Abstract
Endometrial cancer is the second most common cancer in our country, similarly to the USA. In the Czech Republic, its incidence is constantly rising and in 2005 it reached a ratio of 33.2 / 100,000 women, which in absolute numbers means that 1,739 women became ill.
On a European scale, we are in first place. Looking at the statistical numbers, the upward trend in the incidence of endometrial cancer is alarming.
In 1975, the incidence was 21.1 / 100,000 women, in fifteen years (in 1990) it was 24.2 / 100,000 and in the next fifteen years (in 2005) it was already 33.2 / 100,000 women. What are the causes? The first reason is the ever-increasing average age of our women's population, and the second, even more significant reason is that the cohort of Czech women after the age of 50 leads in BMI - we are therefore the most obese in Europe.
However, what we can enjoy from statistical data is that mortality associated with endometrial cancer, despite an increase in incidence, fell from 9.6 / 100,000 women in 1975 to 5.9 / 100,000 in 2005. The authors of the article are therefore quite correct point out that the quality of life of women after treatment of endometrial cancer is very important, and it is also true that these women have a high mortality from other causes due to obesity.
Unfortunately, most women between the ages of 50 and 80 have a minimal will to reduce their overweight, which is the most significant. From my own practice, I can confirm that most "cured" women, on the other hand, gain weight in the first year after successful treatment.
These women often compensate for the stress associated with cancer treatment and subsequent follow-up. So it is really appropriate to try to convince these women that less (weight) is more.
Unfortunately, lessons are usually not enough. However, it is true that we have no evidence that obesity is a risk factor for a worse prognosis.
On the contrary. Obese women generally have a better prognosis, more often they are "grown" due to hyperestrogenic stimulation, type I cancer, which is more biologically "worthy".
The article publishes recommendations for dispensaries common in the USA. These differ significantly from the Czech ones.
Removing cytology from the vagina every six months only makes sense if you do not have a colposcope in the clinic and are unable to examine the vagina colposcopically. Half of the recurrences of endometrial cancers are located in the vagina and in the stump area.
Brachytherapy, which is a popular adjuvant method in our country, significantly reduces the risk of these recurrences. Similarly, the recommendation of annual anteroposterior X-ray examinations of the lungs is irrelevant and not in our recommended procedures.
We recommend mammography with us in the usual two-year interval. Similarly, the recommendation of annual osteoporosis screening examinations is not feasible in our conditions.
Obese women usually have higher values of bone density due to peripheral conversion from adipose tissue than skinny women and smokers. However, the comorbidity is clear, so it is necessary to ask during the inspections whether the woman is in the care of her general practitioner.
Recommendations for the administration of selective estrogen receptor modulators (SERMs) as an alternative to estrogen hormone therapy (ET) to women at low risk, vegetative problems and vaginal atrophy are somewhat out of reality, and I personally agree that these symptomatic women can be substituted with low doses of estrogen. What is very important is information about sexual life, especially in women after adjuvant radiotherapy.
Within three to six months, the vagina tends to form synechiae and stenosis. Women who have been active in the disease should be instructed very well about the appropriateness of early sexual intercourse.
We ourselves recommend contact with lumbricance or the application of vaginal estrogens in women with vaginal atrophy after two months. For further monitoring of the vagina, its clarity is very important.
Therapeutically, we are able to cure most vaginal relapses. Distant metastases are prognostically infamous, so intensive examination (X-ray of the lungs, CT and PET) is unnecessary in symptomatic women.
In conclusion, we can agree with the authors of the original article that, especially with regard to high treatability, women deserve increased attention after treatment of endometrial cancer. However, our standard recommendations are significantly different from the American ones.
However, due to the age distribution (maximum of women between the ages of 55 and 80), most of the well-meaning recommendations for our clients are only a style exercise.