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Sunday, June 9, 2013

Can you treat precancer disease of the uterus without surgery?

Uterine cancer is the most common gynecologic cancer in the United States.  There are over 40,000 American women develop this cancer yearly.   The most common types is the endometrial adenocarcinoma.  If you recall from my previous blog, this is mostly due to excess estrogen from obesity.  In a paper by Dr. Trimble, he quoted case control study which suggests a 200-400% increase risk of endometrial uterine cancer with BMI > 25.  BMI >25 means I weigh 160 lb with height of 5feet 6 inches.  I think you know many people are heavier than this BMI and are at risk of uterine cancer.

Before the uterus turns into cancer due to excess estrogen stimulation, the uterine lining thickens (we call it hyperplasia - excess growth).   This is a precancerous stage and usually accompanied by abnormal uterine bleeding.  In postmenopausal women with bleeding, your doctor usually recommend uterine endometrial biopsy.  Once confirmed, the most effective way is hysterectomy.

However, there are patients who are poor candidate for surgery because of poor health (poorly controlled diabetes, COPD, heart disease, etc).   Dr. Trimble reviewed the literatures and recommended the usage of progestin by mouth or intrauterine (using IUD).   Progestin is basically another hormone that is against the estrogen.   In my patients, I strongly recommend weight loss since many of the excess estrogen is produced by fat.

Reference:
Trimble CL, et al.  Management of endometrial precancers.  Obstet Gynecol. 2012; 120: 1160-75

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