Endometrial hyperplasia and cancer: Clinical

Endometrial cancer or endometrial carcinoma is when cancer cells arise in the glands within the lining of the uterus.

Initially the abnormal growth is called endometrial hyperplasia, a precancerous lesion that can eventually progress to endometrial cancer.

Now, the main cause of endometrial hyperplasia and cancer is excess estrogen - either endogenous or exogenous.

In fact, estrogen has a cumulative effect throughout a female’s lifetime - so risk factors include early menarche or late menopause, both of which increase the number of ovulatory cycles, each of which contributes to a spike in estrogen.

Females who have never been pregnant are also at risk - because they don’t have a pause in their menstrual cycles.

Additionally, obese females are also at risk, because excess adipose tissue converts adrenal androgens to estrogen.

Another risk factor is chronic anovulation, like with polycystic ovarian syndrome. That’s because the ovarian follicles keep secreting estrogen, and there’s no luteal phase progesterone to counteract its effects on the endometrium.

Iatrogenic causes include hormone replacement therapy with estrogen, as well as tamoxifen, a breast cancer medication that blocks the estrogen receptor in the breast, but stimulates the estrogen receptor in the uterus.

Finally, there’s Lynch syndrome, an autosomal dominant disorder which causes non-polypoid tumors to sprout in the colon, and also increases the risk of endometrial cancer.

Endometrial cancer can cause different symptoms based on age and reproductive status.