Endometrial cancer in young women. A retrospective matched cohort study.
Date
2021-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: OBJECTIVE: Endometrial cancer is the second most common gynaecological cancer in South Africa. It
typically arises in the sixth and seventh decades of life. However, an increasing number of premenopausal
women are being diagnosed with endometrial cancer. Delay in diagnosis in younger women is due to
symptoms being ascribed to abnormal uterine bleeding. The objective of this study was to carry a review
of the clinical, pathological and management of endometrial cancers in younger women to identify risk
factors, characterise histology and appraisal of treatment received.
METHODS: We did a retrospective matched study of a cohort of women aged 55 years or younger with
histologically confirmed endometrial carcinoma. Each case was matched to two randomly selected
control cases of histologically proven endometrial cancer patients aged more than 55 years old. It was
conducted at Tygerberg Hospital, the largest tertiary hospital in the Western Cape Province of South
Africa. We examined patient folders from the Department of Gynaecologic Oncology from 2014 – 2018.
Clinical characteristics including age, parity, hypertension, diabetes mellitus, hormone therapy, tamoxifen
use, personal history of cancer and family history of cancer were obtained. Outcomes including
histological type and grade, myometrial depth invasion, lympho‐vascular space invasion, lymph node
involvement, extrauterine spread, stage, treatment plan and need for adjuvant therapy were reviewed.
RESULTS: 15 patients 55 years of age or less were identified (range 40‐55, median 52). Only 20% were
nulliparous. All the patients had at least class 2 obesity with 50% having class 3 obesity. The incidence of
hypertension and diabetes were 66.7% and 56.7% respectively. Only 2 patients had a history of tamoxifen
use for breast cancer. 33.3% had a personal history of a cancer and 26.7% reported having a first degree‐
relative with cancer. All the 15 patients (100%) in the younger cohort had Type I (endometrioid
adenocarcinoma) compared to 50% in more than 55‐year‐old group. Statistical significance differences
were found for histological grade (p‐value 0.004), myometrial depth invasion (p‐value 0.02), extrauterine
spread other than lymph node (p‐value 0.006) and need for adjuvant therapy (p‐value 0.007). No
significant differences were found for lympho‐vascular space invasion (p‐value 0.18), lymph node spread
(p‐value 0.95) and stage (p‐value 0.107). Despite no statistical significance was found for overall disease
stage between the two groups, 11 patients (73.4%) presented with stage I disease in the younger cohort.
None of the patients received conservative management and were surgically staged by open laparotomy.
CONCLUSION: Obesity is a significant risk factor in our population. Oestrogen excess seems to be the
main aetiology of endometrial cancer in the local population. Younger patients typically present with
Type I endometrioid adenocarcinoma, low grade and less myometrial invasion. There is less need for
adjuvant radiotherapy in this group of patients.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
Description
Thesis (MMed)--Stellenbosch University, 2021.
Keywords
Endometrium -- Cancer, Gynecologic cancer, UCTD, Gynecology -- Diagnosis