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Wednesday, 6 March 2013

Endometrial Cancer

Endometrial Cancer is a cancer of the inner lining of the womb. It is the next most common cancer after the ovary but has a much better prognosis and survival rate. Endometrial cancers tend to be less aggressive and are almost always related to high and prolonged exposure to oestrogen. Which is why they are more common and typically affect women who are "fat, fair, and fifty". Late menopause, obesity predispose to endometrial cancer. The good news is that they are often detected early and when treated by surgery in the early stage have a 95% chance of 5 year survival or cure.
My patient presented at age 52 with bleeding in between her periods. Her GP had given her hormones to try and regulate her menstrual flow and stop the bleeding without success. When I saw her, an ultrasound scan of her uterus was unremarkable except that the lining of her womb was unusually thick. This raised my suspicions, and I immediately arranged to do a hysteroscopy (viewing the cavity of the womb with a telescope) and performing a biopsy. The hysterscope enabled me to view and locate a very small suspicious area on the lining. Now in the olden days, the standard procedure would be to perform a dilatation and curettage or scrapping of the womb. This small nidus would almost certainly have been missed with such a blind procedure and produced a false negative result. A biopsy of the suspicious area confirmed a stage I(a) endometrial cancer. Over the next week, I performed a total hysterectomy and bilateral salpingo-oophorectomy for my patient, taking out her womb, tubes and ovaries. No further treatment was necessary and I could confidantly tell her that she had a very good prognosis and was indeed a very lucky woman. The message to remember is to have any form of bleeding per vaginum or change in periods investigated thoroughly and not delay having your annual check-ups. A vigilant gynaecologist will pick up anything that could progress to something more sinister and not delay a cure. Avoid taking soy products (not fermented soy) as they are high in plant oestrogens, maintain a healthy weight through excercise.