Endometrium is the innermost layer of the uterus, and cancers that develop here are the most common gynecological cancers in developed countries. The precursor lesion of this cancer is hyperplasia. In other words, there is an undesirable increase in the volume of endometrium cells. With the increase here, endometrial glands of irregular structure and size appear. It is largely caused by estrogen. If this behavior of estrogen affecting the endometrium tissue is not suppressed by another hormone called progesterone, the mentioned hyperplasia occurs. As it is known, progesterone is secreted only following ovulation and during pregnancy. In this case, hyperplasia will be seen more frequently in women who do not ovulate, are obese, and are less fertile. Since extra estrogen is produced in fat tissues in obese people, it will have a bad effect on the endometrium. In addition, polycystic ovary patients have problems with ovulation, and if progesterone is not given to these patients, they will be the biggest candidates for endometrial hyperplasia in their later ages.
There are also types of uncontrolled growth of the endometrial tissue we mentioned. While the risk of developing cancer in simple types is 1%, this risk is very high, such as 30%, in cases with complex atypia.
These cases may present with complaints of intermittent bleeding and prolonged menstruation, or they can only be detected by ultrasound. In a vaginal ultrasound performed in a case without complaints, it is determined that the inner layer of the uterus, that is, the endometrium, is thicker than usual and sometimes has small pores in it.
The definitive diagnosis must be made by curettage, taking a piece of the inner layer of the uterus and examining it pathologically.
So what should be the treatment? If it is a simple type of hyperplasia, the patient is either given natural progesterone and monitored, or if there is no desire for children anymore and in patients who will have follow-up problems, the uterus should be removed.
In cases with complex hyperplasia, if there is no desire for children, the uterus should be removed without hesitation. In fact, in these cases, an instant pathological examination called frozen section should be performed during the surgery and a possible cancer focus should be excluded. In cases where both ovaries and tubes should be removed, it should be recommended.
In young cases who want to have children, check-ups, that is, intermittent (3-month intervals) removal of pieces of endometrium and pathological scanning, are required. a strong progesterone can be given.
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