IF SYMPTOMS PERSIST
By DR. JOSE PUJALTE JR.
“O! my accursed womb, the bed of death”
– William Shakespeare (1564-1616) English playwright,
King Richard III(1591) Act IV. Sc.1 Line 59
Read this if you have a uterus (or if you love someone who does). Think of cancer starting at the surface or lining (endometrium) of the uterus causing madness and mayhem by what the uterus only knows how – to bleed. This bleeding incidentally makes endometrial cancer less treacherous than some cancers that, when discovered, are too late. The predominant female hormone estrogen, and its abnormal increase – is strongly implicated in the development of this cancer. We understand cancer as healthy cells that mutate for many reasons and then grow as abnormal (cancer) cells.
The Very Basic. Two main female hormones control the menstrual cycle –estrogen which thickens the endometrial lining just in case pregnancy takes place; progesterone which helps this lining in being sloughed-off if no fertilized egg is implanted (thus, menstruation). If by many reasons there is too much of estrogen, causing overstimulation of the endometrium, the risk of cancer of this part increases.
Risk Factors. There’s a list of factors that increase estrogen in the body. These are: too many years of menstruation, usually if you start menstruating before 12. The earlier you start menstruating, the more often the endometrium is exposed to estrogen. Never having been pregnant; irregular ovulation; being obese; a high fat diet, diabetes; and estrogen-only replacement therapy after menopause.
Symptoms. Take note of bleeding after menopause, prolonged periods or bleeding in between periods; dyspareunia or pain during intercourse, weight loss without diet or exercise (unintended), pelvic pain and even an abnormal, non-bloody vaginal discharge.
Diagnosis. With any of the symptoms above, it’s best to see your OB-GYNE. Expect history-taking (volunteer a cancer history in the family if any) and a physical examination highlighted by a pelvic examination. Your friendly doctor may suggest any or all of the following: a Pap smear, an endometrial biopsy, a transvaginal ultrasound or if tissue samples are poor or the biopsy suggests cancer, a D and C or dilatation and curettage.
Treatment. As in all cancers, endometrial cancer is staged for prognosis and treatment. And as in all cancers, it is treated with radiation (high dose rays to kill cancer cells) – though this would be the type that will come from a machine. In brachytherapy, radiation is in the form of small seeds or wires placed inside the vagina for a short period. Surgery expunges the malignancy from the rest of the normal body (removing the uterus but usually the fallopian tubes and ovaries as well); hormone therapy, usually synthetic progesterone ( progestin); and chemotherapy.
Prevention. Lessen your chances of developing endometrial cancer by maintaining a healthy weight and exercising. It’s also been noted that endometrial cancer risk is reduced with the use of oral contraceptives and taking hormone therapy with progestin in menopause.
As the Bard would have it, endometrial cancer is like an “an accursed womb” yet for it to be a “bed of death” is partly up to you.
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