[기고] Endometrial cancer can be cured if diagnosed early

According to national cancer registry statistics, endometrial cancer occurred in 3.1 cases per 100,000 women in 1999, but it increased approximately 4.7 times to 14.6 cases in 2021. Let’s learn about endometrial cancer, whose incidence has been increasing soon recently.

Endometrial cancer is a cancer that grows and sheds again according to a woman’s menstrual cycle and occurs in the lining of the uterus, where implantation occurs during heavy In the past, it happened often in Western countries, but recently the frequency of incidents in Korea has been increasing steadily.

Endometrial cancer is caused by overexposure to the female hormone estrogen. Recently, endometrial cancer is increasing due to excess exposure to estrogen due to the increase in the obese population due to western eating habits, low birth rate, and advanced pregnancy.

There are two types of endometrial cancer: type 1 endometrial cancer, which is caused by excess estrogen stimulation, and type 2 endometrial cancer, which is less related to estrogen. Type 1 describes the majority of endometrial cancer, usually arising from atypical endometriosis, diagnosed at an early stage, and has a good prognosis. On the other hand, type 2 occurs in atrophic intima and progresses quickly and has a poor prognosis.

Endometrial cancer is usually caused by genetic mutations that occur when the endometrium proliferates. Major risk factors include estrogen replacement therapy, obesity, long anovulatory cycles, and estrogen-secreting tumors. About 5% of endometrial cancer cases are caused by genetic mutations and are characterized by occurring before the age of 50.

The main symptom of endometrial cancer is vaginal bleeding, but it can also be detected during an asymptomatic examination. Postmenopausal women may experience bleeding, and premenopausal women may experience heavy menstruation or irregular bleeding outside of the menstrual period.

In women with suspicious symptoms for endometrial cancer, the risk of endometrial cancer should be assessed through a detailed medical history. It is suspected when the endometrium is thicker than the normal range, and all suspected patients can be diagnosed through biopsy after endometrial biopsy and endocervical scraping. Recently, as a screening test for genetic predisposition in endometrial cancer patients, additional tests are recommended to check for ‘DNA mismatch repair (MMR)’, which may occur during re- DNA representation and recombination in tumors.

If the infection progresses without treatment, the bleeding of the vagina can worsen and complications can occur by attacking the organs around the pelvis, so it is important to diagnose and treat it early.

Treatment options for endometrial cancer vary depending on the stage. Stages 1 and 2 endometrial cancer only invades the uterus or cervix, and adjuvant radiation therapy is performed according to risk factors for recurrence after hysterectomy and surgery. If surgical treatment is difficult for the patient due to underlying diseases such as old age, obesity, diabetes, or high blood pressure, radiation therapy can be performed beforehand. In addition, total hysterectomy, bilateral salpingo-oophorectomy, pelvic and aortic lymph node dissection, and pelvic and abdominal lavage cytology can be performed to confirm the stage.

For patients with stage 3 or 4 endometrial cancer, the primary surgical treatment is maximum tumor reduction, including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and aortic lymphadenectomy. However, if the cancer has progressed to the point where surgery is difficult based on imaging tests, chemotherapy or radiation therapy is recommended. Recently, chemotherapy containing checkpoint inhibitors has shown better treatment results in the initial treatment of patients with advanced or recurrent endometrial cancer, and chemotherapy containing checkpoint inhibitors is recommended check as initial treatment.

It is expected that the number of endometrial cancer in Korea will continue to increase in the future. Endometrial cancer is a disease that is 100% curable when an initial diagnosis is made, so in addition to regular gynecological examinations once a year, do not overlook the signs of vaginal bleeding in postmenopausal women, heavy menstruation in premenopausal women, or irregular bleeding and be sure to do so. You need to get a proper diagnosis and appropriate treatment at an early stage.