Skip to main content Accessibility help
×
Home
  • Print publication year: 2004
  • Online publication date: August 2009

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

from Part IV - Cancer prevention

Summary

Endometrial carcinoma is one of the most common cancers in women, with an incidence of 2.6%. This chapter examines the effects of the woman's hormonal environment on the development of endometrial hyperplasia and endometrial carcinoma, additional risk factors, and preventive measures for this common malignancy. When hormonetherapy consisted of unopposed estrogen, a higher incidence of endometrial hyperplasia and carcinoma was found in women on this therapy compared with non-treated women. A systematic review of randomized controlled trials found unopposed estrogen therapy in moderate to high doses to be associated with significant increases in rates of endometrial hyperplasia. The risk of endometrial carcinoma in complex atypical hyperplasia is approximately 25%, and warrants surgical management with hysterectomy and salpingoophorectomy. The accuracy of endometrial biopsy as compared with dilation and curettage in detection of endometrial carcinoma ranges from 91 to 99.6% with sampling devices such as the Pipelle.
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; 56:403
Dietel, M.The histological diagnosis of endometrial hyperplasia. Is there a need to simplify?Virchows Arch. 2001; 439:604–8
Horn, L. C., Bilek, K. and Schnurrbusch, U.[Endometrial hyperplasias: histology, classification, prognostic significance, and therapy.]Zentralbl. Gynakol. 1997; 119:251–9
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; 21:180–83
Sherman, M. E.Theories of endometrial carcinogenesis: a multidisciplinary approach. Mod. Pathol. 2000; 13:295–308
Sung, J., Zheng, Y., Quddus, M. R., et al.p53 as a significant prognostic marker in endometrial carcinoma. Int. J. Gynecol. Cancer 2000; 10:119–27
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; 275:370–75
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; 170:1213–23
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; 92:2578–84
Duska, L. R., Garrett, A., Rueda, B. R., et al.Endometrial cancer in women 40 years of age and younger. Gynecol. Oncol. 2001; 83:388–93
Ricci, E., Moronia, S., Parazzini, F., et al.Risk factors for endometrial hyperplasia: results from a case-control study. Int. J. Gynecol. Cancer 2002; 12:257–60
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; 10:611–16
Ricci, E., Moroni, S., Parazinni, F., et al.Risk factors or endometrial hyperplasia: results from a case–control study. Int. J. Gynecol. Cancer 2002; 12:257–60
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; 11:185–92
Bernstein, L., Deape, D., Cerhan, J. R., et al.Tamoxifen therapy for breast cancer and endometrial cancer risk. J. Natl. Cancer Inst. 1999; 91:1654–62
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; 100:337–41
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; 110:157–67
Lynch, H. T. and Lynch, J.Lynch syndrome: genetics, natural history, genetic counseling, and prevention. J. Clin. Oncol. 2000; 18(21 supp):19–31S
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; 96:516–20
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; 3:101–5
Yamazawa, K., Matsui, H., Seki, K. and Sekiya, S.A case–control study of endometrial cancer after antipsychotics exposure in premenopausal women. Oncology 2003; 64:116–23
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; 181:525–9
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; 21:131–4
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; 43:695–710
Balen, A.Polycystic ovary syndrome and cancer. Hum. Reprod. Update 2001; 7:522–5
Feeley, K. M. and Wells, M.Hormone replacement therapy and the endometrium. J. Clin. Pathol. 2001; 54:435–40
Pickar, J. H., Yeh, I., Wheeler, J. E., Cunnane, M. F. and Speroff, L.Fertil. Steril. 2001; 76:25–31
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; 265:209–13
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; 100:445–50
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; 26:123–7
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; 44:557–66
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; 182:1278–82
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; 93:351–6
Nakagawa-Okamura, C., Sato, S., Tsuiji, I., et al.Effectiveness of mass screening for endometrial cancer. Acta Cytol. 2002; 46:277–83
Gol, K., Saracoglu, F., Ekici, A. and Sahin, I.Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women. Gynecol. Endocrinol. 2001; 15:63–7
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; 176:377–80
Archer, D. F., Mc-Intyre Seltman, K., Wilborn, W. W. Jr, et al.Endometrial morphology in asymptomatic postmenopausal women. Am. J. Obstet. Gynecol. 1991; 165:317–20
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; 18:3459–63
Epstein, E. and Valentin, L.Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women. Ultrasound Obstet. Gynecol. 2002; 20:486–91
Andolf, E., Dahlander, K. and Aspenberg, P.Ultrasonic thickness of the endometrium correlated to body weight in asymptomatic postmenopausal women. Obstet. Gynecol. 1993; 82:936–40
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; 184:70–75
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; 337:1792–8
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; 37:64–71
Neven, P. and Vernaeve, J.Guidelines for monitoring patients taking tamoxifen treatment. Drug Saf. 2000; 22:1–11
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; 17:2050
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; 18:3464–70
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; 81:975–80
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; 52:278–82
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; 94:1708–12
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; 182:509–15
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; 172:1488–94
Weber, G., Merz, E., Bahlmann, F. and Rosch, B.Evaluation of different transvaginal sonographic parameters in women with postmenopausal bleeding. Ultrasound Obstet. Gynecol. 1998; 12:265–70
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; 19:62–8
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; 18:499–504
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; 20:1025–36
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; 222:619–27
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; 9:277–82
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; 288:1610–21
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; 89:1765–72
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; 39:300–303
Livengood, C. H. 3rd, Land, M. R. and Addison, W. A.Endometrial biopsy, bacteremia, and endocarditis risk. Obstet. Gynecol. 1985; 65:678–81
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; 95:345–7
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; 43:1014–18