Back To CoursePathophysiology Textbook
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Heather has taught reproductive biology and has researched neuro, repro and endocrinology. She has a PhD in Zoology/Biology.
Did you know there is a vaccine for cancer? The HPV vaccine for women helps prevent cancer of the cervix. That's this part of the reproductive tract. But, even though we have created a vaccine for cervical cancer, it's actually not even the most common form of cancer found in the reproductive tract.
The most common cancer of the female reproductive tract is endometrial cancer, a cancer that occurs in the endometrial lining of the uterus. The endometrium is the inner lining or layer of the uterine wall, the one that grows and sheds during menstruation. An estimated 50,000 women were diagnosed with endometrial, also called uterine, cancer in 2013 and, of these, about 8,000 had fatal cases of the disease. So what is endometrial cancer? And how do you get it?
While we don't know the exact cause of endometrial cancer, we do know that it involves a mutation in the cells of the endometrium. This mutation in their DNA causes normal, happy and healthy endometrial cells to become abnormal and unhealthy cells that overgrow and multiply. Kind of like Bruce Banner vs. the Incredible Hulk, or Dr. Jekyll and Mr. Hyde. The mutated cells are out of control compared to their normal counterparts.
These out-of-control cells keep on multiplying and don't die off when they are supposed to, creating a tumor in the epithelial tissue. In some cases, if the cancer isn't caught soon enough, the tumor cells can metastasize, or spread to other parts of the body.
So who exactly is at risk for this type of cancer? Well, females obviously, but is there anything that makes one female more susceptible to endometrial cancer than another?
Well, one of the main risk factors is actually the hormone estrogen. I know, you may be thinking, 'But aren't females supposed to have estrogen?' And yes, they are. Normally, both estrogen and progesterone levels rise and fall naturally, but sometimes certain conditions or diseases can alter estrogen metabolism. This can prevent estrogen levels from decreasing naturally or can cause higher-than-normal estrogen levels.
Prolonged exposure to estrogen has been identified as a risk factor for many female reproductive cancers, including endometrial cancer. Some of the conditions that can alter estrogen levels include:
Obesity and diabetes in association with a high-fat diet. You may not think that fat and your reproductive tract are related but they are. Excess fat can increase estrogen levels and interfere with fertility. Body fat can actually produce estrogen, and at the same time that estrogen makes it harder to break down abdominal fat, making estrogen and obesity linked.
Anovulation is our next risk factor. Now sometimes this can also be associated with obesity, but what does it mean? Well, let's break down the keyword. 'An' means without, so without what? Well, the definition is right there in the word. An'ovulation' means without, or lack of, ovulation.
Anovulation usually indicates abnormal hormone levels. Think about it this way. When a woman takes birth control pills, she is taking estrogen, well, estrogen and progesterone, and what do birth control pills do? They stop her cycle, right? Similarly, naturally occurring anovulation can be caused by excess estrogen.
PCOS, or polycystic ovarian syndrome, is also a cause of anovulation. It's thought to be a result of abnormal hormone levels, specifically the male hormone androgen that interferes with or prevents normal egg growth and ovulation.
Usually androgens in females are really low, which is why we don't have all that excess hair growth! And, our androgens can be converted to estrogens. So when androgens increase, estrogens also increase, raising the estrogen levels in PCOS patients, making it another risk factor associated with endometrial cancer.
Tumors or other growths of tissue that secrete estrogen. Sometimes non-cancerous tissue growths can be found in the ovaries or the uterus, and, in some cases, even though the growth itself isn't dangerous with respect to cancer, the cells inside it can produce estrogen. This then increases the level of estrogen in the body, thus increasing one's chance of developing endometrial cancer.
And even estrogen therapy for breast cancer or menopause can cause prolonged exposure of the endometrium to higher-than-normal estrogen levels.
Now let's take a moment and look at that last one. Why would doctors prescribe something that could cause cancer? Well, in the case of breast cancer, the risk for developing endometrial cancer is lower than the risk of letting breast cancer spread. So for some women, this is worth the risk.
But, research has found that to reduce the risk of endometrial cancer from taking other forms of estrogen therapy, women should take a combination of both estrogen and progesterone therapy. You see, since estrogen and progesterone work together naturally, the risk for cancer only increases when estrogen is increased by itself.
It's like baking cookies or cake. If you want to increase the recipe yield, you have to increase all the ingredients together; you can't just add more flour or more butter because that would mess up the ratios and you would end up with cookies that were too dry or too flat.
When estrogen is increased alone, it can increase the risk. But, if you include progesterone in the hormone therapy, then the risk decreases because it more closely mimics your natural hormone ratios.
Also, if a family has a genetic predisposition to colon cancer, then they may have a mutated gene that also makes the women more susceptible to endometrial cancer.
Some other risk factors include early menstruation or late menopause. Females who menstruate prior to the age of 12, or those who go through menopause later in life than normal, have estrogen in their bodies for a longer period of time. This means that over the course of their life, their endometrium is exposed to more estrogen than women who menstruate later and go through menopause earlier.
Similar to this idea is pregnancy. See, women who are pregnant during their lifespan decrease their estrogen exposure because levels are lower during pregnancy. So, by contrast, those who have never been pregnant have more exposure to estrogen and thus higher chances of developing endometrial cancer.
Now, unlike our 'at-risk woman' you saw here, most women don't have every single risk factor for endometrial cancer. But now that you are aware of what risk factors there are, you will be better prepared to know if you, a family member or a patient is at higher risk for endometrial cancer.
Remember, endometrial or uterine cancer is a cancer that occurs in the endometrial, or inner, lining of the uterus. Common risk factors that increase one's chance of developing endometrial cancer are related to lifestyle or medical conditions that increase exposure to estrogen over prolonged periods of time. These include:
To learn more about the diagnosis and treatment of endometrial cancer, be sure to check out other lessons on our website.
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Back To CoursePathophysiology Textbook
20 chapters | 274 lessons