand the warning signs of gynecologic cancers and bravely seek explanations, we become stronger. The strength to face cancer is as important as knowing about the diagnosis. When we put our fear into words, we allow those who love us to understand. They are our support and can help strengthen us when our fear becomes overwhelming.
What are the risk factors for endometrial cancer?
Factors that influence the risk for endometrial cancer include obesity, disorders such as polycystic ovary syndrome, long-term use of high-dose menopausal estrogens and early age at the first menstrual period. Additional factors include:
- Late age of natural menopause
- History of infertility
- Never having given birth
- Menstrual irregularities
- Residency in North America or northern Europe
- Higher level of education or income
- White race
- Older age
- High doses of tamoxifen over a period of time
- History of diabetes, hypertension or gallbladder disease
What are the signs of endometrial cancer?
Most women who have endometrial cancer will experience abnormal uterine bleeding early in the course of the disease.
If you are in the premenopausal age range and are experiencing heavy, prolonged menstrual bleeding, you must see your gynecologist for an evaluation. The importance of seeking medical attention is especially significant if your body mass index (BMI) is in the obesity range or if you have been diagnosed with chronic anovulation (decreased or absence of ovulation). Obesity increases the risk of endometrial cancer due to the production of high levels of estrone, a type of estrogen produced by fat cells. Your prolonged exposure to estrogens can stimulate the growth of endometrial cells within the uterus. If you miss your menstrual bleeding, the endometrial lining does not shed and persistent estrogen stimulation leads to a higher risk of endometrial cancer.
If you are in the perimenopausal age range and your menstrual bleeding has become heavy and prolonged you must insist that your gynecologist perform an endometrial biopsy (a sample of the endometrium is obtained during your gyn office visit) before you are scheduled for an endometrial ablation procedure (a procedure which destroys the inner lining of the uterus).
If you are postmenopausal you must have your gynecologist examine you for any bleeding you experience, even if it is just a single episode. Only approximately 10 percent of women with postmenopausal bleeding have endometrial cancer, however, the likelihood of endometrial cancer with postmenopausal bleeding increases with age.