Only a proportion of obese, diabetic andhypertensive women develop endometrialcancer and similarly only a proportion ofwomen with endometrial cancer are obesediabetic or hypertensive. The questionremains whether estrogen is a causal agentor is acting in its normal capacity as agrowth factor and is really to be regardedasa co-carcinogen.2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 6 Only a proportion of obese，diabetic and hypertensive women develop endometrial cancer and similarly only a proportion of women with endometrial cancer are obese， diabetic or hypertensive．The question remains whether estrogen is a causal agent， or is acting in its normal capacity as a growth factor and is really to be regarded as a co－carcinogen．
Risk Factors for Endometrial Hyperplasia and CarcinomaDiscussionRelative RiskFactor2~32.4 times more likely for women undergoingMenopausemenopause after age 52 than between 49 and 524-8UnopposedEstrogen replacement without progestins; riskincreased with dosage and duration of useestrogentherapy2-3Nulliparity3-10Obesity3 times more likely at 20-50 pounds overweightup to 10 times if more than 50 poundsoverweight; associated with aromatizationof adrenally produced androstenedione toestronein fat cells2-3Tamoxifen therapy3Diabetes mellitus2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 7
Oral contraception, especially afterlong term use, reduces the incidenceof both endometrial and ovariancarcinomas2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 8 Oral contraception，especially after long term use，reduces the incidence of both endometrial and ovarian carcinomas．
The endometrial hyperplasia inducedby Tamoxifen produces endometrialpolyps. A report in the Lancet in1999 suggested a four-fold increasein endometrial carcinoma.2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 9 The endometrial hyperplasia induced by Tamoxifen produces endometrial polyps．A report in the Lancet in 1999 suggested a four-fold increase in endometrial carcinoma．．
SymptomatologyThe usual presenting symptom of endometrialcarcinoma is postmenopausal bleedingwhich carries a 10% risk of associatedmalignancy in the absence of hormonereplacement therapy. Curettage, orendometrial sampling is mandatory.Postmenopausal discharge frompyometra carries a 50% risk of associatedmalignancy. Pain may occur with pyometraor metastatic spread.2003-10-27Carcinomaofthe Endometrium10
2003-10-27 Carcinoma of the Endometrium 10 Symptomatology The usual presenting symptom of endometrial carcinoma is postmenopausal bleeding which carries a 10％ risk of associated malignancy in the absence of hormone replacement therapy. Curettage，or endometrial sampling is mandatory. Postmenopausal discharge from pyometra carries a 50％ risk of associated malignancy. Pain may occur with pyometra or metastatic spread．