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Uterine Cancer

The Uterus

The uterus is part of a woman's reproductive system. It's a hollow organ in the pelvis.

The uterus has three parts:

  • Top: The top (fundus) of your uterus is shaped like a dome. From the top of your uterus, the fallopian tubes extend to the ovaries.

  • Middle: The middle part of your uterus is the body (corpus). This is where a baby grows.

  • Bottom: The narrow, lower part of your uterus is the cervix. The cervix is a passageway to the vagina.

The wall of the uterus has two layers of tissue:

  • Inner layer: The inner layer (lining) of the uterus is the endometrium. In women of childbearing age, the lining grows and thickens each month to prepare for pregnancy. If a woman does not become pregnant, the thick, bloody lining flows out of the body. This flow is a menstrual period.

  • Outer layer: The outer layer of muscle tissue is the myometrium.


Uterine Cancer

Uterine cancer begins when normal cells in the uterus change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Noncancerous conditions of the uterus include fibroids (benign tumors in the muscle of the uterus), endometriosis (endometrial tissue on the outside of the uterus or other organs), and endometrial hyperplasia (an increased number of cells in the uterine lining).

Cancer of the uterus is the most common cancer of the female reproductive organs. It's the fourth most common cancer among women overall, behind breast cancer, lung cancer, and colorectal cancer. 19 out of 20 uterine cancers are cancers of theendometrium, the inner lining of the uterus. This is calledendometrial cancer. The remaining 5% are tumours of the outer muscular lining, called sarcomas. In general, sarcomas are more aggressive and faster spreading.


Different Types of Uterine Cancer

Most cases of cancer of the uterus are cancers of the uterus lining (endometrium), though some cancers grow in the muscle layers of the uterus. The different types of uterine cancer include:

  • Adenocarcinoma of the Endometrium – around 85 per cent of women diagnosed with cancer of the uterus have this form. An adenocarcinoma is a cancer that starts in the glandular tissue.

  • High-risk Cancers − less common types of cancer (such as adenosquamous carcinoma, papillary serous carcinoma and clear cell carcinoma) are more likely than others to spread around the body.

  • Endometrial Hyperplasia − sometimes women develop a thick uterus lining which can cause heavy periods. Some types of endometrial hyperplasia may later become precancerous.


Staging of Uterine Cancer

Staging is a way to describe how large the cancer is. It also describes how far the cancer has spread. Finding the stage helps your doctor decide on the best treatment for you. For uterine cancer, these are the 4 stages:

  • Stage I - Stage I uterine cancer is only in the uterus. It is not in the cervix.

  • Stage II - Stage II cancer means that there are also cancer cells in the cervix.

  • Stage III - Stage III cancer has spread outside of the uterus. It may have spread to the ovaries, tubes, or surface of the uterus (serosa). Or cancer cells may be detected in abdominal fluid. Involvement of lymph nodes is also classified as stage III.

  • Stage IV - This means that the cancer has spread to other parts of the body. It may have spread to the abdominal cavity, lungs, or liver.


Risk Factors

There is no way to know for sure if you will get uterine cancer.  Some women get it without being at high risk.  However, several factors may increase the chance that you will get uterine cancer, including if you. The following increase your risk of endometrial cancer:

  • Diabetes

  • Estrogen replacement therapy without the use of progesterone

  • History of endometrial polyps or other benign growths of the uterine lining

  • Infertility (inability to become pregnant)

  • Infrequent periods

  • Tamoxifen, a drug for breast cancer treatment

  • Never being pregnant

  • Obesity

  • Polycystic ovarian syndrome (PCOS)

  • Starting menstruation at an early age (before age 12)

  • Starting menopause after age 50

If one or more of these things is true for you, it does not mean you will get uterine cancer.  But you should speak with your doctor to see if he or she recommends more frequent exams.


Symptoms

Abnormal bleeding from the vagina is the most common early symptom. Abnormal bleeding includes;

  • Bleeding after menopause

  • Bleeding between menstrual periods

  • Periods that are irregular, heavy, or longer than normal

  • Pain or difficulty when emptying the bladder

  • Pain during sex

  • Pain in the pelvic area

One of three women with vaginal bleeding after menopause has endometrial cancer. Women who have vaginal bleeding after menopause should see a doctor promptly. A watery, blood-tinged discharge may also occur. Postmenopausal women may have a vaginal discharge for several weeks or months, followed by vaginal bleeding.


Diagnosis

When evaluated for uterine cancer, your doctor will take a complete medical and family history, as well as perform a pelvic exam to examine the organs of the female reproductive tract for any changes in size or shape.  The following tests may be ordered by your doctor to fully evaluate you for uterine cancer:

  • Blood and urine tests

  • Pap smear.  This test includes collecting cells from the cervix and upper vagina. An experienced gynecological pathologist  will then check the cells for any sign of malignancy.  

  • Transvaginal ultrasound.  Your doctor will use a receiver inserted in the vagina to examine the uterus, ovaries and vagina by ultrasound.  Using high-frequency waves that ‘bounce’ back to the machine, your doctor can fully visualize the internal anatomy.  If the endometrium of the uterus looks like it has thickened, your doctor will probably order a biopsy.

  • Biopsy.  In this procedure, which can be done in your doctor’s office, your doctor will remove a sample of tissue from the endometrium.  There may be times when your doctor will order a dilation and curettage (D&C), an outpatient procedure performed in the hospital under general anesthesia. A pathologist will carefully examine the sample of tissue to check for possibly malignancies and other conditions.  Recovery for this procedure usually involves some cramping and vaginal bleeding.


Medical Treatment

The following surgeries and therapies are used to treat uterine cancer.


Surgery

Removing the cancer in an operation is the most common treatment of uterine cancer. During surgery, the physician evaluates the extent of the cancer and uses a staging guide to assess each patient's cancer stage. The following surgical procedures may be used:

  • Radical Hysterectomy —The primary treatment of uterine cancer is a hysterectomy in which the uterus, fallopian tubes, cervix, ovaries, surrounding tissue, and lymph glands are removed. A radical hysterectomy is usually done through the abdomen.

  • Total Hysterectomy —This type of hysterectomy involves removal of just the uterus and cervix. It can be done through the abdomen or through the vagina. Sometimes a total vaginal hysterectomy can be done with the aid of a laparoscope (a viewing instrument passed through a small incision in the abdomen).

  • Lymph Node Surgery - Lymph Node Surgery is where the lymph nodes of the pelvis (pelvic lymph nodes) and those along the aorta (para-aortic lymph nodes) may be removed during a hysterectomy if lymph node involvement is suspected. When all or most of the lymph nodes of a certain area are removed, it is known as lymph node dissection. If only some are removed, it is called lymph node sampling.

  • Bilateral Salpingo-Oophorectomy — A bilateral salpingo-oophorectomy is the removal of both ovaries and both fallopian tubes via surgery. It is used in conjunction with a hysterectomy.


Radiation Therapy

Radiation therapy (also called x-ray therapy, radiotherapy, or irradiation) uses high-energy rays to kill cancer cells. It is often used in combination with surgical treatment. Radiation may be given from a machine located outside the body (external radiation therapy), or radioactive material may be placed inside the body (internal radiation therapy).


Chemotherapy

Chemotherapy is the use of drugs to treat cancer. Often, a combination of these methods is used. In some cases, the patient is referred to specialists in the different kinds of cancer treatment.


Hormonal Therapy

In hormone therapy, female hormones are used to stop the growth of cancer cells. Hormone therapy is sometimes used to slow the growth of cancer cells. It is an excellent choice for those who cannot undergo surgery for health reasons. In order to grow, cancer cells feed off of hormones that the body produces.


Complementary Therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

  • Acupuncture to relieve pain.

  • Meditation or yoga to relieve stress.

  • Massage and biofeedback to reduce pain and ease tension.

  • Breathing exercises for relaxation.

Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments. Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects.


Recovery and Follow-Up Care

Recovery and follow-up are different for everyone and depend on the treatment you have. It takes time to recover from the various types of treatment: there are physical and emotional changes to cope with. You may need to talk with your employer about how the treatment may affect your work, and with your family about the support that you need.

You will need regular health checks that will include tests and examinations after treatment is over. As well as checking to make sure your cancer hasn't come back, follow-up visits may be necessary because of the possible physical changes that will occur as a result of the cancer and the cancer treatment.

Check-ups will continue to be necessary even if you haven't had any sign of cancer for some years. This can make it difficult to put the experience of a cancer diagnosis and treatment behind you. For family and friends, your cancer may be a thing of the past, but check-ups may well bring it into the present for you again-you may feel quite anxious at check-up time. Finding ways of supporting yourself and taking care of yourself when a check-up is scheduled is a part of living with cancer. 


Complications of Surgery for Uterine Cancer

The main complications of hysterectomy, besides the complications that may occur with any major surgery, are the inability to fall pregnant since the uterus has been removed. This is more of a consequence rather than a complication but needs to be taken into consideration in women who desire to fall pregnant. With the onset of menopause due to removal of the ovaries, the symptoms of menopause may then appear which includes hot flashes, night sweats, and vaginal dryness. The psychological impact of a hysterectomy should also be considered.


Recurrent Cancer

Approximately 70 percent of recurrences take place within three years of the initial therapy. Symptoms of recurrent cancer may include vaginal bleeding or discharge, pain in the pelvis, abdomen, back or legs, leg swelling (edema), weight loss and chronic cough.

Local recurrences-those on the pelvic wall, in the vagina and the tissue surrounding the cervix and uterus (parametrium)-are the most common sites in women who have not received pelvic radiation; distant metastases to the lung, liver or abdominal cavity may also occur.

Radiation therapy, if not given previously, may cure those women with a vaginal or parametrial recurrence. In women who have a localized vaginal recurrence involving the bladder or rectum, the removal of the bladder and/or rectum and vagina (pelvic exenteration) can be curative in up to 40 to 50 percent of cases.

Unfortunately, most women with recurrent endometrial cancer outside the pelvis cannot be cured. But symptoms may be relieved with progestational therapy, anti-estrogen therapy or chemotherapy as noted above.

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