Doctor Le Hoang Gia, from the Obstetrics and Gynecology Center at Tam Anh General Hospital, TP HCM, reported that Ms. Suong's uterus contained fibroids, an echo mass measuring 43x47x30 mm with increased vascularity, and an endometrial thickness of 28 mm. Normally, the endometrium in post-menopausal women measures 4-5 mm, while in younger women it is up to 12 mm. A biopsy confirmed grade 3 endometrial cancer, necessitating immediate treatment.

Endometrial cancer is common, primarily affecting older, post-menopausal women. Ms. Suong, a mother of two, was not obese. During menopause, she experienced hot flashes and discomfort, using calcium supplements but no hormone therapy. She began menstruating at 10 years old, which is considered early puberty, given the average onset age of 12.

Doctor Gia suspects Ms. Suong's early menstruation is a factor increasing her risk of endometrial cancer. Menstruating before 12 years old prolongs the body's exposure to estrogen, leading to extended endometrial proliferation. This extended proliferation can accumulate cell mutations, promoting uncontrolled cell growth that forms cancer. Even in post-menopausal women, endometrial cells can develop abnormally if prolonged proliferation occurred years prior. These cell mutations accumulate silently throughout the reproductive phase, becoming apparent as the body ages, immunity declines, and hormones change.

A meta-analysis of 9 research groups, published in Cancer Research in 2021, indicated that women who start menstruating later reduce their risk of endometrial cancer by 9% each year. Individuals who begin menstruation before 12 years old face a higher risk. However, Doctor Gia emphasized that early menstruation is not the sole factor directly causing this cancer. According to the American Cancer Society, endometrial cancer is often associated with factors such as hormones, obesity, estrogen therapy, and nulliparity (never having been pregnant).

The medical team performed an open abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy on Ms. Suong. *Photo: Tue Diem*

Doctors prescribed open abdominal surgery to remove the uterus and both adnexa, combined with a pelvic lymphadenectomy. Ms. Suong is currently under observation and undergoing further evaluation to determine the need for adjuvant chemotherapy. Doctor Gia anticipates a more favorable treatment prognosis for her compared to cases diagnosed at later stages.

In Vietnam, Globocan reported nearly 1,400 new deaths from uterine cancer in 2022. To prevent the disease, women should undergo regular gynecological examinations, ultrasounds, and endometrial screenings, especially when experiencing abnormal bleeding outside of their menstrual cycle or after menopause. Women should also maintain a healthy weight and limit obesity, as it is a factor that increases estrogen levels and, consequently, cancer risk.

Tue Diem