Uterine
cancer (or cancer of the uterus) is the most commonly diagnosed
gynaecological cancer in Australia, particularly in women over the
age of 50 years old. There are two main types of uterine cancer:
endometrial cancer which initiates in the uterus lining (endometrium)
and uterine sarcomas which develop in the muscle tissue of the uterus
(myometrium).
Symptoms
Although
these symptoms can occur for reasons other than uterine cancer, it is
recommended that you talk to your GP if you experience any of the
following (particularly if you are postmenopausal):
- Unusual vaginal bleeding
- Watery discharge
- Smelly discharge
What
causes uterine cancer?
When
a woman does not ovulate, her ovaries continue to produce oestrogen
but no longer produce progesterone. The exposure of the endometrium
to 'unopposed oestrogen' can lead to a benign condition known as
endometrial hyperplasia (thickened uterus wall lining) which with
continuing exposure to oestrogen may later develop into endometrial
cancer.
Circumstances
which lead to a continuous exposure to 'unopposed oestrogen' increase
the risk of developing endometrial hyperplasia and endometrial
cancer. For example:
- Coming into menopause late (>55 years), or being postmenopausal
- Previous ovarian tumours or polycystic ovary syndrome (PCOS)
- Infertility, when associated with a lack of ovulation
- Oestrogen-only hormone replacement therapy
- Taking tamoxifen for breast cancer (the benefits outweigh the risks, discuss any concerns with your doctor)
- Being overweight or obese
- Family history of ovarian, uterine, breast or bowel cancer
Diagnosing
uterine cancer
Screening
for uterine cancer is not feasible as there is no available simple
method to detect early stage uterine cancer and only about 50% of
women with uterine cancer will have malignant cells that can be
detected by a Pap test.
If
a woman presents with symptoms of uterine cancer, diagnostic tests
may include:
Physical
examination
- Checking abdomen for swelling, checking the uterus (possibly with use of a speculum)
Transvaginal
ultrasound
- The most common diagnostic test for uterine cancer, a transvaginal ultrasound observes size of uterus, ovaries and thickness of endometrium. If anything unusual if seen a biopsy (tissue sample) may be recommended.
Hysteroscopy
and biopsy
- Insertion of a hysteroscope through the vagina into the uterus allows a gynaecologist to see the inside of the uterus and allow a biopsy to be taken if required.
Blood
and urine tests
- Assess general health
Other
tests
- If uterine cancer is detected, other tests such as X-rays, CT scans MRI scans or PET scans may be used to determine whether the cancer has spread to other parts of the body.
Staging:
Uterine
cancer is staged according to the International Federation of
Gynecology and Obstetrics (FIGO):
- Stage I – the cancer is confined to the body of the uterus
- Stage II – the cancer has spread to the cervix
- Stage III – the cancer has spread to the vagina, tubes, ovaries or lymph nodes
- Stage IV – the cancer has spread to the bowel, bladder or to distant organs such as the lungs or liver
Treatment
or uterine cancer
Surgery
(hysterectomy and bilateral salpingo-oophorectomy)
As
long as the cancer has not spread to other areas of the body, the
majority of women can be treated solely with surgery. The most common
surgical treatment is a total hysterectomy, where the uterus and
cervix are removed. When the fallopian tubes and ovaries are also
removed the process is called a bilateral salpingo-oophorectomy.
Removing the ovaries reduces the risk of the cancer returning as the
oestrogen they produce can cause cancer to grow. Pre-menopausal women
who a have bilateral salpingo-oophorectomy will experience menopause
following the removal of their ovaries.
Radiotherapy
uses X-rays to kill or injure cancer cells to help prevent the cancer
from returning. Radioactive material may be given internally via
tubes placed near the cancer or else the radiation may be directed
externally by a machine
Hormone
treatment
If
the cancer has spread or recurred, or if surgery is not a viable
treatment option, hormone treatment where progesterone is given to
the patient may help shrink the cancer and control symptoms.
Chemotherapy
(given intravenously) may be used to control the cancer or to relieve
symptoms for certain types of uterine cancer, when cancer has
returned following surgery or radiotherapy, or if it hasn't responded
to hormone treatment.
Useful
resources
Australian
gynaecological cancer foundation
https://www.agcf.org.au/about-gynae-cancer/cancers-of-the-body-of-the-uterus-womb/endometrial-cancer
Cancer
Council Australia
Understanding
cancer of the uterus
No comments:
Post a Comment