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자궁내막암에 대한 내용(영문)

작성자 닥터코리아 조회수 1883

Definition: A cancerous growth of the endometrium (lining of the uterus).
정의:자궁 내막의 암성 증식

Causes, incidence, and risk factors:

Endometrial cancer is the most common type of uterine cancer.
Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to have a role.
에스트로젠의 분비 증가가 자궁내막암의 발생과 연관될 가능성이 있다.


One of estrogen's normal physiological functions is to stimulate the build up of the epithelial wall of the uterus.
에스트로젠은 자궁내막세포의 생성을 돕는다.


Excess estrogen administered to laboratory animals produces endometrial hyperplasia and cancer.
실험동물에게 과잉으로 에스트로젠을 투여하면 자궁내막이 과증식하거나 암이 발생한다.

The incidence of endometrial cancer in women in the U.S. is 1 to 2%.
The incidence peaks between the ages of 60 and 70 years, but 2 to 5% of cases may occur before the age of 40 years.
미국여성의 자궁내막암 발생율은 1-2%이다.
60-70세 사이에 가장 많이 발생힌다. 하지만 전체발생의 2-4%는 49세 이전에 발생한다.

Increased risk of developing endometrial cancer has been noted in women with increased levels of natural estrogen.
Associated conditions include obesity, hypertension, and polycystic ovarian disease.
에스트로젠 호르몬의 농도가 높아질수록 자궁내막암의 발병이 늘어난다. 비만, 고혈압, 다낭포성 자궁질환 등에서도 발병율이 증가한다.


Increased risk is also associated with nulliparity (never having carried a pregnancy),
infertility (inability to become pregnant),
early menarche (onset of menstruation)
and late menopause (cessation of menstruation).
Women who have a history of endometrial polyps or other benign growths of the uterine lining, postmenopausal women who use estrogen-replacement therapy (specifically if not given in conjunction with periodic progestin), and those with diabetes also fit into the higher risk category.
한번도 임신하지 않은 여성, 임신이 불가능한 여성, 초경이 이르거나 폐경이 늦은 여성,자궁내막의 폴립이나 내막의 양성 증식질환, 폐경기에 호르몬 대체요법을 프로게스틴과의 동시투여 없이 행한 여성, 당뇨환자 등이 발생위험이 높은 그룹이다.

Prevention:

All women should have regular pelvic exams and Pap smears (beginning at the onset of sexual activity or at the age of 20 if not sexually active) to help detect signs of any abnormal development.

정기적인 산부인과 검사가 중요하다.


Since conditions associated with increased risk have been identified, it is important for women with such conditions to be followed more closely by their physicians.
Frequent pelvic examinations and screening tests, including a pap smear and endometrial biopsy, should be done. Women who are taking estrogen replacement therapy should also take these precautions. Any of the following symptoms should be reported immediately to the doctor:
bleeding or spotting after intercourse or douching
bleeding that lasts longer than 7 days
periods that recur every 21 days or less
reappearance of blood or staining after six months or more of no bleeding at all.
아스트로겐 복용하는 분

혈액 반흔이 보일 때, 7일 이상 출령이 보일 때, 21일 이내에 다시 출혈이 보일 때

6개월 이상 출형이 없다가 다시 시작할 때

이런 분들은 산부인과 검사를 받으실 것

 


Symptoms:

abnormal uterine bleeding,
비정상 자궁 출혈
abnormal menstrual periods
비정상 멘스 기간
bleeding between normal periods in premenopausal women
정상 기간 사이의 출혈
vaginal bleeding and/or spotting in postmenopausal women
질내 출혈 및 점혈
in women over the age of 40, extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes)
40세 이상의 여성의 경우 매우 기간이 긴, 양이 많은, 잦은 출혈이 발생하는 것은 악성변화 초기 증상일 수 있다.
lower abdominal pain or pelvic cramping
하복통과 골반통


Signs and tests:

A pelvic examination is frequently normal, especially in the early stages of disease.
Changes in the size, shape, or consistency of the uterus and/or its surrounding, supporting structures may exist when the disease is more advanced.

A Pap smear may be either normal or show abnormal cellular changes.
Endometrial aspiration may assist the diagnosis.
A dilation and curettage (D&C) procedure is usually necessary for diagnosing and staging the cancer.
An endometrial biopsy may assist in diagnosis.



Stages of endometrial cancer:
자궁내막암의 병기

1. The cancer is confined to the uterine body.
2. The cancer involves the uterine body and the cervix, but does not extend any further.
3. The cancer extends outside of the uterus but not beyond the true pelvis (gynecological organs).
4. The cancer has extended beyond the true pelvis and:
4a. spread to adjacent organs.
4b. spread to distant organs.

Treatment:

Women with the early stage 1 disease may be candidates for treatment with surgical hysterectomy, but removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended for two reasons.
Tumor cells can spread to the ovaries very early in the disease, and any dormant cancer cells that may be present could possibly be stimulated by estrogen production by the ovaries. Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.
For all other women with endometrial cancer, the preferred treatment is surgery in combination with radiation therapy.
Chemotherapy may be considered in some cases.

early stage 1 환자의 경우 자궁절제술이 치료법으로 많이 시도되는데 이때 난관과 난소를 같이 제거하는 경우가 많다. 이유는 조기에 난소로 암세포의 전이가 많고 난소의 에스트로젠 분비의 영향으로 숨어 있던 암세포의 성장이 촉진되기 때문이다.
질을 통한 자궁절제술보다 복부를 통한 절제술이 더 많이 시행되는 이유는 복강의 암세포 세척이 가능하기 때문이다.
자궁절제술과 방사선치료법이 가장 선호되는 치료법이다.
화학요법을 같이 시행하는 경우도 있다.

Support groups:

The stress of illness can often be helped by joining a support group where members share common experiences and problems.

Expectations (prognosis):예후

Because endometrial cancer is usually diagnosed in the early stages
(70 to 75% of cases are in stage 1 at diagnosis;
10 to 15% of cases are in stage 2;
10 to 15% of cases are in stage 3 or 4),
there is a better prognosis (probable outcome) associated with it than with other types of gynecological cancers such as cervical or ovarian cancer.
자궁내막암은 조기발견될 확률이 높아서 자궁경부암이나 난소암에 비해 좋은 예후를 보인다.

The 5 year survival rate for endometrial cancer following appropriate treatment is:
적절한 치료후의 5년 생존율

75 to 95% for stage 1
50% for stage 2
30% for stage 3
less than 5% for stage 4

Complications:

Anemia may result, caused by chronic loss of blood.
(This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.)
A perforation (hole) of the uterus may occur during a D&C or an endometrial biopsy.
빈혈이 오래 지속된 출혈에 의해서 나타날 수 있다. 자궁내막의 생검, 소파수술 중에 자궁 천공이 발생할 수 있다.