We all have a general idea about the uterus. It is a part of the female reproductive system. The unborn baby or the foetus grows in the upper part or the body of the uterus. The uterus is an organ of the female reproductive system, which normally carries the foetus in the pregnant woman till childbirth. There are two parts of the uterus, the upper part called the body and the lower part extending into vagina called the cervix.Again, the wall of the uterus has two layers. The uterus’s inner layer is the endometrium and outer layer of muscle or myometrium. It is this muscular layer which pushes the baby out in childbirth.
What are uterine cancers ?
Uterine Cancers are basically tumours of the UTERUS.
What are the risk factors for uterine cancer ?
- Intake of only estrogen without taking progesterone, for example in the treatment of menopause.
- Number of menstrual cycles- Having more cycles during a female’s lifetime increases the endometrial cancer risk. Having menstrual periods (also known as menarche) before the age of 12 years and/or getting menopause later in life ups the risk.
- Being obese or overweight.
- Having a family history of Uterine cancer.
- Having diabetes can increase risk of Uterine Cancer slightly.
- Being afflicted by a condition called hereditary nonpolyposis colon cancer (HNPCC or also, Lynch syndrome).
- Polycystic Ovarian Syndrome- Women with polycystic ovarian syndrome (PCOS) have irregular levels of hormones, such as more androgens (or male hormones) and oestrogen levels, and decreased levels of progesterone.
- Having a condition called Endometrial Hyperplasia, in which there is an overgrowth of endometrium.
- Having breast cancers or Ovarian Tumours that produce estrogen.
- Getting radiation therapy for another tumour to the pelvis.
What are the types of uterine cancer ?
There are several types of cancer that can initiate in the uterus, either in the endometrium or the myometrium. They can also either be benign (not cancer) or malignant (cancer). Benign tumours are not as harmful and do not spread as malignant tumours do. Benign tumours include fibroids, a polyps, or endometriosis, which can be removed with an excellent cure rate. Malignant tumours include the uterine carcinomas or the uterine sarcomas.
I) Uterine sarcomas, are either initiated in the inner muscular layers or the connective tissue of the uterus. The tumours involving muscle or the myometrium, if benign are uterine leiomyomas, and if malignant, are called uterine leiomyosarcomas. The tumours involving the connective tissue are called endometrial stromal sarcomas.
II) Endometrial carcinomas, as the name suggests, are initiated in the endometrium or the uterine inner lining. Most uterine cancers are this type of cancer. The chief types of endometrial cancers are squamous cell carcinomas and adenocarcinomas.
- Squamous cell carcinoma: These carcinomas arise from cells in the squamous inner lining of the endometrium. The changes in the squamous cells are first precancerous. The precancerous lesions can be referred to as dysplasia or intraepithelial lesions.
Slowly the precancerous lesions may progress to become squamous cell carcinomas or invasive cancers. - Adenocarcinoma: A majority of the endometrial cancers are adenocarcinomas. Adenocarcinomas are cancers that arise from glandular cells, that is from the mucus-producing cells of the uterine lining. These are also invasive.
III) Uterine carcinosarcoma (CS) is initiated in the endometrium and is endometrial carcinoma and sarcoma occuring together.
What are the clinical features of uterine cancers ?
Symptoms of Uterine cancers include vaginal bleeding or foul smelling, yellowish discharge. Pain during sex or spotting after sex can also be noted. In the later stages of uterine cancers, back pain, lethargy, or nausea/vomiting can be noted.
How are uterine cancers diagnosed ?
- A complete Physical Examination of the body is mandatory.
- Ultrasound of the uterus : This will have to be undergone to see its lining. The uterine cancer check-up involves pelvic ultrasonography, endometrial biopsy, or dilatation and curettage (D&C) with or without hysteroscopy.
- Dilatation And Curettage (D&C) : If the biopsy sample is inadequate, or if it is hard to tell if the patient has cancer, a Dilatation And Curettage or a D & C has to be performed. The patient’s cervix is opened or dilated and a particular curettage instrument removes tissue from the uterus. This is done in the operating room, when patient is under general anesthesia.
- Hysteroscopy : This is a way the doctors can scan and examine the uterus. The doctor with the help of a miniature telescope inserted through the cervix, can see entire uterus.
- Biopsy: Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a uterine cancer diagnosis.
- Imaging Tests : To determine the exact extent of disease, additional imaging and radiographic tests may need to be performed so doctors can view, assess and judge the cancer. These imaging tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans.
- CA 125 Blood Test: CA 125 is basically a substance that several cancers liberate in the blood. This test can show how much the cancer has spread, by showing levels in blood or in seeing how the treatment is progressing.
How are uterine cancers staged ?
The stage is the exact spread of the disease in the human body. Staging is used to assess the risks and prognosis associated with the cancer extent to determine the appropriate treatment. The less advanced the stage, the better the prognosis.
Stage 0: The abnormal cells are found only on the surface of the epithelium of the uterus. This is also called as carcinoma in situ.
Stage I: The tumour has grown through the inner lining of the uterus to the endometrium and might have involved the myometrium.
Stage II: The tumour has invaded the cervix.
Stage III: The tumour has grown through the uterus to reach adjacent tissues, such as the vagina or neighbouring lymph nodes.
Stage IV: The tumour has invaded the bladder or intestine. Cancer cells may have spread to parts of the body far away from the uterus, such as the liver, lungs, or bones.
How are uterine cancers treated ?
The standard treatment is basically surgical. A surgical intervention has to be done on the uterus and the removal of lymph nodes, as well within the pelvis.
Young patients with benign tumours, who are wishful of pregnancy, can opt for uterus-preserving surgery.
Patients with malignant tumours can either have a simple surgical removal of the uterus called simple hysterectomy or the surgical removal of the ovaries and the upper vagina as well as the uterus called radical hysterectomy, based on spread of cancer.
For more advanced stages, radiotherapy and chemotherapy should be given together. In this external radiotherapy, the radiation is generated by an outside source and targeted to the tumour as well as lymph nodes & vessels. The chemotherapy has an arsenal drugs to kill the remnant cancer cells in the body.
What is the care to be taken after the treatment of uterine cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans.
Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
Are uterine cancers preventable ?
By maintaining a healthy weight, being physically active, not taking estrogen therapy indiscriminately goes a long way in preventing uterine cancer.
Either we can prevent the pre-cancer from occurring or we can prevent the progression of pre-cancer into full blown cancers. Early detection tests refer to the use of tests to find a disease such as cancer in asymptomatic people.
For cervical cancer, routine & regular screening with a smear test called the PAP test (which can be combined with a test for human papilloma virus or HPV) is useful. For uterine cancer, patient’s own monitoring of excessive or unusual vaginal bleeding or discharge is important. A doctor must be consulted immediately if these symptoms are noted. A pelvic ultrasound is also of help in early diagnosis.
How to find and reach cancer specialists for uterine cancer treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
