Is there a relationship between endometrial cancer and endometrial hyperplasia? Five types of people are prone to it! Be vigilant in this situation!

Author: Zhang Jingfei, deputy chief physician, Beijing Century Altar Hospital, Capital Medical University

Zhao ZheAttending physician at Beijing Century Altar Hospital, Capital Medical University

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Many female friends have heard of the term "endometrial hyperplasia". For those who don’t know much about it, they may think that endometrial hyperplasia is a precancerous lesion of endometrial cancer and feel a little panic.

The relationship between endometrial cancer and endometrial hyperplasia:

During a normal menstrual cycle, the hypothalamus-pituitary-ovarian axis controls the secretion of reproductive hormones through a sophisticated endocrine regulatory mechanism. Estrogen promotes the thickening of the endometrium, while progesterone plays an antagonistic role after ovulation to prevent excessive proliferation of the endometrium. If the antagonistic effect of progesterone is insufficient, abnormal proliferation of the endometrium may occur.

WHO divides endometrial hyperplasia into two types according to whether it is accompanied by cell atypia: endometrial hyperplasia without atypia and endometrial atypical hyperplasia. The former is mostly caused by continuous estrogen stimulation and is associated with anovulatory abnormal uterine bleeding, and its risk of progression to endometrial cancer is low (<5%); the latter is a precancerous lesion of endometrial cancer, with a canceration rate of 8%-27%.

Figure 1 Original copyright image, no permission to reprint

The treatment of endometrial hyperplasia needs to be managed in a stratified manner according to the pathological type: non-atypical endometrial hyperplasia can be treated conservatively with drugs; atypical hyperplasia is a precancerous lesion and requires active drug or surgical intervention. The treatment plan needs to be formulated in combination with the patient's age, fertility needs and pathological characteristics.

Risk factors for endometrial cancer:

The occurrence of endometrial cancer is mainly related to the long-term exposure of the endometrium to estrogen stimulation without progesterone antagonism. Women with abnormally elevated estrogen levels have a significantly increased risk of the disease. Specific risk factors can be divided into the following categories:

First, suffer from metabolic-related diseases. Obesity, diabetes, and hypertension are called the "endometrial cancer triad." Obesity: aromatase in adipose tissue can convert androstenedione into estrone, leading to elevated estrogen levels; diabetes: patients have a 2-4 times higher risk of endometrial cancer than normal women, which may be related to hyperinsulinemia and elevated insulin-like growth factor-1 (IGF-1) levels; hypertension: may increase the risk by affecting endothelial function and hormone metabolism.

Second, you have reproductive system diseases. Polycystic ovary syndrome (PCOS): chronic anovulation leads to progesterone deficiency; ovarian sex cord stromal tumors: such as granulosa cell tumors, which can secrete excessive estrogen; infertility: related to ovulatory dysfunction.

Third, women with premature menarche or delayed menopause. Premature menarche (<12 years old): prolongs the time the endometrium is exposed to estrogen; delayed menopause (>55 years old): depletion of follicle reserves leads to an increase in anovulatory cycles and insufficient progesterone secretion.

Fourth, women exposed to exogenous hormones. Irregular hormone replacement therapy after menopause: Estrogen therapy alone significantly increases the risk of endometrial cancer; Tamoxifen therapy: It has a weak estrogen-like effect, and long-term use increases the risk of cancer.

Fifth, patients with hereditary endometrial cancer syndrome. Hereditary non-polyposis colorectal cancer (Lynch syndrome) is the most common hereditary endometrial cancer syndrome, with a lifetime risk of endometrial cancer of up to 40%-60%.

Endometrial cancer warning signs:

Endometrial cancer often has no symptoms in its early stages, so regular gynecological examinations are very important. As the disease progresses, common warning signs include:

1. Abnormal uterine bleeding: Premenopausal women may experience menstrual cycle disorders, prolonged menstruation (>7 days) or increased menstrual flow (>80ml/cycle); any form of vaginal bleeding in postmenopausal women is abnormal.

2. Changes in vaginal discharge: including increased discharge volume, changes in nature (watery or bloody), or an odor.

Special reminder: Postmenopausal vaginal bleeding is the most common clinical manifestation of endometrial cancer, accounting for about 90% of cases. When the above symptoms occur, it is recommended to first perform a transvaginal ultrasound examination to evaluate the thickness of the endometrium (normal value for postmenopausal women ≤4mm) and the condition of the uterine cavity. If abnormalities are found, further endometrial biopsy or hysteroscopy and diagnostic curettage are required to confirm the diagnosis. It should be emphasized that although these symptoms are not unique to endometrial cancer, timely medical treatment and standardized examinations are the key to early diagnosis.

If the pathological diagnosis is endometrial cancer, we also need to do imaging examinations for clinical staging to determine the treatment method or scope of surgery. Pelvic enhanced MRI is the preferred imaging examination, which can clearly show: tumor size and location, depth of myometrial invasion, whether the cervical stroma is involved, whether there is metastasis to the adnexal area, and the condition of the pelvic lymph nodes. We also need to understand whether there is distant metastasis, such as chest CT examination to determine whether there is lung metastasis. In addition, serum tumor markers can be assisted in the detection of CA125, which is familiar to everyone, and may be elevated in advanced patients, while HE4, as a new marker, has a higher specificity.

Of course, the diagnosis of endometrial cancer is a very professional issue. We must follow the doctor's instructions for examination so that we can make a clear diagnosis as early as possible and take appropriate treatment measures.