**3. Prevention**

Pain was the most common complain in patients with recurrent disease, in the follow-up of endometrial cancer patients, followed by vaginal bleeding, general malaise, loss of weight and intestinal complaints (Zhang, 2010). The routine use of the Pap smear and systematic radiography are not clinically justified in the follow-up of patients with endometrial carcinoma (Agboola, 1997; Morice, 2001). In Lynch syndrome, the current gynecologic carcinoma screening guidelines include annual endometrial sampling and transvaginal ultrasonography beginning at age 30-35 years (178). Primary prevention by using a progesterone device in utero, such as the Mirena IUCD is an alternative approach. This merits full evaluation (Hitchener, 2006). Prophylactic hysterectomy and bilateral salpingoophorectomy should be offered as risk-reducing surgery to women aged 35 years or older who do not wish to preserve fertility. Schmeler et al. reported a retrospective analysis with known germ line mutations associated with Lynch syndrome. There were sixty-one participants who underwent prophylactic hysterectomy and were compared to over 200 matched controls with similar mutations that did not have preventive surgery. In 33% of the controls was eventually diagnosed the endometrial cancer, with no cases in the prophylactic group (Schmeler, 2006). There was detected asymptomatic muscle invasive endometrial carcinoma by Pistorius et al, in two of four women who underwent prophylactic hysterectomy after requiring surgery for Lynch syndrome related colorectal carcinoma (Schmeler, 2006). In 2006, a multiinstitutional, matched case-control study found that prophylactic bilateral salpingoophorectomy and hysterectomy preventive strategy in women with HNPCC syndrome [Schmeler, 2006]. Most cases of endometrial cancer cannot be prevented, but women can take some measures to reduce their risk of developing endometrial cancer. Risks might be reduced with using oral contraceptives controlling obesity and controlling diabetes.

In addition, women who are considering estrogen replacement therapy should talk to their doctors to assess their risk of endometrial cancer. Use of combination oral contraceptives (birth control pills) decreases the risk of developing endometrial cancer.

Women who use oral contraceptives at some time have half the risk of developing endometrial cancer as women who have never used oral contraceptives.

lymphadenectomy report rates of occult pelvic lymph node disease ranging from 8 to 28% depending on grade and depth of myometrial invasion [Zivanovic, 2009; Lin, 2008]. Lymphadenectomy causes significant morbidity in approximately 11% of cases [Nunns, 2000]. Pelvic MRI and sentinel lymph node evaluation appear equally effective in detecting pelvic node metastases although the ability to detect the sentinel node varies significantly between studies [Selman, 2008]. Hirahatake reported that para-aortic lymph node metastases in 2.5% of stage IA, 8.5% of stage IB, and 15.7% of stage II endometrial cancers [Hirahatake, 1997]. Mariani and Tanaka reported a direct correlation between pelvic and para-aortic lymph node involvement [Mariani, 2004; Tanaka, 2006]. In a study of 291 endometrial cancer patients by Goudge 18% were upgraded postoperative [Goudge, 2004]. Ben-Shachar reported that tumor was upgraded in 19% of 181 patients with a preoperative grade 1 tumor [Ben-Shachar, 2005]. The results of surgical staging also led to adjuvant treatment in 12% of patients who were found to have extrauterine disease or other high-risk

Pain was the most common complain in patients with recurrent disease, in the follow-up of endometrial cancer patients, followed by vaginal bleeding, general malaise, loss of weight and intestinal complaints (Zhang, 2010). The routine use of the Pap smear and systematic radiography are not clinically justified in the follow-up of patients with endometrial carcinoma (Agboola, 1997; Morice, 2001). In Lynch syndrome, the current gynecologic carcinoma screening guidelines include annual endometrial sampling and transvaginal ultrasonography beginning at age 30-35 years (178). Primary prevention by using a progesterone device in utero, such as the Mirena IUCD is an alternative approach. This merits full evaluation (Hitchener, 2006). Prophylactic hysterectomy and bilateral salpingoophorectomy should be offered as risk-reducing surgery to women aged 35 years or older who do not wish to preserve fertility. Schmeler et al. reported a retrospective analysis with known germ line mutations associated with Lynch syndrome. There were sixty-one participants who underwent prophylactic hysterectomy and were compared to over 200 matched controls with similar mutations that did not have preventive surgery. In 33% of the controls was eventually diagnosed the endometrial cancer, with no cases in the prophylactic group (Schmeler, 2006). There was detected asymptomatic muscle invasive endometrial carcinoma by Pistorius et al, in two of four women who underwent prophylactic hysterectomy after requiring surgery for Lynch syndrome related colorectal carcinoma (Schmeler, 2006). In 2006, a multiinstitutional, matched case-control study found that prophylactic bilateral salpingoophorectomy and hysterectomy preventive strategy in women with HNPCC syndrome [Schmeler, 2006]. Most cases of endometrial cancer cannot be prevented, but women can take some measures to reduce their risk of developing endometrial cancer. Risks might be reduced with using oral contraceptives controlling

In addition, women who are considering estrogen replacement therapy should talk to their doctors to assess their risk of endometrial cancer. Use of combination oral contraceptives

Women who use oral contraceptives at some time have half the risk of developing

(birth control pills) decreases the risk of developing endometrial cancer.

endometrial cancer as women who have never used oral contraceptives.

characteristics [Ben-Shachar, 2005].

obesity and controlling diabetes.

**3. Prevention** 

This protection occurs in women who have used oral contraceptives for at least 12 months, and continues for at least 10 years after oral contraceptive use. The protection is most notable for women who have never been pregnant.

Edward Giovannucci, M.D., Sc.D., Professor of Nutrition and Epidemiology at the Harvard School of Public Health, said coffee is emerging as a protective agent in cancers that are linked to obesity, estrogen and insulin. Giovannucci, along with Youjin Je, a doctoral candidate in his lab, and colleagues observed cumulative coffee intake in relation to endometrial cancer in 67,470 women who enrolled in the Nurses' Health Study. During the course of 26 years of follow-up, researchers documented 672 cases of endometrial cancer. Drinking more than four cups of coffee per day was linked with a 25 percent reduced risk for endometrial cancer. Drinking between two and three cups per day was linked with a 7 percent reduced risk [Giovannucci, 2005]. A similar link was seen in decaffeinated coffee, where drinking more than two cups per day was linked with a 22 percent reduced risk for endometrial cancer.

Hormone and lifestyle factors explain up to 80% of risk for endometrial cancer. The investigators found that women who were normal weight and active had a reduction in risk of 73%, compared with inactive women who were overweight (BMI above 25 kg/m2). Women who were normal weight but inactive had a 55% lower risk for endometrial cancer than inactive women who were overweight. Women who were overweight but active had a 38% lower risk for endometrial cancer.

Aspirin has been shown in vitro to inhibit endometrial cancer cell growth through the induction of apoptosis in a dose-dependent manner [Arango, 2001].

Other NSAIDs have also been shown to reduce endometrial cancer cell proliferation and induce apoptosis in a dose- and time-dependent manner [Gao, 2004; Li, 2002].

African-american women with advanced stage endometrial cancer have lower survival rates than white women with the disease even when both groups receive similar treatments, according to a study published online September 25, 2006, in the journal Cancer .
