Factores de riesgo y progresión a malignidad de la hiperplasia endometrial

Abstract

Endometrial hyperplasia is considered a precursor of endometrial cancer, being the most frequent in developed countries, the fourth cause of cancer and the sixth cause of cancer death in women. Although it usually appears in the postmenopause up to 14%, more than 5% of cancers are diagnosed between 35 and 44 years of age and 2% between 20 and 44 years of age, who usually present with abnormal uterine or vaginal bleeding, menorrhagia or postmenopausal bleeding. Subsequent to the review of the scientific database, it was evidenced that a stimulation of endogenous estrogens as a result of chronic anovulation, associated with polycystic ovarian syndrome; in addition obesity also causes estrogen exposure and ovarian tumors. It was concluded that obesity, infertility, transient menarche and late menopause are common risk factors for endometrial hyperplasia and endometrial cancer. Independent factors predicting the simultaneous presence of endometrial hyperplasia and cancer include age over 53 years, postmenopause, diabetes, hematologic abnormalities and a body mass index of at least 27. In addition, cancer progression is 1% for simple hyperplasia, 3% for complex hyperplasia, 8% for simple atypical hyperplasia and 29% for complex atypical hyperplasia with atypical hyperplasia being a strong trigger for progression to invasive cancer if left untreated.