Uterine Cancer

Uterine Cancer :

Uterine cancer, or cancer of the uterus (the womb) is the most common cancer of the female reproductive organs. Almost all cases start in the lining of the uterus, called the endometrium.

The uterus is where a fetus grows when a woman is pregnant. It is hollow and pear shaped with two main parts:
• The cervix, which is the bottom part and extends into the vagina (the birth canal)
• The body of the uterus is the upper part. It also may be called the corpus. It has two main parts — the muscle wall, which contracts when a woman has a baby, and the inner lining (endometrium).
When a woman menstruates (has a period), the endometrium becomes thicker. If she does not become pregnant, the new endometrial tissue goes out of the body as menstrual flow (blood). This happens about every month until a woman stops having periods. When a woman stops having periods it is called menopause.


Uterine cancer types :

There are three types of uterine cancer.
Endometrial cancer: Almost all uterine cancers start in the lining of the uterus (endometrium). The two main types of endometrial cancer are:
• Endometrioid adenocarcinoma: This accounts for most cases of endometrium cancer.
• Uterine carcinosarcoma: The cancer cells look like endometrium cancer and sarcoma.
Uterine sarcomas: These are less common types of uterine cancer and start in the muscle wall of the uterus.


 


Uterine cancer risk factors

Anything that increases the chance of getting uterine cancer is a risk factor. These include:
• Obesity: Being overweight raises your risk two to four times. A higher level of fat tissue increases your level of estrogen.
• Eating a diet high in fat
• Age: More than 95% of uterine cancers occur in women 40 and older.
• Tamoxifen: This breast cancer drug can cause the uterine lining to grow. If you take tamoxifen and have changes in your menstrual period or bleeding after menopause, it is important to let your doctor know.
• Estrogen replacement therapy (ERT) without progesterone if you have a uterus. Birth control pills may lower your risk.
• Personal/family history of uterine, ovarian or colon cancer. This may be a sign of Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC).
• Ovarian diseases, such as polycystic ovarian syndrome (PCOS)
• Complex atypical endometrial hyperplasia: This precancerous condition may become uterine cancer if not treated. Simple hyperplasia rarely becomes cancer.
• Diabetes
• Never having been pregnant
• If you started having periods before 12 years old or late menopause.
• Breast or ovarian cancer
• Pelvic radiation to treat other kinds of cancer. The main risk factor for uterine sarcoma is a history of high-dose radiation therapy in the pelvic area.
Not everyone with risk factors gets uterine cancer. However, if you have risk factors, it’s a good idea to discuss them with our gynae oncology.

Symptoms

Symptoms may vary from woman to woman. If you have any vaginal bleeding, spotting or unusual discharge after menopause, consult gynae oncologist. If you are still menstruating and have any of the following symptoms for more than two weeks, consult gynae oncology

  • • Unusual bleeding, such as between periods or heavier flow
  • • Abnormal vaginal discharge
  • • Pelvic pain or pressure
  • • Weight loss
Uterine Cancer Diagnosis

Early and accurate diagnosis of uterine cancer can help increase the chance for successful treatment. Our center uses the most advanced techniques and technology to diagnose uterine cancer and find out the exact extent of the disease. This helps our doctor to choose the best type of treatment for you. Our staff includes pathologists, diagnostic radiologists and specially trained technicians who are highly skilled in diagnosing uterine cancer.

Uterine Cancer Diagnostic Tests

If you have any symptoms that may signal uterine cancer, will examine you and ask you questions about your health; lifestyle, including smoking and drinking habits; and your family history.

If our Gynae oncologist thinks you might have uterine cancer, the first step will be a biopsy. Methods to do biopsy are

Endometrial biopsy: A thin, flexible tube is inserted through the cervix and into the uterus. Using suction, a small amount of tissue is removed through the tube.

D&C (dilation and curettage): If an endometrial biopsy does not provide enough tissue or if a uterine cancer diagnosis is not definite, a D&C may be done. The cervix is dilated (enlarged) with a series of increasingly larger metal rods. A tool called a curette is used to take cells from the uterus lining.

Hysteroscopy: A thin, telescope-like device with a light (hysteroscope) is put into the uterus through the vagina. Then looks at the uterus and the openings to the Fallopian tubes. Small pieces of tissue can be removed. Hysteroscopy may be done with a D&C.

One or more of the following tests may be used to find out if you have uterine cancer and if it has spread. These tests also may be used to find out if treatment is working.

Surgery, which may include:
• Hysterectomy: Removal of the uterus
• Bilateral salpingo-oophorectomy: Removal of the uterus, ovaries and Fallopian tubes
• Lymph node dissection: Removal of lymph nodes in the pelvis and lower abdomen
Imaging tests, which may include:
• Ultrasound
• CT or CAT (computed axial tomography) scans
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans
• Chest X-ray
Blood tests, which may include:
• Complete blood count (CBC)
• CA 125: Uterine cancers sometimes release this substance into the blood. High levels of CA 125 may mean the cancer has spread beyond the uterus or come back after treatment.
Genetic Testing

The Gynae oncology department at our center offers genetic testing for some women with uterine cancer or who are at risk. Genetic counseling may be recommended if you:
• Were diagnosed with endometrium cancer before age 50
• Have had colon or rectal cancer
• Have any close relatives with colon, rectal or endometrium cancer
• Have a relative who has tested positive for a Lynch syndrome gene mutation (MLH1, MSH2, MSH6, PMS2 genes)

Uterine Cancer Treatment

At our center, treatment for uterine cancer is customized just for you by our leading experts. They work in teams, collaborating at every step, to be sure you receive comprehensive, yet highly specialized care. We personalize your care to include the most advanced treatments with the least impact on your body. For uterine cancer, surgery often is one of the main treatments.



Surgical Skill, Experience

Like all surgeries, uterine cancer surgery is most successful when done by a gynae oncology with a great deal of experience in the particular procedure.

They perform a large number of uterine cancer surgeries each year, using the least-invasive and most-advanced techniques. For some patients, minimally invasive surgeries can mean faster healing and less time in the hospital.

 

Our Uterine Cancer Treatments

If you are diagnosed with uterine cancer, our gynae oncology will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. One or more of the following therapies may be recommended to treat uterine cancer or help relieve symptoms.


Surgery

Surgery is the main treatment for uterine cancer. Usually surgery for uterine cancer includes:

• Total hysterectomy (surgical removal of the uterus)
• Bilateral salpingo-oophorectomy (removal of both ovaries and Fallopian tubes)
• Biopsy of the omentum, a fat pad in the pelvis
• Removal of lymph nodes in the pelvis and lower abdomen

Sometimes a radical hysterectomy is done. This means removal of the:

• Uterus
• Cervix and surrounding tissue
• Upper vagina

Depending on your health and how far uterine cancer has spread, surgery may be:

• Minimally invasive: After making several small incisions (cuts) in the abdomen, the doctor uses a laparoscope or robotic surgery to remove the organs. The uterus often is removed through the vagina.
• Open: A large incision is made in the abdomen.

 

 

Surgery for uterine cancer may include:

Pelvic washings: The surgeon puts saline into the pelvic area after the uterus has been removed. The saline is then examined under a microscope.
Tumor debulking: If the cancer has spread into the abdomen, it may be debulked. This means the surgeon removes as much of the cancer as possible before other types of treatment.

Radiation Therapy

Radiation therapy may be used to treat uterine cancer after a hysterectomy or as the main treatment when surgery is not possible. Depending on the stage and grade of the cancer, radiation therapy also may be used at other points of treatment.

New radiation therapy techniques and remarkable skill allow our doctors to target uterine cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Our Center provides the most advanced radiation treatments for uterine cancer, including:

• Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
• 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
• Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Talk to your doctor about possible side effects of radiation treatment for uterine cancer. Some women get lymphedema in their legs. This is caused by blockage of the lymph fluid. Lymphedema may not start until months after treatment, but it usually does not go away. However, there are treatments to help.

Chemotherapy

Our Center offers the most up-to-date and advanced chemotherapy options for uterine cancer.

Hormone Therapy

Some hormones can cause certain uterine cancers to grow. If tests show the cancer cells have receptors where hormones can attach, drugs can be used to reduce hormones or block them from working.

Hormones that may be used to treat uterine cancer include:

• Progestins
• Tamoxifen
• Aromatase inhibitors