UTERUS CANCER

Uterine Cancer (also known as Endometrial Cancer) is a type of cancer that begins in the uterus, a hollow, pear-shaped organ in a woman’s pelvis where fetal development occurs. The most common type of uterine cancer starts in the lining of the uterus, known as the endometrium, and is referred to as endometrial cancer. Less commonly, uterine cancer can begin in the muscle layer of the uterus, called uterine sarcoma.

Types of Uterine Cancer

  1. Endometrial Carcinoma:
    • The most common type of uterine cancer.
    • Begins in the endometrium, the inner lining of the uterus.
    • Subtypes include:
      • Endometrioid adenocarcinoma: The most common subtype, often linked to excess estrogen.
      • Serous carcinoma: A more aggressive form, less common.
      • Clear cell carcinoma: A rare and aggressive subtype.
  2. Uterine Sarcoma:
    • A rare type of cancer that forms in the muscles or other supporting tissues of the uterus.
    • Subtypes include:
      • Leiomyosarcoma: Arises from the smooth muscle layer of the uterus.
      • Endometrial stromal sarcoma: Arises from the connective tissues in the endometrium.

Risk Factors

  • Age: Most cases occur in women over the age of 50.
  • Hormone Replacement Therapy: Estrogen-only hormone therapy, especially after menopause, increases the risk.
  • Obesity: Excess body fat can lead to higher levels of estrogen, increasing the risk of endometrial cancer.
  • Menstrual History: Early onset of menstruation (before age 12) or late menopause (after age 55) increases risk due to prolonged exposure to estrogen.
  • Never Having Been Pregnant: Women who have never been pregnant have a higher risk of uterine cancer.
  • Tamoxifen Use: A drug used for breast cancer treatment may slightly increase the risk of endometrial cancer.
  • Polycystic Ovary Syndrome (PCOS): Associated with obesity and high levels of estrogen, increasing risk.
  • Diabetes: Women with diabetes are at higher risk, possibly due to associated obesity and other metabolic factors.
  • Family History: A family history of endometrial or colon cancer, particularly if linked to Lynch syndrome (hereditary nonpolyposis colorectal cancer, HNPCC), increases risk.

Symptoms

Uterine cancer often presents with symptoms, particularly in its early stages, which makes early detection possible:

  • Abnormal Vaginal Bleeding: The most common symptom, especially postmenopausal bleeding or unusually heavy or irregular periods.
  • Pelvic Pain: Persistent pain or discomfort in the pelvic area.
  • Pain During Intercourse: Discomfort or pain during sexual intercourse.
  • Vaginal Discharge: Watery or blood-tinged discharge that is not normal for the individual.
  • Unexplained Weight Loss: Losing weight without trying can be a sign of cancer.

Diagnosis

Diagnosing uterine cancer typically involves several steps:

  • Pelvic Examination: A physical exam to check for any abnormalities in the uterus or other reproductive organs.
  • Transvaginal Ultrasound: Uses sound waves to create images of the uterus, helping to identify abnormalities in the endometrium.
  • Endometrial Biopsy: A small sample of the endometrium is taken for laboratory analysis to check for cancer cells.
  • Hysteroscopy: A procedure where a thin, lighted tube (hysteroscope) is inserted into the uterus to visually examine the lining and collect tissue samples.
  • Dilation and Curettage (D&C): A more extensive procedure to scrape and collect tissue from the lining of the uterus for analysis if a biopsy is inconclusive.
  • Imaging Tests:
    • CT Scan or MRI: Helps determine if the cancer has spread beyond the uterus.
    • Chest X-ray: To check if cancer has spread to the lungs.
    • Blood Tests: Including tests for anemia and tumor markers like CA-125.

Staging

Once diagnosed, uterine cancer is staged based on the extent of the disease:

  • Stage I: Cancer is confined to the uterus.
  • Stage II: Cancer has spread to the cervix but not beyond the uterus.
  • Stage III: Cancer has spread beyond the uterus to nearby tissues, such as the vagina or lymph nodes.
  • Stage IV: Cancer has spread to distant organs, such as the bladder, bowel, or lungs.

Treatment

Treatment for uterine cancer depends on the stage, type, and overall health of the patient:

  • Surgery:

    • Hysterectomy: The most common treatment, involving the removal of the uterus. It may also include the removal of the ovaries (oophorectomy) and fallopian tubes (salpingectomy).
    • Lymph Node Dissection: Removal of nearby lymph nodes to check for the spread of cancer.

  • Radiation Therapy:

    • Often used after surgery to kill any remaining cancer cells, particularly in higher-stage cancers.
    • Can also be used as a primary treatment in patients who cannot undergo surgery.

  • Chemotherapy:

    • Used in advanced or aggressive cases, either alone or in combination with radiation therapy.
    • Commonly used drugs include carboplatin and paclitaxel.

  • Hormone Therapy:

    • For cancers that are hormone-receptor positive, hormone therapy can be used to block the effects of estrogen on cancer cells.
    • Includes drugs like progestins, tamoxifen, or aromatase inhibitors.

  • Targeted Therapy:

    • Newer treatments that target specific pathways involved in cancer growth, such as VEGF inhibitors or mTOR inhibitors, may be used in advanced cases.

  • Immunotherapy:

    • For certain advanced or recurrent uterine cancers, particularly those with high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR), immune checkpoint inhibitors may be considered.

Prognosis

The prognosis for uterine cancer is generally favorable, especially when diagnosed early. The five-year survival rate for localized uterine cancer (confined to the uterus) is about 95%. However, survival rates decrease if the cancer has spread to nearby tissues or distant organs. The prognosis also depends on factors like the cancer’s stage, type, and grade.

Prevention and Early Detection

  • Regular Check-Ups: Routine gynecological exams can help detect abnormal changes in the uterus early.
  • Manage Risk Factors: Maintaining a healthy weight, managing diabetes, and being cautious with hormone replacement therapy can reduce the risk.
  • Consider Birth Control: Oral contraceptives have been shown to reduce the risk of endometrial cancer.
  • Genetic Counseling: For those with a family history of uterine or related cancers, especially linked to Lynch syndrome, genetic counseling and regular screening are recommended.
  • Healthy Lifestyle: A balanced diet, regular exercise, and avoiding smoking and excessive alcohol use can help lower the risk of uterine cancer.