21st June 2023

Uterine cancer

Cancer of the uterus typically presents early due to the presence of post-menopausal or irregular menstrual bleeding, present in 90% of cases. The risk of uterine cancer increases with age, with a peak of cancers diagnosed between ages 40-74. Oestrogen has a pivotal role in the genesis of uterine malignancy as it causes the cells of the endometrium to grow and divide. Related risk factors include obesity, due to the presence of greater levels of oestrogen as a result of increased production of the enzyme aromatase, which peripherally converts circulating androgens into oestrogens. Early menarche and late menopause increase exposure to oestrogen. Hormone replacement therapy and tamoxifen are also implicated. Risk is also elevated in those with Lynch syndrome.

The primary treatment in early-stage disease is a simple hysterectomy. Vaginal vault brachytherapy, external beam radiotherapy and chemotherapy have roles to reduce the risk of recurrence. Chemotherapy, immunotherapy, and radiotherapy have a role in the management of metastatic disease as well as progesterone in the management of ER+ve disease.