Uterine cancer refers to abnormal cell growth in the uterus (womb) in females. This abnormal uncontrolled growth of cells leads to post menopausal bleeding or heavy menstrual bleeding in women of reproductive age.
Associated Anatomy of Uterine Cancer
Female Uterus (Womb)
Uterine Cancer Epidemiology
- Uterine cancer is the most common malignancy of the female genital tract in developed countries and the fourth most common cancer in women after breast, lung and colorectum.
- The average age of patients with uterine cancer is approximately 63 years & 70% of the cases have disease limited to the uterus at the time of diagnosis.
Causes of Uterine Cancer
The exact cause of uterine cancer is unknown, but the following factors act as risk factors for the development of uterine cancer -
- Advancing age : Risk increases in women aged 50 years and above
- Early menarche (Onset of periods before age 12)
- Late menopause (after age 52)
- Never having kids
- A thickened uterine wall (endometrial hyperplasia)
- High blood pressure or diabetes
- Obesity (females having a triad of obesity, diabetes and increased blood pressure are labelled as having corpus cancer syndrome which predisposes to the development of uterine cancer)
- Prior history of polycystic ovarian syndrome
- Ovarian, uterine, or bowel cancer in the family
- A genetic disorder like Cowden or Lynch syndrome
- Using oestrogen hormone replacement therapy or oestrogen secreting tumor
- Using tamoxifen to treat breast cancer
- Prior pelvic radiation treatment
- Race : White and black women are at high risk of developing uterine cancers
Symptoms of Uterine Cancer
Symptoms of uterine cancer include -
- Abnormal vaginal bleeding
- Post-menopausal bleeding (bleeding which starts any time after 1 year of menopause)
- Heavy and prolonged menstrual bleeding
- Irregular bleeding or spotting in between two periods
- Vaginal discharge (Pink /Brown) which may be foul smelling
- Painful urination
- Pelvic pain: A feeling of pressure in the pelvic region caused by an enlarged uterus
- Weakness, fatigue, abdominal distention due to fluid in abdomen, back pain, or leg pain when cancer has spread to other organs
Tests for Uterine Cancer
An office endometrial biopsy is one of the most common tests used to diagnose uterine cancer. It is considered to be very accurate for postmenopausal women. This can can be done easily in the doctor's chamber. It is done through a thin, flexible tube, which is inserted into the uterus through the cervix and the specimen obtained is sent for examination to the lab. Some patients may require hysteroscopy and dilatation and curettage under anaesthesia in OT to obtain tissue for biopsy.
- Imaging is also done to assess whether the cancer is confined to the uterus or has spread to other tissues / organs and consists of ultrasound, CT Scan or MRI of abdomen or whole body PET CT.
Stages of Uterine Cancer
Uterine cancer has 4 stages:
Stage 1: Cancer is localized to the uterus and has not spread to other tissues/ parts of the body
Stage 2: Spread of cancer from uterine tissue to the cervix
Stage 3: Spread of cancer to parts within the pelvic region such as fallopian tubes, ovaries, vagina, pelvic lymph nodes
Stage 4: Spread of cancer to nearby organs like urinary bladder, rectum or distant body organs (liver, lung, bone)
Nearly 70% of women are diagnosed to have early stage of uterine cancer when the cancer is still confined to the uterus. In 20% of cases, cancer has spread to local organs and lymph nodes, and only in 10% to distant organs.
Possible Treatment for Uterine Cancer
It is the best and the most appropriate treatment for uterine cancer in medically fit patients and involves the removal of uterus, cervix, ovaries, fallopian tubes and lymph nodes adjacent to pelvic and abdominal blood vessels. A sentinel lymph node biopsy involves injecting coloured dye into the uterine cervix and removing only the lymph nodes that get highlighted by the uptake of the dye.
Involves using high-intensity radiation beams to destroy the cancer cells. Depending on the stage of uterine cancer as determined by the final biopsy report of surgery, patients may or may not require radiation therapy. Radiation can also be the treatment of choice in medically unfit patients and in those who refuse surgery.
Chemotherapy uses medications to kill cancer cells by preventing them from growing and dividing. Chemotherapy is given following surgery for endometrial cancer in advanced-stage disease. Following initial treatment, chemotherapy is usually given if endometrial cancer returns.
It involves the use of hormonal medicines in certain specific types of uterine cancer after primary treatment to prevent or delay the cancer from coming back.
Administration of medications that specifically target cancerous uterine cells / tissues, sparing the healthy cells.
Primary Prevention of Uterine Cancer
Prevention includes working on the potential risk factors of uterine cancer. The following preventive steps can be taken:
- Maintain a healthy weight: Healthy weight helps you manage obesity, significantly reducing the chances of uterine cancer.
- Control your diabetes: Control of blood sugar levels will help you reduce the risk of uterine cancer.
- Use birth control pills: Using oral contraceptives reduces the risk of uterine cancer
- Monitored use of hormonal replacement therapy: You should consult your doctor regarding hormonal replacement therapy and add progesterone if only using estrogens.
Secondary Prevention of Uterine Cancer
Once you have undergone surgery or any other treatment for uterine cancer, the focus shifts to avoiding any complications or prevent recurrences. The following preventive measures can help to delay the recurrence, progression or other complications:
- Regular follow-ups: Follow-ups should be made as per the schedule to assess the recovery, risk of recurrence, and overall quality of life.
- Symptom watch-out: Always look for symptoms of recurrence or complications and seek immediate medical attention.
- Lifestyle: Exercise regularly and eat a well-balanced diet
- Manage weight and diabetes: Control of blood sugar levels and maintaining a healthy weight will help to reduce the chances of complications or recurrences.
- Awareness: Being aware of the disease and having realistic expectations help in better planning and management.
Endometrial Cancer (most common type)
Differential Diagnosis of Uterine Cancer
The main symptom of uterine cancer is bleeding post-menopause. However, this could mimic other underlying conditions in the uterus or nearby regions such as non-malignant uterine hyperplasia, atrophy of the endometrium, benign endometrial polyps, cervical carcinoma, cervical polyps, malignant or non-malignant vulval conditions.
Expected Prognosis of Uterine Cancer
Prognosis is affected by age, stage of disease, type of uterine cancer and response to treatment. In the initial stages, the treatment of uterine cancer is more effective, and the survival rate is higher. The 5 year survival is approximately 83%.
Natural Progression of Uterine Cancer
Untreated uterine cancer will progress to tissues and organs beyond the uterus, such as the vagina, urinary bladder, rectal tissues, or other organs, including lungs, bones, etc.
Possible Complications of Uterine Cancer
The first and the foremost complication of untreated uterine cancer is anaemia due to the loss of blood. Fatigue, weakness, and pale skin with a yellow tinge are symptoms of anaemia. Anaemia induced by blood loss causes an iron deficiency in the body. Thankfully, it's easily curable with a vitamin-rich diet and iron supplements, as well as treating endometrial cancer to stop the bleeding. Consult your oncologist before using supplements. Other complications could include bowel obstruction or hemorrhages. Metastasis is a severe complication when cancer spreads to other tissue and organs, making the treatment more difficult.
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