[Sportschosun Reporter Jang Jong-ho] The incidence of endometrial cancer in South Korea is rising rapidly. In 1999, the rate was 3.1 cases per 100,000 women, but by 2022 it had climbed to 15.4, nearly five times higher. Endometrial cancer often shows a clear warning sign from the early stages: abnormal vaginal bleeding. However, many people mistake it for irregular periods or changes around menopause and leave it untreated, making early diagnosis and proper treatment especially important.
Professor Kim Jeong-cheol of the Department of Obstetrics and Gynecology at Soonchunhyang University Bucheon Hospital said, "Endometrial cancer usually occurs in women in their 50s and 60s, around menopause and after menopause, but diagnoses are also increasing among women under 40 in connection with obesity, metabolic disease, anovulatory menstruation, and polycystic ovary syndrome."
Endometrial cancer is a malignant tumor that develops in the endometrium, the lining of the uterus. In many cases, it shows the warning sign of abnormal vaginal bleeding relatively early. In particular, postmenopausal bleeding is an important symptom that must be checked. Even before menopause, medical evaluation is needed if menstrual flow suddenly becomes heavier, periods last longer, or bleeding occurs repeatedly between periods. Bleeding after sex, unexplained bloody discharge, foul-smelling discharge, or pelvic pain also warrant a visit to a gynecologist.
However, not all abnormal vaginal bleeding means endometrial cancer. Similar symptoms can also appear with uterine fibroids, adenomyosis, endometrial polyps, endometrial hyperplasia, vaginitis, cervicitis, cervical cancer, hormone therapy, or anticoagulant use. Because symptoms alone cannot provide an accurate distinction, the cause must be confirmed through examination and testing.
One of the key mechanisms behind endometrial cancer is prolonged exposure to estrogen. Westernized diets, obesity, low birth rates, infertility, and late menopause are known contributing factors. In particular, fat tissue continues to convert androgens into estrogen even after menopause, so a higher body fat percentage can leave the endometrium exposed to estrogen stimulation for longer.
There are also high-risk groups. Women with obesity or metabolic syndrome, women with anovulatory menstruation or polycystic ovary syndrome, women who have never given birth, women who had a long menstrual history due to early menarche or late menopause, and women diagnosed with atypical endometrial hyperplasia may face a higher risk of endometrial cancer. Those with a family history of hereditary cancer syndromes such as Lynch syndrome are also considered high risk.
Diagnosis proceeds in the order of symptom review, imaging tests, tissue biopsy, and staging assessment. First, doctors check for abnormal vaginal bleeding, menopausal status, obesity, diabetes, hypertension, infertility, hormone therapy use, a history of breast cancer treatment, and family history. Next, transvaginal ultrasound is used to assess endometrial thickness and the condition of the uterus and ovaries, and an endometrial biopsy is performed if needed. A definitive diagnosis of endometrial cancer is made through biopsy. In some cases, an outpatient endometrial aspiration biopsy is performed, or a biopsy is taken while directly examining the lesion with hysteroscopy.
If cancer is confirmed, Magnetic Resonance Imaging (MRI), computed tomography (CT), and Positron emission tomography-computed tomography (PET-CT) are used to assess myometrial invasion, cervical involvement, lymph node metastasis, and spread within the abdominal cavity. Recently, treatment planning has become more precise by considering not only histologic type and stage, but also molecular pathology data such as MMR/MSI, p53, POLE mutations, hormone receptors, and HER2 in order to determine recurrence risk and treatment strategy more accurately.
The standard treatment for endometrial cancer is surgery in most cases. Typically, a hysterectomy and bilateral salpingo-oophorectomy are performed, and depending on the stage, histologic type, and imaging findings, sentinel lymph node dissection or lymph node dissection may also be considered. In recent years, minimally invasive procedures such as laparoscopic surgery and robotic surgery have been widely used.
After surgery, additional treatment is decided based on the final pathology results. In low-risk cases, surgery alone may be sufficient, but if the risk of recurrence is high, radiation therapy, chemotherapy, or a combination of both is used. For advanced or recurrent endometrial cancer, platinum-based chemotherapy is the standard, and more recently, immune checkpoint inhibitors, targeted therapy, and hormone therapy are used depending on the patient's pathological and molecular characteristics. In particular, tumors with MMR deficiency or MSI-high status may respond to immune checkpoint inhibitors, and HER2-targeted treatment may be considered for some HER2-positive tumors.
For younger patients with very early, low-grade endometrial cancer who strongly wish to become pregnant, fertility-sparing treatment using high-dose progestins or a levonorgestrel intrauterine device may be considered under strict conditions. However, this should only be done after carefully confirming that the lesion is confined to the endometrium and that there are no high-risk findings.
Regular follow-up is important after treatment. Patients should undergo pelvic examinations, imaging tests, and blood tests according to their scheduled visits. If abnormal bleeding, new pelvic pain, abdominal bloating, weight loss, persistent cough or shortness of breath, or leg swelling occurs after treatment, it is best to visit the hospital immediately. Maintaining a healthy weight and exercising regularly are also important after treatment, and metabolic diseases such as diabetes, hypertension, and dyslipidemia should be managed consistently.
Professor Kim Jeong-cheol said, "The most important thing in endometrial cancer treatment is to receive an accurate diagnosis and the most appropriate treatment based on the stage and molecular characteristics. When the disease is found early, treatment outcomes are often good, so if you have abnormal bleeding, do not hide your symptoms or delay care. Please visit a hospital."
Jang Jong-ho, bellho@sportschosun.com
