The Indian Council of Medical Research (ICMR) has issued consensus document for management of uterine cancers.

This consensus document represents the current views on uterine malignancies based on available evidence. This has been compiled by doctors who are experienced in treating these cancers and does not bind any clinician to follow this guideline and mention of pharmaceutical drugs for therapy does not endorse or recommend for use but is a guideline for the clinician. One can use other alternate modes of treatment as per national or international guidelines after discussion.

The ICMR has invited suggestions and comments from the experts on the subject by June 7, 2016.

This is significant on the part of ICMR as carcinoma of uterine cervix remains the leading cause of gynecological cancers in the developing countries like India. There is a massive shift of lifestyle globally affecting both the developing and the developed countries. The magnitude of this effect is more with the developed countries than the developing countries. Because of this massive shift, breast cancer now overtook cervical cancer as the most common cancer in India. Uterine cancer also is related to shift in the lifestyle changes and also due to increased incidence of metabolic syndrome and hormonal therapies.

The normal physiology of hormonal milieu is to strike the right balance between the estrogen and progesterone. Many of the effects of estrogen are counteracted by progesterone. God made mechanism for enhancing this progesterone effect is fixed 14 days of progesterone phase during each menstrual cycle and pregnancy. After the menopause, ovarian function declines and the main source of estrogen and progesterone is the peripheral conversion at adipose tissues.

Changes in the hormonal milieu are the main risk factor in the development of uterine cancer. Unopposed estrogen action may be exogenous and endogenous. Early menarche, late menopause, nulliparity, number of children, increased anovulatory cycles, obesity are the causes of unopposed estrogen effect due to endogenous causes. Others include diabetes, hypertension, metabolic syndrome, insulin resistance, estrogen producing tumors etc.

Exogenous causes includes estrogen only oral contraceptives, tamoxifen etc. Other factors are the genetic factors which account for less than 5 per cent of the endometrial cancers (HNPCC syndrome- due to mismatch repair gene effect) and previous history of pelvic radiation. Below is the table which gives the relative risk for each risk factor.