Transcription:
Endometrial Cancer: Early Detection, Prevention, and Treatment

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.

Melanie Cole (Host): Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss endometrial cancers, early detection, prevention and treatment. Joining me is Dr. Chris Jones. He's an Obstetrician Gynecologist with Memorial Hospital. Dr. Jones, it's a pleasure to have you with us today. Can you start by telling listeners a little bit about endometrial cancer, what it is and how is it?

Chris Jones, MD, OB/GYN, FACOG (Guest): Yeah. Thanks for having me. So, endometrial cancer is cancer of the uterus. It's actually a cancer of the lining of the uterus. The uterus as some of your listeners or our listeners may know, is the organ that carries a baby. And also is the organ that's responsible for women's periods on a monthly basis. The organ itself, the uterus, is made up of muscle and that muscle portion of the uterus actually is not very susceptible to cancer. But the lining of the uterus, where the embryo is implanted when a pregnancy begins, it's called the endometrium. So, this is the lining of the uterus, and this was the active portion of the uterus, and this is the portion of the uterus that is susceptible to cancer. And so that's called endometrial cancer. There is, there are some other uterine cancers that are from the uterus that are not uterine or endometrial cancer. However, those are relatively rare. So, so endometrial cancer is actually the most common gynecologic cancer in the United States and for that matter, probably worldwide. Probably about 55,000 a year, women a year are diagnosed with endometrial cancer in the United States and probably about 10,000 women yearly are dying from this disease.

Host: Wow. Those are incredible statistics. So, let's talk about risk, Dr. Jones. What characteristics contribute to risk level? Is there a genetic component to this? Tell us a little bit about risk factors.

Dr. Jones: Yeah. So, there's a couple of, I'll just start by saying there's a couple of different types of endometrial cancer. And the main one that we're talking about today and the most common type is you know, for our purposes, it's just called type one cancer. And you can pretty much think of risk factors for type one endometrial cancer as being any condition in which a woman is exposed to too much estrogen. There are two major hormones, when we talk about endocrine hormones, sex hormones in the female, and that's estrogen and progesterone. And any condition, which exposes the woman to too much estrogen as in relation to progesterone, will also increase her risk of endometrial cancer.

Some of these things that expose women to too much estrogen are obesity. That's probably the number one cause of too much estrogen that leads to endometrial cancer, because the adipose tissue converts different hormones in the body to a different type of estrogen. So, obesity predisposes a woman to too much estrogen, which subsequently increases her risk for endometrial cancer and then any condition in which a woman is not ovulating on a regular basis. After ovulation, the ovaries produce progesterone. And if you don't ovulate, you're not going to be producing progesterone and subsequently those women are again, exposed to too much estrogen. So, if you're not ovulating appropriately, that will usually manifest by irregular bleeding. And that's how most women can know that they're not ovulating appropriately is if they're not bleeding on a regular basis. So, anovulation, so a woman who's not ovulating has an increased risk. And that's probably why women with a history of infertility have an increased risk of endometrial cancer. And then there's a few other things. Early age of starting periods. So, I think the average age in the United States is probably about 10 or 11.

So if a girl starts her periods earlier in life, like you know, seven or eight years of age, that will increase her risk a little bit. And then also a late age of natural menopause. Average age in the United States is probably 52. So, if you go through menopause later than that, that's also a risk factor for endometrial cancer. And probably besides obesity, the other one, the other thing that we get concerned about is women who are on exogenous. So, estrogen that are prescribed to them by their providers. So, even though this is widely known in the medical community, there are instances where a provider will for whatever reason prescribe a woman estrogen and not prescribe them progesterone at the same time.

And that's a big risk factor for developing endometrial cancer. So, you know, if you're a patient out there and your provider has just given you estrogen and not progesterone, then you might want to question them as to the reason behind that. And then you also asked about if there's a genetic component.

Well, yeah, I mean, there are some pretty kind of classic genetic syndromes that can predispose to endometrial cancer. One of those is called Lynch syndrome, L-Y-N-C-H syndrome that predisposes a woman to various forms of cancer, including colon, ovarian and endometrial cancer.

And then, you know, also there's probably a you know, less classic genetic component to other reasons for increased risk. So, if you get a genetic predisposition to obesity, or, you know, just not ovulating appropriately, like PCOS, which 10% of our population has, there's probably a genetic component to that as well.

So, there is some genetic components, but I would say that the vast majority of women who are diagnosed with endometrial cancer do not have a family member that have a history of endometrial cancer.

Host: So then Doctor, I think the most probably important question for women is symptoms. Because a lot of symptoms that mimic gynecologic cancers are things that we women go through all the time anyway. I'm post-menopausal so I'm in my late fifties, but I know that for a lot of us, bloating and cramping and heavy bleeding and not heavy bleeding, I mean, it's all so difficult to tell. Do you have some symptoms you can point to for us?

Dr. Jones: Yes, absolutely. And this is a key point you're bringing up. So you, you, essentially what you're alluding to is that in cancers that cause non-specific symptoms. So, just kind of general symptoms, that's sometimes difficult for a patient and her provider to decide, well, is this important or not?

So you talked about bloating. So, this relates really, and we may talk about this later on in our session here today, but that relates really to things like ovarian cancer. So, you hear oftentimes that ovarian cancer presents late in its disease course. And that's because just as you say, some of the symptoms are just so common, you know, bloating, a little indigestion, some cramping. So, that's extremely common in women who don't have any serious disease, but it's also common in women with ovarian cancer. And that's why a lot of times, we miss ovarian cancer for a long period of time, both patients and doctors alike. The key point here though, is endometrial cancer is different than that.

Endometrial cancer, as we talked about is the lining of the uterus and the endometrium. Its function is to accept the embryo when it comes time to, to have a baby. And, and then if it doesn't have a baby, then it bleeds off and you have a nice normal period. The nice thing, if that could be said, I always tell patients it's a little hard to say this, but the nice thing about endometrial cancer is it tells us that there's a problem.

And in fact, in the United States, about 70% of cases of endometrial cancer are diagnosed in the very first stage when it's very treatable. And the reason why that is, is that the uterus tells us there's a problem and it shows us, and it shows us by bleeding on an irregular basis. So, it's real easy for post-menopausal women. So, if you're a post-menopausal woman, and you have any bleeding at all, when you shouldn't be having bleeding, ah, ha well, that could be a sign of endometrial cancer. And that's why we diagnose it early because most women, at some point, if they have post-menopausal bleeding, they'll say, well, I'm not supposed to be having bleeding anymore.

And they'll go to the doctor and they'll get, they'll get diagnosed and they'll get diagnosed in the early stages and they'll get treated and they'll be cured. So, that's an easy one for post-menopausal women, as far as knowing what to do when they show up when they're bleeding, when they're not supposed to be. A little bit more, more of a difficult diagnostic issue and an issue as to whether or not a patient should come in to the doctor is when you're premenopausal.

So, premenopausal women who have irregular periods, they might just chalk it up to just irregular periods. And in most cases it is not a sign of anything real significant, however, eventually a woman with irregular periods that is being caused by something more significant, like an endometrial cancer will end up coming to the doctor and hopefully they'll be diagnosed relatively early.

So, you know, and again it's, it's a strange thing to say, but that's really the nice thing about endometrial cancer., Is it, it tells us early that there was a problem. And, and in general, again, I would say that the main number one symptom that a woman probably should contact their healthcare provider is number one, if they're post-menopausal. So, if they've haven't had periods for a year, which is the definition of menopause and then let's say five years after their last period, they have some spotting, even just a little bit of spotting, they should go in and be evaluated. And then in the younger woman if irregular bleeding, you know, I wouldn't necessarily make an appointment if you have one irregular period, but you know, if you start to establish a pattern where you're having irregular bleeding, if you're a premenopausal woman, you should probably go in to, to talk to your healthcare provider about that.

Host: Wow. This is so informative and if we have any of those symptoms, really the abnormal bleeding that you discussed, tell us a little bit about what the doctor's going to do to diagnose this. And then I'd like you to talk about some of the treatment options and services that you provide at Memorial hospital.

Dr. Jones: Yeah, thanks, Melanie. You know, I guess I'd like to back up just a tad bit and just you know, especially to the premenopausal women who have irregular bleeding. Now, the vast majority of those women are not going to have endometrial cancer. So, I don't to have anybody have an abnormal period and automatically think that they, oh my gosh, I have cancer.

But you know, again, if they have bleeding that continues on an irregular basis for a period of time, you know, at some point they need to get in to see their provider and then even the post-menopausal woman. I wouldn't say the vast majority don't have cancer when they have post-menopausal bleeding, but the, but certainly the majority won't have cancer.

So it's no reason to panic, but it certainly is a reason to get in to be evaluated. As far as diagnosis of endometrial cancer, it's relatively straight forward, in most cases. So, if you're a post-menopausal woman and this is kinda how we need to break things up as far as different types of patients is post-menopausal and pre-menopausal. And post-menopausal patients who have bleeding, your provider will either do one of two things. They will certainly perform a pelvic exam, but an exam will not, in almost all cases, not be able to diagnose endometrial cancer and they may do one or two things. They may do a, an ultrasound of the uterus and, and depending on the thickness of the lining of the uterus, they, they may subsequently do a biopsy of the lining of the uterus in the office.

It's a really simple, straightforward procedure with I don't want no one to say no discomfort, but relatively minimal discomfort that can diagnose the endometrial cancer. So, in a post-menopausal woman, again either or an ultrasound either, or in both, I should say an ultrasound and a biopsy of the uterus. And then in a premenopausal woman, it depends on the risk factors really. So, if I've got a 20 year old woman who comes in with irregular bleeding, I won't necessarily look for endometrial cancer in her because she's essentially got no risk at all.

However, if I've got a 40 year old woman who has some of those risk factors that we talked about before, mainly being obesity or a long history of irregular periods; I would probably also do a biopsy of the lining of the uterus in that patient as well. And then sometimes if those biopsies don't give us the information that we want, then we may be left with taking the patient to the operating room for an old fashioned dilation and curretage where we kind of, are able to evaluate a greater portion of the lining of the uterus.

And then when we talk about treatment, like I said earlier, in the United States, because we do catch this early because patients come in and tell us that they're having a problem, 70% of women are diagnosed with stage one disease. And then of those women, about 90% of them are essentially cured.

And how do we cure those women after we diagnose endometrial cancer? Well, and for the majority of cases, a, the surgical option is, will be the best option for those patients. And that generally includes a hysterectomy as well as taking out the ovaries and the fallopian tubes. And then depending on the doctor who is doing the surgery, because there's some variation in practices to what the best thing to do is, some people, some doctors will do some surgery to remove some of the lymph nodes as well. But again, in, in 90% of patients who are diagnosed with stage one endometrial cancer, that surgery itself will be curative.

And then in the women who either can't go through surgery because of other conditions that make surgery let's say, too risky; there are different forms of treatment. There's radiation treatment. There's also some chemotherapy treatment and in some women, there's the option of hormonal treatment. And as I alluded to earlier, is actually the progesterone which we alluded to the fact that in women with endometrial cancer, they have too much estrogen. So, actually the hormone progesterone can be helpful in treatment of some women with different types of endometrial cancer,

Host: Well, Dr. Jones can you tell about some of the services that you provide at Hospital? This can be confusing and certainly really dizzying for any woman hearing word cancer. And you've given us so much hope for endometrial cancers and the treatments that are available today. Tell us a little bit about how they navigate all of that, the multidisciplinary approach that you all use to really help women that are diagnosed.

Dr. Jones: You asked first about the services we provide. I'm a general OB GYN. And for the most part, if I ever have a patient who is diagnosed with endometrial cancer, I refer them to a gynecologic oncologist, which is a gynecologic doctor like myself, but who's also had a further training in gynecologic cancers.

And so my role in, in terms of endometrial cancer, is detection. And, kind of the other services, I provide again, are just general OB GYN. So of course, obstetrics is care of the pregnant mother and her fetus. So, I'll do prenatal care, preconceptual care, labor and delivery care and postpartum care.

And then in terms of gynecology, I spend a lot of my time diagnosing and treating either medically or surgically, abnormal uterine bleeding, pelvic pain, abnormal pap smears. That's one of the screening tests we do for the, the other major gynecologic cancer, cervical cancer. And you know, of course I'll do just a well-woman exam to see if a patient is a candidate for a colonoscopy, which we know saves lives. See if they're a candidate for mammography, things of that nature.

Host: Well, certainly you mentioned pelvic and that's a big one, so many women of ages, really. So, that's such wide services that you offer any way that we can possibly prevent cancer? Can you just tell bit about lifestyle and when you're counseling your patients, what is it that you tell them every day, Dr. Jones.

Dr. Jones: Yeah, well, as far as is actually is a relatively easy answer. It's not easy to do, but it's an easy answer. So, the majority of women in the United States who are diagnosed with endometrial cancer are going to be obese. So, obviously there's something that we can do to help try to prevent endometrial cancer, and that's living a healthy lifestyle. So certainly anything we can do to restore that in a premenopausal woman that, that natural normal cycle. So, a healthy lifestyle and healthy weight will make it more likely that a woman will be ovulating and having normal periods. And that certainly would go a long way to decreasing risk of endometrial cancer. And then, also actually oral contraceptive pills can decrease the risk of endometrial cancer as well.

Host: That's so interesting. So, you have just really given us a lot of great information. Do you have any final thoughts you'd like to leave the listeners with about gynecologic cancers in general? We only have a minute left Dr. Jones, but what would you like to tell women listening about being their own best health advocate? And when you feel it's important that they speak to their gynecologist really about any of their concerns.

Dr. Jones: Sure. Yeah. I mean the healthy is a big one. I mean, I think not just in relation to endometrial cancer, but for example, vulvar cancer is increased in women who smoke. So, you know, keeping a healthy weight, eating a good diet, exercising, not smoking certainly would go a long way to preventing a lot of gynecologic cancers.

And then, you know, as we talked about before, early detection is always the best, early detection of cancer. So if there's ever any questions, I think the most important thing to do is to get in to see your provider and not just, you know, I get a lot of women who will come in unfortunately, I wouldn't say a lot, but you'll get those women who will come in later in the stage of their cancer and you'll ask them why they waited so long and they just thought, well, I thought it was a normal part of aging.

So, it's important that, that if you have any concerns at all about your gynecologic health or any of your other health for that matter, to go talk to a healthcare provider that could direct you to appropriate screening tests.

Host: Great information, Dr. Jones. Wow. Thank you so much for joining us today and sharing your incredible expertise. And you've given us so much to think about and certainly really great advice about speaking to your provider. Being your own best health advocate, not waiting to come in and not to be afraid of asking because some of these things are not a normal part of aging. And thank you so much for joining us.

To schedule an appointment with Dr. Chris Jones, you can call 217- 357-2173, or you can visit our website at mhtlc.org to learn more about Memorial Hospital's obstetric services. That concludes this episode of Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole. Thanks so much for listening.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.