What is uterine cancer?
Uterine cancer is a growth of malignant cells in endometrial (uterine) lining and/or endometrial muscle. It usually occurs after 50 years of age but minority of women may present with uterine cancer before 40 years of age also. However, more than 80% of uterine cancer do present in early stage (thanks to early presentation of symptoms) and thus, can be 100% cured in majority cases.
What causes uterine cancer?
Not all the times, but majority women with uterine cancer have imbalance of hormones. The ovaries make most of the female hormones estrogen and progesterone. So, if the uterus is exposed to too much estrogen over a long period of time due to any underlying reason, cancer cells may develop.
Thus, there are many risk factors that can lead to excess hormone levels in the body:
☆ Poly cystic ovarian disease (PCOS): PCOS causes hormonal imbalance that can actually increase the risk to many folds.
☆ Early menstruation and late menopause: Women with early resumption of menses as well those with late menopause have higher chances of uterine cancer.
☆ No Pregnancies: Women who had never been pregnant are at higher risk as they are constantly exposed to hormones without a break
☆ Family history of cancer: Women with first or second degree relative with breast, ovarian, colon or uterine cancer might harbour greater chances of uterine cancer.
☆ Previous history of radiation therapy: if you had a radiation to your lower abdomen and/or pelvis in the past due to any reason, your risk of developing uterine cancer is increased.
☆ Obesity: Obese women are 3 times at higher risk for uterine cancer as compared to non-obese women.
☆ Older age: Increasing age itself is a risk factor for uterine cancer
☆ Tamoxifen use: Tamoxifen is a drug given to breast cancer women. However, it does increase the risk of uterine cancer.
How do uterine tumors present?
☆ Unusual/heavy bleeding, spotting or discharge from vagina
☆ Bleeding after menopause
☆ A lump in the lower abdomen
☆ Pain in lower abdomen
☆ Unexplained weight loss and loss of appetite (hunger)
How is the diagnosis of uterine cancer confirmed?
With above mentioned symptoms, your doctor with do a physical examination, this will include a pelvic examination and some further test:
☆ A Transvaginal ultrasound: This is the first investigation of choice in presence of any abnormal symptoms. USG will provide information regarding uterus and both the ovaries.
☆ Hysteroscopy: This helps to visualise inside of uterus and take a biopsy
☆ Endometrial Biopsy: Biopsy is gold standard to confirm the diagnosis of cancer.
☆ MRI/CECT: After confirmation of cancer on biopsy report, a further imaging preferably an MRI should be done to assess if cancer has spread to other areas.
NOTE: Its a very common myth that taking biopsy spreads cancer further. IT IS NOT AT ALL TRUE. Biopsy only confirms cancer. It DOES NOT spread the cancer further.
What are the treatment options for uterine cancer?
Surgery is the first modality of treatment for uterine cancer and most of the times, it is the only modality required. Surgery for uterine cancer includes removal of uterus along with both the ovaries and tubes, pelvic and para-aortic lymph nodes (to see if the cancer has spread to these areas). Surgery can be performed either by incision on abdomen (open technique) or through laparoscope/robot (minimal invasive approach). Your doctor shall discuss with you which modality should be preferred in your case.
Radiation therapy is mostly used, if required, after surgery to decrease the chances of recurrence in the future. Whether you require radiation after surgery or not will be decided according to histo-pathological report of surgical specimen.
Chemotherapy is the use of drugs to kill cancer cells. It is usually given to women after surgery whose cancer has spread beyond uterus at the time of diagnosis or to treat a cancer which comes back.
NOTE: Uterine cancer is generally consider as one of good cancers where cure is 100% possible in about >95% of women.
How can I prevent /reduce my risk of uterine cancer?
By avoiding as many risk factors as possible. However, early reporting of symptoms to your doctor is the key to early diagnosis and successful treatment.
☆ Uterine cancer can be cured completely
☆ Surgery is the main modality of treatment
☆ A Good surgery by Gynaec Oncologist gives best results