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Uterine Cancer

Uterine Cancer Definition: As we all know, uterus is the name given to the hollow organ that is located in the female pelvic region. It is also known as the ‘womb’. The uterus helps and supports the fetus as it is responsible for providing a supportive environment for the development of the fetus until birth. In terms of shape, it resembles the shape of an inverted pear. It has the following parts; • Fundus at the top • Corpus in the middle, and • Cervix in the bottom Endometrium is the name given to the inner layer of the uterus and endometrium, to the outer layer.

When there is an abnormal growth in any of the cells of the uterine region then it is said to be uterine cancer. Such abnormal growth/ growths (tumors) can also take the form of huge mass/ masses if they are malignant i.e., spreadable in nature. There are two major types of uterine cancer,

  1. Endometrial Cancer: These cancers start within the lining of the uterus i.e., in the endometrium. Nearly 95 % of all uterine cancers are of this type and hence, uterine cancers are also commonly known as endometrial cancer.

  2. Myometrial Cancer: Myometrial Cancer is the cancer that develops/ grows in the myometrium i.e., the outer layer of the uterus. This is a very rare type of uterine cancer.

Causes of Uterine Cancer:

Uterine cancer or endometrial cancer is an idiopathic disease i.e., there is no specific cause that researchers have found to be responsible for the occurrence of uterine cancer. Yet, there are a few factors that are found to be responsible for increasing your risk of developing uterine cancer. These uterine cancer risk factors are:

  1. Age: If you are postmenopausal or about to reach menopause (older than 55 years of age), then there is a high chance that you can develop an endometrial cancer as it mostly occurs in women who are over the age of 50. Because of the same reason, the average age of diagnosis for uterine cancer is also 60. Uterine cancer is rare in the case of women who are younger than 45 years (this is the reason why you don’t hear anyone having uterine cancer in 20s).

  2. Obesity: There is an increased risk of uterine cancer in women who are obese as the additional estrogen is produced by the extra fatty tissue present in such women. This increased estrogen causes an increased risk as it causes additional cell growth in the pelvic region leading to tumors in the area and therefore, cancer. This risk increases with increasing BMI (Body Mass Index). You would be shocked to know that nearly 70% of all the uterine cancer cases can be directly linked to obesity.

  3. Genetic regions: Your risk of developing uterine cancer increases if anyone in your family had endometrial cancer in the past. Your risk also increases if anyone in your family had a certain genetic condition like Lynch syndrome which is a hereditary condition responsible for causing colorectal cancer.  Nearly about 2 to 5 out of every 10 uterine cancer patients have Lynch syndrome as well.

  4. Race: Uterine cancer has been found to develop more likely in white women when compared to women from other races or ethnicities.

  5. Diabetes: There is an increased risk of the development of uterine cancer found in the case of diabetic women as diabetes is often associated with obesity.

  6. Diet: In the case of women who have diets consisting of high animal fats also, there is an increased risk of uterine cancer.

  7. Radiation Therapy: Increased risk of uterine cancer is also seen in women who have undergone radiation therapy. For example, in the case of women who have undergone radiation therapy for any other cancer in the pelvic or colon region.

  8. Drug: The chances of development of uterine cancer increase if the women had earlier received drug any of the following drug therapy:

  • Tamoxifen: Tamoxifen (Nolvadex) is a drug commonly taken by women suffering from breast cancer. Although it is really beneficial for such women still, it has been found to increase the risk of the development of uterine cancer in these women. That is also the reason why one is suggested to do their proper research before going with a particular treatment.

  • Estrogen: If there has been an imbalance in the levels of estrogen in one’s body, then also uterine cancer can take place. This can happen in the following cases:

  • i. Women whose periods got started before they were 12 and/ or gone through menopause late

  • ii. Women who had taken hormone replacement therapy (HRT) after the menopause

  • iii. Women who never got pregnant in their life.

Uterine Cancer Symptoms:

The most common symptom of uterine cancer is unusual/ unexpected vaginal bleeding or any bleeding after menopause has been reached. A few other common symptoms are:

  • Change in periods

  • Heavier than usual periods

  • Continued periods without any break

Other symptoms of endometrial cancer which are uncommon include the following:

  • Weight loss due to unexplained reasons

  • Difficult urination or abnormal bowel habits

  • Pain in the abdomen

  • Witnessing of watery discharge with an unpleasant smell.

One should, however, keep in mind that these symptoms can be caused due to other conditions also as a lot of these symptoms are also seen to be caused due to other problems. You should, hence, never take such symptoms lightly and consult a competent doctor who can perform an accurate diagnosis so as to reach a proper result and therefore, can help you in getting timely treatment.

Prevention of Uterine Cancer:

Even though there is no confirmed way to be completely prevented from uterine cancer, you can still be able to lower the chances of its occurrence. Researchers have found the following things that can help you in preventing yourself from uterine or endometrial cancer:

  1. Maintain a healthy body weight: As we have already discussed, obesity can tremendously increase the chances of the development of endometrial cancer in a person. You should, hence, maintain a healthy body weight so that your BMI remains normal i.e., less than 25. You should do physical activities and have a calorie deficit diet to reduce your weight if it is above the normal values.

  2. Using Birth Control Pills: The use of oral contraceptives has been found to decrease the risk of endometrial cancer. This reduction in risk is thought to be there even after stopping the use of these oral contraceptives. Birth control pills contain a combination of estrogen and progesterone (female reproductive hormones). These pills reduce the chances of endometrial cancer as they reduce the risk of any outgrowth getting formed of the endometrial/ uterine lining, especially in case of being used for a long time. Other than the pills, IUDs are also found to be very effective birth control methods in reducing the risk of endometrial cancers.

  3. Talk to your doctor: If you are thinking about getting Hormone Replacement Therapy (HRT) with an aim to control the menopausal symptoms, you should discuss about all the associated benefits and risks associated with HRT. This is because if you have not undergone a hysterectomy, replacing only estrogen can increase the risk of endometrial cancer as increased estrogen  may cause outgrowths in the lining of uterus. Because of the same reason, a combination of estrogen and progesterone is recommended to drop the risk.

Uterine Cancer Diagnosis:

Diagnosis for endometrial cancer includes the following steps:

  1. Physical examination: The physical examination, as the name suggests, includes a physical test in which your doctor places two fingers inside your vagina along with pressing on the abdomen to check for any swelling. If there is any swelling being found then there are chances you may have an endometrial cancer to deal with.

  2. Pelvic Ultrasound: In this test, ultrasound waves are used to take a picture of the uterus and ovaries being tested. These ultrasound waves ricochet when they meet or collide with anything dense like a tumor or organ. An image is then created by a computer-based on these echoes. This usually takes about 20-30 minutes and if anything unusual appears in the ultrasound, your doctor may ask you to get a biopsy done.

  3. Abdominal Ultrasound: This is another non-invasive ultrasound procedure in which the organs and structures within the abdomen are assessed. This is used for getting pictures of the ovaries and uterus when diagnosing endometrial cancer. This can also be used for assessing other structures like the liver, gall bladder, pancreas, etc.

  4. Transvaginal Ultrasound: Transvaginal means across or through the vagina so in this test, the transducer (ultrasound head) is inserted into the vagina to look at your uterus, ovaries, fallopian tubes, and even the pelvic area. This is not a painful procedure. This is usually performed by a female sonographer.

  5. Hysteroscopy & Biopsy: This procedure is used to look into the uterus with the aim to diagnose and treat the causes of abnormal bleeding. This test involves the use of a telescope-like device known as a hysteroscope that is also used to remove living tissue in order to perform the further test in the lab.

  6. Blood and Urine Testing: This test involves irregularities in the blood and urine of a woman being diagnosed.

  7. Other Tests: Your doctor may ask you to get other tests done like an X-ray, CT scan, MRI if cancer has been detected in your uterus.

It is not enough to diagnose endometrial cancer, your doctor also needs to determine the type of your endometrial cancer. The knowledge of the type of cancer helps the doctor and management team so that the best course of treatment can be followed. There are two types of endometrial cancer:

    1. Type 1 endometrial cancer: This type is the least aggressive as such cancer doesn’t spread to the nearby tissues quickly.

    2. Type 2 endometrial cancer: Type 2 endometrial cancer comes in the aggressive spectrum as such cancer spreads outside of the uterus quickly and there is also a need for stronger treatment when dealing with this type.

Along with the type of endometrial cancer, your doctor will also need to determine the severity of your cancer. For this, she/ he may stage the cancer according to the scale of the stage 1 to 4. The stages of uterine cancer are as follows:

  • Stage 1: In this stage, the cancer stays in the uterus only and has not yet spread beyond it.

  • Stage 2: In this stage, the cancer gets spread up to the cervix

  • Stage 3: In this stage of endometrial cancer, the cancer can be found spread to the ovaries, vagina, and even the lymph nodes.

  • Stage 4: In this stage, the cancer has spread to the urinary bladder and other organs away from the uterus.

There can also be cases where no determination of the stage can be done till it is surgically removed from the body.

Treatment for Uterine Cancer:

For the majority of women who have uterine cancer, surgery will be the sole treatment needed, especially if the diagnosis has been done in the early stage and has not been spread to other areas of the body.

  1. Surgery:

  • This is the most common treatment used for treating cancer. In this conventional method, the organ having cancer (usually, uterus and cervix) is surgically removed out of the body i.e., hysterectomy. Your surgeon will perform either a simple or a radical hysterectomy.

Simple Hysterectomy: This includes the surgical removal of the uterus and the cervix.

Radical Hysterectomy: This includes the removal of the vagina’s upper part and nearby tissues also along with the uterus and cervix. In the case of the patients who have gone through menopause, a bilateral salpingo-oophorectomy will be performed by the surgeon which includes the removal of both the fallopian tubes along with the ovaries. Hysterectomy is done with the help of incisions made on the abdominal region. A laparoscopy can also be done with the help of a robot these days (known as robot-assisted laparoscopy). In laparoscopy, a camera is inserted along with a few instruments through the tiny incisions. These instruments are used to remove the uterus, cervix, nearby tissues, etc. There is no requirement for any additional treatment if a woman has no cancer left in the tissue extracted during the hysterectomy procedure. Regular screen tests should, however, are always recommended so as to make sure that the cancer has not returned again.

  • Lymph Node Removal: Along with the hysterectomy, your surgeon may also go for lymph node removal around the tumor if she/ he finds the cancer to be spread beyond the uterus. It is carried out by a procedure known as the sentinel lymph node biopsy. This mostly involves your uterus getting an injection of dye first during the hysterectomy and then removal of the lymph nodes where this dye gets collected.
  1. Radiation Therapy: This involves the use of X-rays to make the cancer cells injured and dead. It is commonly used along with some other main treatment with an aim to lower the chances of the cancer returning again. It can, however, also be recommended for patients who are not well enough to tolerate/ undergo surgery. Radiation Therapy can be done both, externally and internally. When radiation therapy is given externally, the radiation is projected at the cancerous cells and nearby tissues via a machine. When it is given internally, radioactive materials are delivered to the cancer site internally using thin tubes. If you are among the people concerned about the impact of radiation on your future fertility capabilities, then you should know that radiation therapy to the pelvic region can bring menopause, and hence, you should talk with your doctor before moving ahead with any kind of treatment.
  2. Hormone Therapy: This refers to the use of hormones like progesterone to treat women with uterine cancer as it has been found to be very effective in shrinking cancers.
  3. Chemotherapy: As the name suggests, this involves the use of powerful chemicals (drugs) to kill the cancer cells growing rapidly in a person’s body. Chemotherapy is generally used when the cancer has spread to other areas, not showing any response to hormonal therapy, or when it reappears. Your doctor is the one responsible for explaining the course and duration of the chemotherapy treatment.
  4. Palliative Care: Palliative care or treatment focuses on relieving the symptoms of the cancer and improving the quality of life. It has been found to help people in the advanced stages also to live longer and that too, with more comfort.

Conclusion:

One should always remember that even though, uterine cancer is an idiopathic disease, and it does not have any specific causes yet, it is a dangerous kind of cancer if it starts advancing. One should hence, get regular check-ups done and make sure that they are at bay from such an painful disease. In case you notice the associated symptoms, you should not hesitate in getting a competent medical help as in such cases, you not only lose the chance of having a prolonged life yourself but, you may get unable to bring a new life in this world. You should hence, always have the best medical help by your side who does not only is there when you tell them that you need them but are even there when you yourself don’t know that you need help.

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