UTERINE CANCER

Uterus is the child bearing organ of the female reproductive system. Anatomically, it comprises of the uterus (body), cervix and the fallopian tubes. However, uterine or endometrial cancer commonly means cancer of the body of the uterus, or specifically, the inner lining of the body (endometrium) of uterus. Cancer of the cervix and fallopian tube are treated differently. Other rare cancers of the uterus include sarcomas (cancer arising from the uterine muscle) or carcinosarcoma (a hybrid cancer with features of carcinoma and sarcoma) and lymphomas.
The incidence of uterine cancer is on the rise especially in the developing countries. It is mainly linked to excess estrogen. Early age at menarche (the beginning of menses), late menopause, use of estrogen containing pills and infertility are some of the known risk factors for endometrial cancer. In addition, women suffering from polycystic ovarian disease, increasing age, obesity, diabetes, hypertension and a family history of breast or uterine cancer are additional risk factors. Tamoxifen (a drug used for treatment of breast cancer) can also cause uterine cancer in some women.
Post-menopausal bleeding (vaginal bleeding after complete cessation of menses) is the commonest symptom of uterine cancer. Some women may present with low backache, abdominal fullness, foul smelling vaginal discharge and weight loss. Vaginal bleeding is an easily noticeable symptom and hence most women with uterine cancer present at a relatively earlier stage as compared to other cancers and hence the success rate of treatment is better than other cancers. However, neglecting these symptoms may lead to a delay in diagnosis making treatment difficult and less successful.
An increase in the uterine thickness detected on an abdominal ultrasound in postmenopausal women may be the first sign of uterine cancer. Magnetic resonance Imaging (MRI) scan is the imaging of choice for uterine cancer. In addition, evaluation of the abdomen and chest for presence of possible spread of cancer needs to be done using a suitable imaging modality.
Diagnosis of uterine cancer is established by an endometrial biopsy (removal of a piece of endometrium) under anaesthesia. In case of an advanced growth, a Pap smear may also reveal presence of cancer cells on the surface of the uterine cervix. However, a Pap smear is not a confirmatory test for diagnosis of endometrial cancer.
Surgery is the mainstay of treatment of uterine cancer. However, the surgery has to be a radical one, removing not only the uterus but also the ovaries, fallopian tubes, surrounding areas and the draining lymph nodes. An incomplete surgery (removal of the uterus alone) is not sufficient for cure.
A pathological examination of the surgically removed specimen is essential for a complete staging of uterine cancer. Depending upon the involvement of the muscle of uterus, surrounding lymph nodes and involvement of other abdominal organs, a final diagnosis of the stage can be made.
After surgery, radiotherapy to prevent recurrence at the same site may be required in some patients. In some patients, the pelvic nodes may be involved by cancer. In these patients, chemotherapy is also required in addition to radiotherapy. The prognosis of such patients remains guarded.
Uterine cancer presents with symptoms at a very early stage. Prompt medical attention to these symptoms is warranted to ensure an early diagnosis. Treatment of uterine cancer in early stage is rewarding and less morbid. Hence, postmenopausal women need to report symptoms suggestive of uterine cancer immediately to avoid delay in diagnosis.

- Oncologist in Pune | Cancer Specialist | Dr. Chetan Deshmukh