HRT and Gynecologic Malignancy (Endometrial Cancer)
Nakorn Sirisabya*
Affiliation : * Department of Obstetrics and Gynaecology, Chulalongkorn Hospital, Rama IV Road. Bangkok I0330. Thailand
Endometrial cancer is the most common female genital tract cancer in developed or
industrialized countries. In USA endometrial cancer is the most common female genital tract
cancer and the fourth common female cancers. 2.3'/c. of female patients will develop this
disease during their lifetimes. Peak incidence of endometrial cancer in USA was in 1975 and
was gradually decreased from ICJSO. The changes of incidence paralleled with widespread usc of
estrogen in 1960-1970 and estrogen plus progestin in 1980. But the incidence of endometrial
cancer in developing countries had not been changed for the past two decades.
The etiology of endometrial cancer is not clearly known. From epidemiological study.
unopposed estrogen usage for long period or unopposed endogenous estrogen productions as
in obesity, polycystic ovarian disease and estrogen producing ovarian tumor has increased
risk of the disease 2-8 folds. Prolonged usage of estrogen in experiment animals can cause
endometrial cancer (but not in subprimate animals). Risk factors as OM. hypertension. infertility and etc. are found in 113 of patients with endometrial cancer. But the risk factors cannot
be applied in developing countries.
Endometrial cancer can be estrogen dependent or non estrogen dependent type. Knowledge of hormonal receptors and of molecular biology are expanding. Scientists arc trying to
explain the etiology of the cancer. Any how 75CJr of patients with endometrial cancer come for
treatment at early stages. so the prognosis of this cancer after treatment is good. After treatment
some patients develop post menopausal symptoms. ERT in this group of patients is debatable.
More and more reports on this issue showed that estrogen replacement can be given to good
prognostic patients after definitive treatment for endometrial cancer without increased risk
concernmg survival and recurrence. Estrogen plus progestin may be usc as alterative to estrogen in this group of patients but the risk and benefits of adding progestin has to be considered.
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