The typical endometrial cancer patient is a post-menopausal woman in her 50s or 60s.
But, lately, that has been skewing younger, especially among obese women, which can affect a woman’s ability to have children.
“What we are seeing now is that more people are getting it in their early and mid-40s than before. So, as a result of that, we now have issues with fertility that we didn’t have before,” said Dr. Jacob Tangir, a gynecologist/oncologist affiliated with Memorial Healthcare System in Broward and co-founder of the Center for Gynecologic Oncology in Miramar.
The American Cancer Society estimates about 66,570 new cases of uterus body or corpus cancers will be diagnosed in 2021, with the estimates including endometrial cancers and uterine sarcomas. Cancer of the uterine lining, known as the endometrium, is the most common cancer of the female reproductive organs, according to the cancer society.
“It’s not that common compared to say breast cancer, lung cancer or colon, but it is the most common among the gynecologic orients,” Tangir said. “Uterine cancer and endometrial, in particular, is the most common of all.”
About 12,940 women will die from uterine cancers in a year, the cancer society says.
Fertility options for younger women
Endometrial cancer patients often have a hysterectomy as part of their treatment, but for younger patients who may want to have children, that may not always be a welcomed option.
“If you are young, premenopausal, then I say to the patient, ‘Where are you at as far as childbearing goes?’” said Dr. Eric Schroeder, a gynecologic oncologist at Miami Cancer Institute, part of Baptist Health South Florida. “There is a fertility-sparing option for the treatment of endometrial cancer and I have a number of ladies doing this right now.”
Patients have to meet strict criteria to qualify for this option and catching the cancer in the early stages is one of them.
“You have to have early disease. It has to be stage 1-A,” Schroeder said. “It has to be the most common, bread and butter, endometrial cancer type.”
The tumor’s location, whether the cancer is caused by too much estrogen and not enough progesterone, the grade of the cancer and other factors also play into a patient’s qualifications for the treatment.
“If that’s the case and you want to have more babies, then we talk,” Schroeder said. “There is the option of giving progesterone back, and it can reserve the cancer, actually cure it. And if you get back to where we can prove you have normal endometrial tissue … then you get pregnant.”
Some common symptoms for endometrial cancer include vaginal bleeding after menopause, bleeding in between periods and pelvic pain. Type 2 diabetes, family history of endometrial cancer, having had breast or ovarian cancer, the age of the woman and the number of menstrual cycles a woman has had over her lifetime are among the risk factors for the cancer.
Cancer link to obesity
The American Cancer Society says obesity is considered a “strong risk factor,” for endometrial cancer. The cancer is twice as common in women who are overweight and about three times as common in women who are considered obese.
“We know that with endometrial cancer, one of the risk factors is high levels of estrogen,” Tangir said. “About 40 percent of endometrial cancer seems to be related to obesity.”
Tangir explains that excess body fat can convert hormones called androgens into estrogen. This may result in women having higher estrogen levels, which can increase the risk of endometrial cancer.
“In the last 20 years or so since 2003, we’ve seen 1 percent more cases of endometrial cancer per year steadily,” Tangir said, adding that obesity may “explain the increase.”
While obesity can be a contributing factor to endometrial cancers in younger patients, other health markers can play a role.
“There are some other factors that go along with obesity, maybe like PCOS, or polycystic ovary syndrome, which we’re seeing a bit more in that population,” Schroeder said. “There’s certainly more young ladies getting it than 10, 20 years ago.”
Regardless of how the cancer started, doctors often have conversations with patients who are overweight or obese at some point during their treatment in order to prevent possible future medical issues.
This story was originally published June 9, 2021 6:00 AM.