oa Southern African Journal of Gynaecological Oncology - Endometrial carcinoma : a South African perspective : review
Endometrial carcinoma is a less common gynaecological malignancy in the developing world, yet a significant number of individuals are diagnosed each year in South Africa. The relative frequency of endometrial carcinomas has increased over the last years in developing economies due to an increase in obesity and a decrease in fertility rate. In South Africa endometrial carcinoma is more common in certain subpopulations. Asian women have a life time risk of 1 in 106 to develop endometrial carcinoma. The overall risk for women of all races in South Africa is 1 in 146. The most common histological type is endometriod-type adenocarcinoma but other histological types include mucinous adenocarcinoma, clear cell carcinoma, uterine papillary serous carcinoma (UPSC), squamous carcinoma and also carcinosarcoma.
The endometrium represents a specialised tissue in the uterine cavity which, during the reproductive years, undergoes profound histological changes during each menstrual cycle. The endometrium is stimulated by trophic hormones during each cycle to undergo normal growth and eventually be transformed into a secretory endometrium with active mucin production. The two hormones controlling the endometrial cycle are oestrogen and progesterone. Oestrogen causes growth (proliferative phase) and progesterone causes luteinisation and mucin secretion (secretory phase). It is clearly established that excessive oestrogen production will lead to over stimulation of the endometrial stratum functionalis and if normal secretory phase endometrial changes do not occur under the influence of progesterone regular shedding of the endometrium is absent which may eventually lead to hyperplastic and malignant changes.
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