Uterine Carcinoma

Uterine Carcinoma

Uterus is a thick-walled, muscular organ hollow organ in the lower abdomen of women with a broader upper portion called corpus and a narrow lower portion called cervix. The wall of the uterus is made up of an inner layer called endometrium and an outer muscular layer called myometrium. The main function of the uterus is to nourish the developing fetus prior to birth. Different types of cancers occur in the uterus. Cancer that occurs in the endometrial lining of the uterus is called endometrial cancer. Since it is by far the most common type of cancer in the uterus, it is sometimes referred to as uterine cancer.


Epidemiology

The disease is more frequent in women over 40 years. The disease is common in Western countries. However, its frequency is increasing in Asia recently. In the UK there are more than 5,000 new cases per year.

Most uterine cancers are adenocarcinomas including:

  • Endometrioid adenocarcinoma
  • Squamous cell adenocarcinoma
  • Undifferentiated adenocarcinoma
  • Papillary serous adenocarcinoma
  • Clear cell adenocarcinoma
  • Mixed adenocarcinoma

 

 Symptoms of endometrial cancer

The general symptoms may include:

1) Unusual bleeding or discharge

2) Bleeding after menopause

3) Pain during intercourse

4) Pain in the pelvic area

5) Weight loss

Diagnosis

Medical history and habits: It is very important for a doctor to know a patient’s previous medical history as well as lifestyle and habits. A doctor should be well informed about the patient before he or she begins diagnosis.

Pelvic exam: Any lumps or changes in shape or size in uterus, vagina, and nearby tissues can be detected by the doctor.

Blood test: CA 125, a tumor marker, is found in abnormally high levels in the blood if a patient has ovarian or uterine tumors.

Ultrasound imaging: This imaging technique is based on the creation of image with the help of sound waves to view the affected region in the pelvis. The device may be inserted into the vagina (transvaginal ultrasound) for a better image. If a saline (saltwater) solution is first injected into the uterus to extend the uterine walls and then imaging is done by the same procedure, the technique is called hydro-ultrasound. This gives even better images.

Endometrial Biopsy: This is the removal of tissue or cells from the endometrium and its analysis under the microscope. This can often be done in the doctor’s office.

Hysteroscopy: This involves insertion of an endoscope into the uterus through the cervix. The pictures of the endometrium can be viewed in a monitor. It helps to guide the doctor while performing Endometrial Biopsy and Dilation and curettage.

Dilation and curettage: It is done if previous reports are not conclusive. A thin instrument is passed through the dilated cervix to scrape tissue from the endometrium. A pathologist then examines the tissue in the laboratory. This is usually done under anesthesia.

CT scan: The CT scan is a procedure by which images of the internal organs of the body can be obtained with a help of x-rays. A contrasting dye may be injected in the veins so that the images are clearly understood. The images of the pelvis can be viewed with the help of a computer.

MRI scan: This imaging procedure is based on the use of radiowaves in the presence of a magnet. The images of the pelvis produced can be viewed with the help of a computer attached to the machine.

Chest X ray: The chest x-ray remains probably the most valuable tool in diagnosing whether cancer has spread to other organs.

Bone scan: Bone scan gives an image of the bones to find out whether or not the cancer has spread to the bones.

Treatment

The type of treatment depends on many factors including the extent of the disease and the health of the patient. The general treatment options are as follows:

Surgery: Surgery of one or another type is the usual treatment for uterine carcinoma. Procedures include removal of uterus (hysterectomy), removal of fallopian tubes and ovaries (salpingo-oophorectomy), dissection of lymph nodes from the pelvis and removal of lymph nodes with the help of a laparoscope.

Radiation therapy: High-energy rays are used to kill cancer cells and reduce the size of the tumor. This can be done in two ways:

External radiation therapy: Radiation is given by a machine from outside the body at the affected region.

Internal radiation therapy: Radioactive substance sealed in a needle or wire is placed into the vagina. Radiation emitted from this radioactive substance kills the cancer cells.

Chemotherapy: Chemotherapeutic agents such as paclitaxel, doxorubicin, carboplatin and cisplatin are used. They can be given alone, but mostly given in combinations such as carboplatin with paclitaxel and cisplatin with doxorubicin.

Hormone therapy:

Hormone therapy interferes with the activity of hormones or stops the production of hormones which have been causing the growth of cancer cells. Tests are initially conducted to find whether the cancer cells are estrogen receptor and/or progesterone receptor positive. If positive, then hormone therapy may be given to help keep the hormone away from the cancer cells.

Progesterone-like drugs called progestins slow down the growth of endometrial cells. Tamoxifen, an anti-estrogen drug, may also be used to treat advanced endometrial cancer. Gonadotropin releasing hormone agonists like goserelin (Zoladex®) and leuprolide (Lupron®) reduce the production of estrogen and may also slow the growth of the cancer. Aromatase inhibitors like letrozole (Femara®), anastrozole (Arimidex®), and exemestane (Aromasin®) also can be used for hormone therapy since they reduce estrogen levels, too.

Prognosis

Prognosis is dependent on the stage of the cancer at which the disease is diagnosed. Chances of survival decrease with increase in stage of the cancer. Fortunately, most women whose endometrial cancer is detected in Stage I have a five-year survival rate of 75-90 %. But, stage IV patients have much less chance of surviving (15-17 % five-year survival rate).

References

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  2. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. (2005) Endometrial cancer. Lancet.;366(9484):491-505.
  3. Moxley KM, McMeekin DS. (2010) Endometrial carcinoma: a review of chemotherapy, drug resistance, and the search for new agents. Oncologist.;15(10):1026-33.
  4. Sorosky JI. (2008) Endometrial cancer. Obstet Gynecol.;111(2 Pt 1):436-47.
  5. Dobrzycka B, Terlikowski SJ. (2010) Biomarkers as prognostic factors in endometrial cancer. Folia Histochem Cytobiol.;48(3):319-22.
  6. Lu KH. (2009) Management of early-stage endometrial cancer. Semin Oncol.;36(2):137-44.
  7. www.cancer.org/Cancer/EndometrialCancer/DetailedGuide/index
  8. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.