HEALTH - UTERINE CANCER (UTERUS) CANCER SYMPTOMS & TREATMENT
What is Uterine Cancer?
Uterine cancer (also known as uterine
adenocarcinoma and endometrial cancer) is the most common cancer of a
woman’s reproductive system.
The uterus is part of a woman's reproductive system. It is the hollow, pear-shaped organ where a baby grows. The uterus is in the pelvis between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix. The broad, middle part of the uterus is the body, or corpus. The dome-shaped top of the uterus is the fundus. The fallopian tubes extend from either side of the top of the uterus to the ovaries.
The wall of the uterus has two layers of tissue. The inner layer, or
lining, is the endometrium. The outer layer is muscle tissue called the
myometrium. In women of childbearing age, the lining of the uterus grows and thickens each month to prepare for pregnancy. If a woman does not become pregnant, the thick, bloody lining flows out of the body through the vagina. This flow is called menstruation.
It has three sections: the cervix (the narrow, lower section), the
corpus (the broad, middle section), and the fundus (the dome-shaped,
top section).
Every month during a woman's childbearing years, the lining of the
uterus grows and thickens in preparation for pregnancy. If the woman
does not get pregnant, this thick, bloody lining passes out of her body
through her vagina during menstruation. This process continues until
menopause.
Uterine cancer begins when cells in the uterus begin to change, grow
uncontrollably, and eventually form a tumor. A tumor can be benign
(noncancerous) or malignant (cancerous). Noncancerous conditions of the
uterus include fibroids (benign tumors in the muscle of the uterus),
endometriosis (endometrial tissue on the outside of the uterus or other
organs), and endometrial hyperplasia (an increased number of cells in
the uterine lining).
When uterine cancer spreads (metastasizes) outside the uterus, cancer cells are often found in nearby lymph nodes, nerves, or blood vessels. If the cancer has reached the lymph nodes, cancer cells may have spread to other lymph nodes and other organs, such as the lungs, liver, and bones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cancer of the uterus spreads to the lungs, the cancer cells in the lungs are actually uterine cancer cells. The disease is metastatic uterine cancer, not lung cancer. It is treated as uterine cancer, not lung cancer. Doctors sometimes call the new tumor "distant" disease.
There are two major types of uterine cancer:
Adenocarcinoma. This type of cancer makes up more than 95% of uterine cancers. It develops from cells in the lining of the uterus, the endometrium. This cancer is also commonly called endometrial cancer.
Sarcoma. This form of uterine cancer develops in the uterine muscle, the myometrium. Sarcoma accounts for about 2% to 4% of uterine cancers.
Other, less common types of uterine cancer include carcinosarcoma and endometrial stromal sarcoma. Carcinosarcoma starts in the endometrium and is similar to both endometrial cancer and sarcoma. Endometrial stromal sarcoma starts in the connective tissue of the endometrium. Treatment for these types of uterine cancer is similar to the treatment of endometrial cancer.
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Health: Risk Factors of Uterine Cancer (Uterus)
With uterine cancer, cancer cells develop in the lining of the
uterus. Why these cancer cells develop isn't entirely known. However,
scientists believe that estrogen levels play a role in the development
of uterine cancer. Factors that can increase the levels of this
hormone and other risk factors for the disease have been identified and
continue to emerge. In addition, ongoing research is devoted to
studying changes in certain genes that may cause the cells in the uterus to become cancerous.
The female reproductive system consists of two ovaries, two fallopian tubes, a uterus and a vagina. The ovaries produce two main female hormones — estrogen and progesterone. The balance between these two hormones changes each month, making the endometrium thicken during the early part of the monthly cycle. If no pregnancy occurs, the endometrium is then shed during the last phase of the menstrual cycle.
When the balance of these two hormones shifts toward more estrogen — which stimulates growth of the endometrium — a woman's risk of developing uterine (endometrial) cancer increases.The following factors may increase a woman’s risk of developing uterine cancer:
Age. Uterine cancer most often occurs in women over 50; the average age is 60.
Obesity and related health conditions. The body makes some of its estrogen in
fatty tissue. That's why obese women are more likely than thin women to have
higher levels of estrogen in their bodies. High levels of estrogen may be the
reason that obese women have an increased risk of developing uterine cancer. The
risk of this disease is also higher in women with diabetes or high blood
pressure (conditions that occur in many obese women).
Race. White women are more likely to develop uterine cancer than African-American women.
Genetics. Uterine cancer may run in families where colon cancer is hereditary. Women who have had an inherited form of colorectal
cancer have a higher risk of developing uterine cancer than other women.
Other health conditions. Women may have an increased risk of uterine cancer if they have had endometrial hyperplasia or if they have diabetes.
Other cancers. Women who have had breast, colon, or ovarian cancer have an increased risk of uterine cancer.
Tamoxifen. Women taking the drug tamoxifen (Nolvadex) to
prevent or treat breast cancer have an increased risk of developing
uterine cancer. However, the benefits of tamoxifen may outweigh the
risk of developing uterine cancer, so women should discuss the benefits
and risks of tamoxifen with their doctor or health care provider.
Radiation therapy. Women who have had previous radiation
therapy in the pelvic area (the lower part of the abdomen between the
hip bones) for another cancer have an increased risk of uterine cancer.
Diet. Women who eat a diet high in animal fat may have an increased risk of uterine cancer.
Estrogen. Exposure to estrogen and/or an imbalance of estrogen is relevant to many of the following risk factors:
- Women who started having their periods before age 12 and/or go through menopause later in life
- Women who take hormone replacement therapy (HRT) after menopause,
especially if they are only taking estrogen; estrogen with progesterone
poses a lower risk.
- Women who have never had children
Women with known risk factors and those who are concerned about uterine cancer should ask their doctor about the symptoms to watch for and how often to have checkups. The doctor's advice will be based on the woman's age, medical history, and other factors.
Health: Symptoms of Uterine Cancer (Uterus)
Women with uterine cancer may experience the following symptoms. Sometimes, women with uterine cancer do not show any of these symptoms. Or, these symptoms may be caused by a health condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor or health care provider.
The most likely time for uterine cancer to occur is after menopause. But it may also occur around the time that menopause begins. The most common symptom is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding during or after menopause is not normal and is always a sign of an health problem. Women should not assume that abnormal vaginal bleeding is part of menopause.
A woman should see her doctor if she has any of the following symptoms:
- Unusual vaginal bleeding, prolonged periods or bleeding between periods, after age 40
- Difficulty or pain when urinating
- Pain during sexual intercourse
- Pain in the pelvic area, or pelvic cramping
- Any bleeding after menopause
- An abnormal, non-bloody discharge from your vagina, thin white or clear vaginal discharge after menopause
- Unintended weight loss
Health: Diagnosis of Uterine Cancer (Uterus)
If a woman has symptoms that suggest uterine cancer, her doctor may check
general signs of health and may order blood and urine tests. The doctor also may
perform one or more of the exams or tests to diagnose uterine cancer described as following:
- Pelvic exam -- The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. A Pap test, often done with a pelvic examination, usually neither finds nor diagnoses uterine cancer. However, a Pap test may occasionally find abnormal glandular cells which are often caused by uterine cancer. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.
- Pap test -- The doctor collects cells from the cervix and upper vagina. A medical laboratory checks for abnormal cells. Although the Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why the doctor collects samples of cells from inside the uterus in a procedure called a biopsy.
- Transvaginal ultrasound - The doctor inserts an instrument into the vagina. The instrument aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to obtain the pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy.
- Endometrial Biopsy -- The doctor removes a sample of tissue from the uterine
lining, for examination under a microscope. This usually can be done in the doctor's office. Other tests can suggest
that cancer is present, but only a biopsy can make a definite
diagnosis. The sample removed from the biopsy is analyzed by a
pathologist (a doctor who specializes in interpreting laboratory tests
and evaluating cells, tissues, and organs to diagnose disease). For an
endometrial biopsy, the doctor removes a small sample of tissue with a
very thin tube.
The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes about one minute. Afterward, the woman may have cramps and vaginal bleeding. These symptoms will go away and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. However, patients who have abnormal vaginal bleeding may still need a dilation curettage (D&C; see below) even if no abnormal cells are found during the biopsy. For a short time after the biopsy, some women have cramps and vaginal bleeding.
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Dilation and curettage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, lighted flexible tube in the vagina, through the cervix, and into the uterus.
Once endometrial tissue has been removed either during a biopsy or D&C, the sample is checked for cancer cells, endometrial hyperplasia, and other conditions. In the past, there was concern that a D&C would push cancer cells out of the uterus into other reproductive organs. However, research studies have shown that this has no effect on patients who received a D&C combined with a hysteroscopy.
- Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines those images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
- X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.
Health: Staging of Uterine Cancer (Uterus)
Staging is a way of describing a cancer, such
as where it is located, if or where it has spread, and if it is
affecting the functions of other organs in the body. Doctors use
diagnostic tests to determine the cancer's stage, so staging may not be
complete until all of the tests are finished. Knowing the stage helps
the doctor to decide what kind of treatment is best and can help
predict a woman's prognosis (chance of recovery).
If uterine cancer is found, you'll likely be referred to a
gynecologic oncologist — a doctor who specializes in treating cancer
involving the female reproductive system. You'll need more tests
(staging) to determine if the cancer has spread (metastasized) to other
parts of your body.
With uterine cancer, final staging is done through a surgical procedure and is done at the same time as any surgical treatment:
- Stage I cancer is found only in your uterus and hasn't spread.
- Stage II cancer is present in both the body of your uterus and in your cervix. In this stage, cancer is no longer confined to the uterus, but hasn't spread beyond the pelvic region.
- Stage III cancer has not involved the rectum and bladder, though pelvic area lymph nodes may be involved.
- Stage IV cancer is the most serious and means that the cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of your body.
In addition to identifying the type and stage of uterine cancer, the tumor's grade is determined. The grade is based on how the tumor cells appear under the microscope. If they look like normal tissue, the cancer is called a low-grade tumor. If the cells do not look like normal cells, the cancer is classified as a high-grade tumor. Knowing the grade is important in determining whether treatment is needed after surgery. For instance, a low grade-tumor usually grows slowly and is less likely to spread than a high-grade tumor.
Recurrent uterine cancer
Recurrent cancer is cancer that comes back after treatment. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. Approximately 70% of recurrent uterine cancer happens within three years of initial treatment. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.
- Vaginal bleeding or discharge
- Pain in the pelvic area, abdomen, or back of the legs
- Difficulty or pain when urinating
- Weight loss
- Chronic cough
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Natural Alternative Treatment Option: NATURAL CANCER TREATMENT
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Health: Conventional Treatment for Uterine Cancer (Uterus)
Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy. Each treatment option is described below, followed by an outline of treatments based on the stage of the disease.
Surgery
Surgery is typically the first treatment given. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the body of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, and the upper part of the vagina and nearby tissues). After a hysterectomy, a woman can no longer become pregnant. In addition, the surgeon will remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus. The surgeon will also perform a bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries) for patients who have been through menopause.
A hysterectomy may be performed as a traditional surgery (with one large incision) or by laparoscopy, which uses several smaller incisions. After surgery, the woman may remain in the hospital for several days to a week. Woman who received laparoscopic surgery often have a shorter hospital stay than women who received traditional surgery. The most common side effects include pain and extreme tiredness. If a woman is experiencing pain, her doctor will prescribe appropriate medicine. Other immediate side effects may include nausea and vomiting, as well as difficulty emptying the bladder and having bowel movements. The woman's diet may be restricted to liquids, followed by a gradual return to solid foods.
If the ovaries are removed, this ends the body's production of sex hormones, resulting in premature menopause (if the woman has not already gone through menopause naturally.) Soon after surgery, the woman is likely to experience menopausal symptoms, including hot flashes and vaginal dryness. A woman should to talk with her doctor about ways to cope with these side effects.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
Some women with Stage I, II, or III uterine cancer need both radiation therapy and surgery. They may have radiation before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, the doctor may suggest radiation treatments for the small number of women who cannot have surgery.
Doctors use two types of radiation therapy to treat uterine cancer:
- External radiation: In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for external radiation therapy.
- Internal radiation: When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina, directly into the tumor and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready. Once the implant is removed, the woman has no radioactivity in her body.
Some women with uterine cancer need both radiation therapy and surgery. The radiation therapy is most often given after surgery to destroy any cancer cells remaining in the area. Radiation therapy is rarely given before surgery to shrink the tumor. If a woman cannot have surgery, the doctor may recommend radiation therapy as another option.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects usually go away soon after treatment is finished.
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects. Although chemotherapy can be given orally (by mouth), most drugs used to treat uterine cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a catheter (a thin tube inserted into a vein).
The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Advances in chemotherapy during the last 10 years include the development of new drugs for the prevention and treatment of side effects, such as antiemetics for nausea and vomiting, and hormones to prevent low white and red blood cell counts.
Other potential side effects of chemotherapy for uterine cancer include the inability to become pregnant and early menopause. Rarely, some drugs cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.
Hormone therapy
Hormonal therapy involves substances that prevent cancer cells from getting
or using the hormones they may need to grow. Hormone therapy for uterine cancer involves the sex hormone
progesterone, given in a pill form.
Hormones can attach to hormone
receptors, causing changes in uterine tissue. Before therapy begins, the doctor
may request a hormone receptor test. This special lab test of uterine tissue
helps the doctor learn if estrogen and progesterone receptors are present. If
the tissue has receptors, the woman is more likely to respond to hormonal
therapy. Hormonal therapy is called a systemic therapy because it can affect cancer
cells throughout the body.
The doctor may use hormonal therapy for women with uterine cancer who are unable to have surgery or radiation therapy. Also, the doctor may give hormonal therapy to women with uterine cancer that has spread to the lungs or other distant sites. It is also given to women with uterine cancer that has come back.
Side effects of hormone therapy include fluid retention, increase in appetite, and weight gain. Women in their childbearing years may have changes in their menstrual cycle.
Treatment options by stage:
Stage I
- Surgery
- Surgery and radiation therapy
- Hormone therapy
Stage II
- Surgery and radiation therapy
Stage III
- Surgery and radiation therapy
- Surgery and chemotherapy
Stage IV
- Surgery
- Radiation therapy
- Hormone therapy
- Chemotherapy
Recurrent cancer
- Hormone therapy
- Radiation therapy
- Chemotherapy
Treatment for advanced uterine cancer includes radiation therapy, especially for recurrent cancer in the pelvis. Hormone therapy may be used for cancer that has spread to distant parts of the body. A cancer that is high grade or that does not respond to hormone therapy is treated with chemotherapy. Women with stage IV uterine cancer are encouraged to consider participating in clinical trials.
Health: Prevention for Uterine Cancer (Uterus)
Research has shown that certain factors can lower the risk of uterine cancer:
- Regular exercise can have a dramatic effect on your risk of uterine cancer. Women who engage in exercise every day have half the risk of uterine cancer compared with women who don't exercise, according to the American Cancer Society.
- Taking hormone therapy (HT) with progestin. Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of uterine cancer. Taking synthetic progestin, a form of the hormone progesterone, with estrogen causes the lining of the uterus to shed. This kind of combination hormone therapy lowers your risk. But not all effects of HT are positive. Taking HT as a combination therapy can result in serious side effects and health risks, such as a higher risk of breast cancer and blood clots. Work with your doctor to evaluate the options and decide what's best for you health wise.
- A history of using birth control pills. Use of oral contraceptives can reduce uterine cancer risk even as long as 10 years after you stop taking them. The risk is lowest in women who take oral contraceptives for many years.
- Maintaining a healthy weight. Obesity is one of the most significant risk factors for the development of uterine cancer. You can help prevent uterine cancer by maintaining a healthy weight. Excess fat tissue can increase levels of estrogen in your body, which increases your risk of uterine cancer. Maintaining a healthy weight as you age lowers your risk of uterine cancer as well as other diseases.
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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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