What is Uterine Cancer?

Uterine cancer is a broad term for cancers that can occur in the uterus. There are two main types of uterine cancer:

  • Endometrial cancer: This type of uterine cancer develops in the endometrium, the inner lining of the uterus. It is the most common form of uterine cancer. 
  • Uterine sarcoma: Uterine sarcoma is a rare type of uterine cancer that develops in the myometrium, which is the muscular wall of the uterus.

Endometrial cancer and uterine cancer are often used interchangeably, even though they are not the same thing. Uterine cancer can include both endometrial and a rare type called uterine sarcoma. However, when discussing uterine cancer, people usually mean endometrial cancer. Endometrial cancer is the most common type, accounting for about 95% of all cases. Uterine sarcoma, on the other hand, is much less common.

What is endometrium, and what does it do?

The endometrium is the inner layer of the uterus, and it undergoes changes throughout the menstrual cycle. Estrogen and progesterone, two hormones, play a role in endometrial changes. When a woman becomes pregnant, these hormones cause the endometrium to thicken. However, if pregnancy does not occur, the body produces less progesterone. This decrease in progesterone leads to the shedding of the endometrial lining, resulting in menstrual periods.

What are the risk factors for Uterine Cancer?

The main risk factors associated with an increased risk of uterine cancer include:

  • Age: The risk of uterine cancer increases with age, especially after age 50.
  • Obesity: Being overweight or obese increases the risk of uterine cancer. Excess body fat alters your body’s balance of hormones.
  • Family history: Having a close relative, such as a mother or sister, with uterine, colon, or ovarian cancer can elevate the risk 
  • Diabetes: Women with diabetes have a higher risk of developing uterine cancer.
  • Hormonal therapy for breast cancer: Tamoxifen is the medication commonly used to treat breast cancer and may slightly increase the risk of developing uterine cancer.
  • Estrogen Replacement Therapy: Estrogen hormonal therapy is sometimes prescribed to alleviate menopause symptoms. However, receiving estrogen therapy without the addition of progesterone increases the risk of uterine cancer.
  • Early menstruation:  Refers to the onset of menstruation before the age of 12.
  • Late menopause:  Menopause occurring after age 50 can also contribute to an increased risk of uterine cancer.
  • No pregnancy:  Women who have not been pregnant have an increased risk of uterine cancer.
  • Genetic factors: Certain hereditary conditions, such as Lynch syndrome, can increase the risk of uterine cancer.
  • Radiation therapy: Previous radiation treatment to the pelvis to treat another type of cancer can raise the risk of uterine cancer later in life.

What causes Uterine Cancer?

The exact cause of endometrial cancer is not fully understood. However, it is known that certain changes, called mutations, occur in the DNA of cells in the endometrium, which is the lining of the uterus. These mutations transform normal, healthy cells into abnormal cells. Healthy cells have a controlled growth and multiplication rate, eventually dying at a specific time. In contrast, abnormal cells grow and multiply uncontrollably and do not die as they should. The accumulation of these abnormal cells forms a mass known as a tumour. Cancer cells can attack nearby tissues and spread to other parts of the body (metastasize). Several risk factors, as mentioned above, put you at increased risk of developing uterine cancer.

What are the symptoms of Uterine Cancer?

The signs and symptoms of uterine cancer can be similar to those of various other conditions, particularly those affecting the reproductive organs. Therefore, if you observe unusual pain or experience irregular vaginal bleeding, it is crucial to consult with your healthcare provider for proper evaluation and diagnosis.

Symptoms of endometrial cancer and uterine sarcoma may include:

  • Vaginal bleeding between periods before menopause.
  • Vaginal bleeding or spotting after menopause, even if it is a small amount.
  • Lower abdominal pain or cramping in the pelvic area, located just below the belly.
  • Thin white or clear vaginal discharge in postmenopausal women.
  • Experiencing prolonged, heavy, or frequent vaginal bleeding if you are over 40.

How is Uterine Cancer diagnosed?

Uterine cancer is typically diagnosed through medical history evaluation, physical examination, and specific diagnostic tests. The following are commonly used methods to diagnose uterine cancer:

  • Medical history and physical examination: Your healthcare provider will review your medical history, including any symptoms you may be experiencing, and perform a physical examination and pelvic examination to check for any abnormalities or signs of uterine cancer.
  • Blood tests:  This will look for the presence of a protein called CA-125, which can indicate cancer
  • Imaging test:
    • Computed tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans may be performed to evaluate the extent of cancer, determine if it has spread to other areas, or assess the overall staging of the disease.
    • Transvaginal ultrasound: A small ultrasound probe is inserted into the vagina to obtain detailed images of the uterus and its lining, allowing the detection of any abnormal growths or thickened areas.
  • Other tests
    • Endometrial biopsy: In this procedure, a small tissue sample is collected from the lining of the uterus (endometrium) for laboratory analysis. The sample is then examined under a microscope to determine if cancer cells are present.
    • Hysteroscopy: This procedure involves the insertion of a thin, lighted tube with a camera (hysteroscope) into the uterus through the vagina and cervix. It allows direct visualization of the uterine lining and can help detect any abnormal areas or tumors. A biopsy may also be taken during hysteroscopy.
    • Dilation and curettage (D&C): This procedure is performed in the operating room to remove tissue from the uterus. The sample is then sent to a pathology lab to examine under a microscope to see if cancer cells are present. 

What are the stages of Uterine Cancer?

The staging system for uterine cancer ranges from I to IV and provides valuable information about the extent of cancer spread:

Stage I: The cancer is limited to the uterus and has not spread beyond it.
Stage II: The cancer has spread to the cervix.
Stage III: The cancer has spread to the vagina, ovaries, and/or lymph nodes.
Stage IV: The cancer has spread to distant organs, such as the bladder or other organs far from the uterus.

How is Uterine Cancer treated?

The treatment of uterine cancer depends on several factors, including the type and stage of cancer, and the individual’s overall health. The main treatment options for uterine cancer include:

  • Surgery: The primary treatment for most cases of uterine cancer involves surgical removal of the uterus (hysterectomy). There are different ways this surgery can be done:
  • Total abdominal hysterectomy: The surgeon makes a cut in the abdomen to remove the uterus.
  • Vaginal hysterectomy: The uterus is removed through the vagina.
  • Radical hysterectomy: A radical hysterectomy may be needed if the cancer has spread to the cervix. This involves removing the uterus, surrounding tissues, and the top part of the vagina.
  • Laparoscopic hysterectomy: The surgeon makes small incisions and uses special tools to remove the uterus. This can be done using laparoscopic techniques.
  • Radiation therapy uses targeted radiation beams that can destroy cancer cells.
  • Chemotherapy: It involves the use of drugs that kill cancer cells or slow down their growth. Chemotherapy may be recommended in advanced or aggressive cases of uterine cancer, either as the primary treatment or in combination with other therapies.
  • Hormone therapy: In certain cases, hormone therapy may be used to block the effects of hormones, such as estrogen, which can stimulate the growth of some types of uterine cancers. 
  • Targeted therapy: This approach utilizes specific drugs that target specific genetic mutations or abnormalities in cancer cells to stop them from multiplying.

Can Uterine Cancer be prevented?

While there is no guaranteed way to prevent uterine cancer, there are some steps that can help lower the risk by:

  • Maintaining a healthy weight
  • Use of combined hormonal contraceptives: Birth control pills or other forms of combined hormonal contraceptives (containing both estrogen and progesterone) can help reduce the risk of uterine cancer.
  • Pregnancy and breastfeeding: Having children and breastfeeding may lower the risk of uterine cancer.
  • Managing hormone replacement therapy (HRT): If you are undergoing hormone replacement therapy to manage menopausal symptoms, discussing the risks and benefits with your healthcare provider is essential. Adding progestin to estrogen therapy can help reduce the risk of uterine cancer.
  • Regular check-ups and screenings: Attend routine gynecological check-ups and discuss any concerning symptoms with your healthcare provider. Depending on your age and risk factors, your healthcare provider may recommend endometrial biopsy or transvaginal ultrasound screenings.

Fortunately, endometrial cancer is frequently detected at an early stage, as women notice abnormal vaginal bleeding. Removing the uterus can often lead to a cure if caught early and has not spread to other organs. So, if you notice anything unusual, such as bleeding or spotting, always talk to your healthcare provider.

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