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Uterine Cancer

Cancer of the endometrium, or uterine cancer, is the most common gynecologic cancer. It usually affects postmenopausal women between ages 50 and 60; it's uncommon between ages 30 and 40 and extremely rare before age 30. Most premenopausal women who develop uterine cancer have a history of anovulatory menstrual cycles or another hormonal imbalance.

An average of 33,000 new cases of uterine cancer are reported annually; of these, 5,500 are eventually fatal.

Causes

Uterine cancer seems linked to several predisposing factors:

• low fertility index and anovulation
• abnormal uterine bleeding
• obesity, hypertension, or diabetes
• familial tendency
• history of uterine polyps or endometrial hyperplasia
• estrogen therapy (still controversial).

Generally, uterine cancer is an adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, through the blood or the lymphatic system. Lymph node involvement can also occur. Less common uterine tumors include adenoacanthoma, endometrial stromal sarcoma, lymphosarcoma, mixed mesodermal tumors (including carcinosarcoma), and leiomyosarcoma.

Signs and symptoms

The following are the most common symptoms of uterine cancer. However, each individual may experience symptoms differently. Symptoms may include:

• unusual vaginal bleeding or discharge
• difficult or painful urination
• pain during sexual intercourse
• pain in the pelvic area

Cancer of the uterus often does not occur before menopause. It usually occurs around the time menopause begins. The occasional reappearance of bleeding should not be considered simply part of menopause. It should always be checked by a physician.

The symptoms of uterine cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

Diagnosis

The tests used to diagnose cancer of the uterus include:

• Physical examination - to check the abdomen for swelling
• Tranvaginal ultrasound - allows the doctor to look at the size of the ovaries, uterus and thickness of the endometrium
• Dilatation and curettage procedure (D&C) - tissue samples of the uterus lining are taken for analysis.
• X-rays.
• Blood tests - to check your general health and help make decisions about your treatment.

Treatment

Uterine cancer treatment varies, depending on the extent of the disease.

Surgery :- Rarely curative, surgery generally involves total abdominal hysterectomy, bilateral salpingo-oophorectomy, or possibly omentectomy with or without pelvic or para-aortic lymphadenectomy.

Total exenteration involves removal of all pelvic organs, including the vagina, and is done only when the disease is sufficiently contained to allow surgical removal of diseased parts.

Radiation therapy :- When the tumor isn't well differentiated, intracavitary or external radiation (or both), given 6 weeks before surgery, may inhibit recurrence and lengthen survival time.

Hormonal therapy :- Synthetic progesterones - such as medroxyprogesterone or megestrol­may be administered for systemic disease. Tamoxifen (which produces a 20% to 40% response rate) may be given as a second-line treatment.

Chemotherapy : -Varying combinations of cisplatin, doxorubicin, etoposide, and dactinomycin are usually tried when other treatments have failed.

Prevention

All women should have regular pelvic exams and Pap smears beginning at the onset of sexual activity (or at the age of 20 if not sexually active) to help detect signs of any abnormal development.

Since conditions associated with increased risk have been identified, it is important for women with such conditions to be followed more closely by their doctors. Frequent pelvic examinations and screening tests, including a Pap smear and endometrial biopsy, should be done.

Women who are taking estrogen replacement therapy should also take these precautions. Any of the following symptoms should be reported immediately to the doctor:

• Bleeding or spotting after intercourse or douching
• Bleeding lasting longer than 7 days
• Periods that recur every 21 days or less
• Reappearance of blood or staining after 6 months or more of no bleeding at all