DEAR DR. ROACH: Can you comment on endometrial cancer? I have stage IV, and I’m in my 50s. I remain concerned about inflammatory foods. I’ve now embraced a macrobiotic diet, and I feel great. — T.P.

ANSWER: In North America, endometrial cancer is the most common gynecological cancer. Most women with endometrial cancer will see their doctor because of abnormal bleeding, usually years after menstruation has stopped. I still occasionally have patients who tell me that they are so glad their periods started again, but this is a serious concern that calls for an immediate evaluation by a gynecologist.

Most cases of endometrial cancer are caught when the disease is localized, but unfortunately, some women will present symptoms to their doctor with the disease already having spread. In these cases, she may notice pain or swelling in the legs; poor appetite; weight loss; chest symptoms such as cough, pain, or shortness of breath or bone pain.

Most cases of stage IV endometrial cancer (stage IV is when the disease has spread to distant organs) aren’t curable, but a woman’s life may be prolonged and improved with treatment. Treatment, even in women with distant disease, sometimes involves surgery of the primary tumor and usually involves chemotherapy. Checkpoint inhibitors have made a significant improvement in prognoses for endometrial cancer.

Treatment, apart from treating the underlying cancer, can also improve a woman’s quality of life. This is the case for all kinds of cancers, whether they’re curable or not. I never tell my patients “there’s nothing we can do” because even when we can’t effectively treat the progression of the cancer, we can help people feel better.

Diet is an important part of this. A macrobiotic diet in principle focuses on whole grains, vegetables, beans and fermented foods. This diet doesn’t help treat cancer, but it can help people tolerate treatment or just feel better. I’m very glad that it is helping you.

I would note that strict adherence to a macrobiotic diet (which avoids meat and meat products) can cause vitamin B12 deficiency. Your body needs vitamin B12 to make new red blood cells and support the cells in your brain and nerves, so you may need supplemental vitamin B12, which can be taken by mouth. (There’s no need for B12 shots.)

In addition to a good diet, exercising regularly, getting regular sleep and participating in activities to support your emotional well-being (such as mindfulness or meditation) can all help people feel better during their cancer treatment.

DEAR DR. ROACH: Both my mother and her mother were diagnosed with wet age-related macular degenaration (AMD). They lost most of their vision as a result. Can I do anything preventively? I’m 68 years old without any current vision problems, and I only use readers when needed. Do vitamins (AREDS, Ocuvite, etc.) help?–L.H.M.

ANSWER: I don’t recommend the AREDS formula vitamins for people who are at risk for but don’t have AMD. AREDS vitamins are given in people with intermediate AMD to prevent its progression, but they aren’t proven to be of any benefit in people who don’t yet have diagnosed AMD.

Quitting smoking can help prevent AMD, as can a Mediterranean-style diet. Unfortunately, there are no proven medication treatments to prevent AMD, so regular screening remains the most important intervention. Screening yourself regularly at home with an Amsler grid and getting regular ophthalmologic exams are both recommended.