13 Jul Uterine Cancer
Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
Uterine cancer is cancer that begins in the lining of the uterus, called the endometrium.
The uterus is a female reproductive system organ located in the pelvic cavity between the bladder and rectum. It is formed from three main parts: (1) cervix, the lower segment of the uterus near the vagina, (2) corpus, the main and wider part of the uterus, and (3) fundus, the top part of the uterus where the two fallopian tubes start.
Uterine cancer is the most common type of cancer of the female reproductive organs and the fourth most common cancer in women. It is more common after menopause, between the ages of 50 and 60, but can occur in younger women.
The wall of the uterus is formed from three layers of tissue:
- Endometrium, is the inner layer that undergoes substantial changes every month.
- Myometrium, is a muscle tissue that becomes functional when the baby has to be propelled out from the uterus at the end of the 9 month pregnancy term.
- Serosa is a thin membrane that partially covers the uterus.
Types of Uterine Cancer
There are two main types of uterine cancer:
I. Endometrial cancer is the most common type of cancer that develops in the lining tissue of the uterus called endometrium. The endometrium is the tissue that thickens every month in preparation for pregnancy. There are three types of endometrial cancer:
- Adenocarcinomas is a type of cancer that develops within the surface of the endometrium. It is the most common type of endometrial cancer.
- Papillary serous adenocarcinomas is a rare, but very aggressive form of cancer and has a high rate of recurrence even when treated in the early stages.
- Clear cell adenocarcinomas is another rare, aggressive form of uterine cancer. This form of cancer develops in women whose mothers took a treatment with DSE hormone during pregnancy.
II. Uterine sarcoma is a rare form of uterine cancer that develops within the muscles and supporting tissues of the uterus. There are three types of uterine sarcoma:
- Uterine Carcinosarcomas: This is the most common type of uterine sarcoma and it develops in the endometrium tissue but gradually spreads to the nearby uterine tissues.
- Endometrial Stromal Sarcoma: This is a rare type of uterine sarcoma that develops within the supporting tissues of the endometrium.
- Uterine Leiomyosarcomas is a cancer that develops in the smooth muscle of the uterus.
Sign and Symptoms
Like any other form of cancer, uterine cancer involves certain signs and symptoms. These symptoms include:
- Abnormal vaginal bleeding is one of the most common and early uterine cancer symptoms that occurs in menopausal women. Bleeding occurs in 90 percent of uterine cancer cases.
- Abnormal Pap Smear is not a common sign of uterine cancer and is usually associated with abnormal uterine bleedings. An abnormal pap smear is a sign of a severe form of cancer.
- Other symptoms include: uterine cancer cause a series of other symptoms like pelvic pain, pain during intercourse, difficult or painful urination, and increasing abdominal girth.
- Uterine cancer is classified on a three grade scale, grades that assign the way cancerous cells look under microscope. Uterine cancer in the first grade has a close to normal appearance and develops at a slow rate, while uterine cancer in the third grade has a cancerous look and has an aggressive rate of development. The second grade is an intermediate stage between the first and third grade.
There’s a good chance of an early diagnosis of uterine cancer because it has very noticeable symptoms in the beginning stages.
Pelvic Exam– Your gynecologist will perform a pelvic exam of following organs: the vagina, uterus, bladder, and rectum. He or she can take a small sample of endometrial tissue, called a biopsy, in the office so the lining of your uterus can be examined under a microscope.
Blood tests– The blood test is a procedure in which a sample of blood is drawn and essential components of blood are being checked.
Pap test – A pap test is a laboratory test that determines if the cancer affected the vagina and the cervix. In order to perform this test, the doctor has to collect a sample of cells from the cervix and upper vagina area.
Transvaginal ultrasound – Transvaginal ultrasound works after the same mechanism like a normal ultrasound. The difference is that the ultrasound device is inserted into the vagina in order to obtain an interior image.
Endometrial biopsy – Endometrial biopsy is an outpatient procedure where a narrow tube is inserted through vagina into the uterus and small samples from different area of the uterine walls are suctioned out. This is a very effective procedure in diagnosing the uterine cancer.
Dilatation and Curettage (D & C)- This medical procedure is performed under general anesthesia. In this process the cervix is stretched open and an instrument called a curet is used to remove a sample of the uterine lining.
Exploratory laparotomy – This procedure is performed to establish the cancer stage. This procedure includes two methods:
- Endoscopic laparotomy is a medical procedure that involves a small incision into the abdomen. Through this small incision, a lighted and flexible instrumented, called an endoscope, is inserted into the abdomen cavity and helps the doctor to closely examine the inside organs and lymphatic nodes.
- Open laparotomy is another medical procedure where the peritoneal cavity is examined thorough a abdominal incision.
Treatment for uterine cancer involves a combination of surgery as the primary treatment, and radiation therapy, hormone therapy and chemotherapy as the adjuvant treatment.
Surgery: Surgical resection is the primary treatment for uterine cancer. There are three types of surgeries available for uterine cancer treatment:
(1) Total hysterectomy is a medical procedure that completely removes the entire uterus. After this type of surgery, women no longer have menstrual cycles or are able to get pregnant.
(2) Transvaginal hysterectomy is a type of surgery performed through an incision in the abdomen or through the vagina
(3) Bilateral salpingo-oophorectomy is another medical procedure that removes the fallopian tubes and ovaries. After the removal of the ovaries, the woman will forcedly enter into the menopause stage and display different symptoms of menopause.
Radiation therapy: Radiation therapy uses a highly focused x-ray to destroy cancer cells. There are two main forms of radiation therapy:
External beam radiation therapy: This form of radiation therapy uses a device called a linear accelerator that generates an external beam that is concentrated on the affected area and destroys the cancer cells or breaks up the tumor into small pieces
Internal radiation or branchytherapy: This form of radiation therapy uses a special applicator to insert pellets of radioactive material into the upper vagina.
Hormone therapy: Some uterine tumors contain on their surface a series of hormone receptors that attract and bind with estrogen and use it to grow. Progesterone is another female hormone like estrogen which balances the estrogen effect and slows down the growing process of the tumors.
Hormone therapy is a systemic treatment (affects cells throughout the entire body) used to treat metastatic and recurrent tumors, or used as a neoadjuvant treatment for those patient that cannot undergo surgery or radiation therapy.
Chemotherapy: Chemotherapy is another systemic treatment (that affects cells throughout the entire body) and involves an intravenous or oral administration of a series of cancer-killing drugs. Chemotherapy treatment follows a specific cycle, where each treatment period is followed by a recovery period. A typical chemotherapy treatment lasts between 3 to 6 months.