Uterine /Endometrial
Uterine Cancer (also known as Endometrial Cancer or Uterine Sarcoma)
Uterine cancer typically affects women between the ages of 60 and 70 years. It is often detected early, so women with this disease have a high recovery rate. Although it is commonly called uterine cancer, endometrial cancer is only one type of uterine cancer and other, less common, forms of uterine cancer also exist.
The endometrium is the inner lining of the uterus (another name for the womb). Endometrial cancer is a type of cancer that occurs when the cells of the endometrium grow out of control. Normal cells divide, grow and die in an organized manner. However, damage to their DNA can cause cells to keep dividing until they form a tumor, or a mass of excess tissue. This tumor may be either non-cancerous or cancerous. Non-cancerous tumors are said to be benign and cancerous tumors are referred to as malignant.
In some cases, the cancer cells become invasive. This means that they spread to tissues and organs outside of the endometrium in a process called metastasis. Scientists are not certain why endometrial cancer cells develop. However, many experts believe that high levels of the female hormone estrogen play an important role in the development of this disease.
Being aware of the signs and symptoms of uterine cancer and discussing them with a doctor in a timely manner can result in early detection of the disease, which increases the likelihood that treatment will be successful. Signs and symptoms of uterine cancer may include:
Abnormal spotting, bleeding or discharge from the vagina: If a woman has gone through menopause (defined as going without a menstrual cycle for 12 consecutive months when there is no other cause for this change). Aging is the chief cause of menopause. It is especially important to report irregular spotting or bleeding to your doctor. Approximately 90 percent of women diagnosed with uterine cancer experience postmenopausal or unusual spotting or bleeding, according to the American Cancer Society (ACS). Although this symptom can accompany certain non-cancerous conditions, women are urged to have an immediate medical evaluation of any abnormal bleeding. It is important to note that the absence of visible blood in an irregular vaginal discharge does not mean that there is also an absence of cancer. According to the ACS, approximately 10 percent of uterine cancers are accompanied by white rather than bloody discharge.
Pelvic mass and/or pelvic pain: Pelvic pain may occur in the later stages of uterine cancer. A pelvic mass may also appear in later stages. A mass can be a growth (cancerous or non-cancerous) or a cyst of almost any size. However, failure to seek prompt medical attention may allow the cancer to progress even further, thereby reducing the odds of successful treatment.
Weight loss: Similar to pelvic pain, weight loss typically occurs in the later stages of uterine cancer. However, unexplained and/or rapid weight loss can be a symptom of a variety of conditions, so be sure to talk to your doctor about it even if you are certain uterine cancer is not the cause.
Fatigue: General weakness or weariness can sometimes be a symptom of uterine cancer.
Difficult or painful urination or painful intercourse: If you experience difficulty or pain during urination or pain during intercourse, you may need to be tested for uterine cancer.
The main risk factor for uterine cancer is the amount of exposure a woman’s body has to the hormone estrogen. Estrogen is produced along with progesterone by the ovaries during a woman’s menstrual cycle. The longer a woman is exposed to estrogen, and the more she is exposed to, the greater her risk of developing uterine cancer. The following are some of the factors that increase a woman’s exposure to estrogen and therefore increase her risk of uterine cancer:
Early menarche: Beginning menstruation before the age of 12 increases the amount of estrogen the uterus is exposed to.
Hereditary non-polyposis colorectal cancer (HNPCC): HNPCC is a condition that develops from a genetic mutation, which results in an approximately 80% chance of eventually manifesting colorectal cancer. Furthermore, a woman with HNPCC has about a 50% chance of developing uterine cancer.
Late menopause: Going through menopause after age 50 increases the amount of estrogen the uterus is exposed to and thus increases the risk of uterine cancer
Number of years between menarche and menopause: The total length of a woman’s menstrual span (between the onset at menarche and the termination at menopause), the more her body has been exposed to estrogen. A woman who starts menstruating at 13 but does not go through menopause until 60 is at increased risk of uterine cancer as a woman who begins menstruating at age 10 but goes through menopause at 45 because the total length of her menstrual span is longer.
Having never become pregnant: During pregnancy, the balance of hormones shifts to more progesterone and less estrogen. Therefore, the more pregnancies a woman has, the less she has been exposed to estrogen than she would have been otherwise.
Obesity: Fat tissues can change some other hormones into estrogen, so the more fat tissue a person has, the greater her risk of uterine cancer.
There are no early detection tests or examinations for women with average risk of developing uterine cancer, and some cases may become advanced before recognizable signs or symptoms occur. If you exhibit signs or symptoms, such as abnormal spotting, bleeding or discharge, get tested for uterine cancer immediately.
Uterine cancer is usually diagnosed after a complete medical history, physical examination and pelvic examination. If cancer is suspected, other tests, such as an endometrial biopsy, will typically follow. An endometrial biopsy is a procedure to obtain an endometrial tissue sample for laboratory examination.
Staging and Treatment
Most uterine cancers can be subdivided by their “stage” and “grade”. Dividing cancers into these categories is helpful in determining appropriate treatment and prognosis. “Stage” basically describes the location of the tumor at the time of diagnosis. All gynecologic cancers are divided into 4 “Stages”. The stage given a cancer at the initial diagnosis does not change.
“Grade” refers to the appearance of the individual cancer cells under the microscope. Gynecologic cancers are generally divided into three Grades. Grade 1 cancers have an appearance not too dissimilar to the normal native tissue from which it arises. Grade 3 cancers bear little resemblance to the tissue of origin.
The stages and treatment for uterine cancers are following:
Stage I
Stage I sarcoma is confined to the corpus uteri. This stage accounts for 50% of all presentations. Stage IA: tumor limited to endometrium. Stage IB: invasion to less than 50% of the myometrium. Stage IC: invasion to more than 50% of the myometrium. Hysterectomy and removal of the ovaries and fallopian tubes is often recommended. Nearby lymph nodes will be removed and tested for cancerous cells. In some cases radiation may be recommended.
Stage II
Stage II uterine sarcoma means the cancer has involved the corpus and the cervix but has not extended outside the uterus.
Stage IIA: endocervical glandular involvement only.
Stage IIB: cervical stromal invasion.
The uterus, ovaries and fallopian tubes are removed and based on the grade and other factors a more extensive or radical hysterectomy may be done, in which paraaortic lymph nodes may be removed to examine for disease along with removal of pelvic lymph nodes and the connective tissue that holds the uterus in place. The extent of the cancer will then determine the type and extent of radiation therapy needed.
Stage III
Stage III uterine sarcoma means extension outside of the uterus but confined to the true pelvis.
Stage IIIA: tumor invades serosa and/or adnexa and/or positive peritoneal cytology.
Stage IIIB: metastasis to the vagina.
Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
At stage III, cancer is found in the uterus and in any of the following: peritoneal fluid, ovaries, fallopian tubes or lymph nodes. The uterus, ovaries and fallopian tubes are removed. A radical hysterectomy may be done (The removal of the entire uterus as well as surrounding tissues and part of the vagina) depending on the grade, physical exam and operative findings. The extent of the cancer will then determine the type and extent of radiation therapy needed.
Stage IV
Stage IV uterine sarcoma means involvement of the bladder or bowel mucosa or metastasis to distant sites.
Stage IVA: tumor invasion of bladder and/or bowel mucosa.
Stage IVB: distant metastases, including intra-abdominal and/or inguinal lymph nodes.
Treatment may include surgery to remove as much tumor as possible, depending on the location and extent of metastases. Hormonal therapy and or chemotherapy may be used when other areas are involved. Internal and external radiation especially when surgical removal is not possible.
y is it so important to be treated by a gynecologic oncologist?The importance of being treated by a gynecologic oncologist cannot be stressed enough. According to numerous medical studies, there are significant survival advantages for those women who are treated, managed, and operated on by a gynecologic oncologist.
A gynecologic oncologist is a professional who specializes in treating women with reproductive tract cancers.
Gynecologic oncologists are initially trained as obstetrician/gynecologists and then undergo three-four years of specialized education in all of the effective forms of treatment for gynecologic cancers (surgery, radiation, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancers.