Table of Content

• What is uterine cancer?

• Are uterine cancer and endometrial cancer the same thing?

• Causes and Risk factors of uterine cancer

• Symptoms of uterine cancer

• Diagnosis of uterine cancer

• Treatment options for uterine cancer

• Take-Home Points

• FAQ on Uterine Cancer

Introduction

Uterine cancer, also known as endometrial cancer, is a deadly enemy that affects thousands of women worldwide in silence. 

The uterus is a cradle for new life, nestled amid the complicated female reproductive system. When the delicate balance of cellular development and control is interrupted, it can result in a potentially fatal illness. 

Uterine cancer, the most frequent gynecologic cancer in developed countries, necessitates attention and comprehension to provide women with information about its causes, symptoms, diagnosis, and treatment options. 

Today in this article we will inform you about this life threatening condition. So read ahead to know more about its causes, symptoms and management. 

What is uterine cancer?

Uterine cancer, also known as endometrial cancer, is the development of cancerous cells in uterine tissues. The uterus, often known as the womb, is a pear-shaped organ found in the pelvis of females. It is essential to the reproductive system because it nurtures and houses a developing fetus throughout pregnancy.

Uterine cancer often begins in the endometrium, the uterine lining that changes cyclically in response to hormonal swings. Each month, the endometrium thickens in preparation for possible embryo implantation. If there is no pregnancy, the endometrium sheds during menstruation. Cancer can develop inside the endometrial tissues if certain cellular abnormalities occur, such as excessive proliferation or mutations.

In affluent countries, uterine cancer is the most common gynecologic malignancy, primarily affecting postmenopausal women. Although it is most commonly found in the endometrium (inner layer), it can also appear in the myometrium (muscular layer) and the uterine serosa (outer layer).

Uterine cancer is a broad phrase that refers to cancer of the uterus:

• Endometrial cancer: Endometrial cancer occurs in the endometrium, the uterine lining. It's one of the most frequent gynecologic malignancies, meaning cancers of the reproductive system.

• Uterine sarcoma: Uterine sarcoma occurs in the myometrium, the uterine muscular wall. Uterine sarcomas are quite uncommon.

Are uterine cancer and endometrial cancer the same thing?

Endometrial carcinoma and uterine sarcoma are two types of uterine cancer. However, many individuals confuse the terms "endometrial cancer" and "uterine cancer." This is because endometrial cancer accounts for approximately 95% of all uterine cancer cases. Uterine sarcoma is an uncommon cancer.

Causes and Risk factors of uterine cancer

The exact cause of uterine cancer is unknown. However, certain risk factors that can raise a person's likelihood of having the condition have been found. It's crucial to remember that having one or more risk factors does not guarantee that a person will have uterine cancer, as many persons with the disease have no known risk factors. Similarly, even if no recognised risk factors exist, some people can acquire uterine cancer. The following are known risk factors for uterine cancer:

• Age: The risk of uterine cancer increases with age, especially after menopause. The vast majority of cases involve women over the age of 50.

• Hormonal Imbalance: Imbalances in estrogen and progesterone, two important female hormones, are a substantial risk factor. Excess or inadequacy of these hormones may promote endometrial overgrowth increasing the risk of cancer. Early menstruation (before the age of 12), late menopause (beyond the age of 55), and hormone therapy with estrogen alone (without progesterone) for menopausal symptoms are all factors related with hormonal abnormalities.

• Obesity: Being overweight or obese is strongly associated with an increased risk of uterine cancer. 

• Menstrual problems: Early age of menarche like before the age of 12 or late menopause i.e. after the age of 50 makes you m9re exposed to certain hormones thus increasing the chances of uterine or endometrial cancer. Women who haven’t ever been pregnant also have a higher risk.

• Family History and Genetics: Having a close relative (such as a mother, sister, or daughter) with uterine cancer increases the risk of developing the disease. Certain hereditary conditions, such as Lynch syndrome, can also predispose individuals to uterine cancer and other cancers.

• Ovarian diseases: Certain ovarian tumors cause high estrogen levels and low progesterone levels. These hormonal changes can increase the risk of uterine cancer.

• Earlier pelvic radiation therapy: Radiation therapy to the pelvis for other malignancies can destroy cell DNA. This damage may raise your chances of having a second cancer.

• Tamoxifen Use: Tamoxifen, a medicine routinely used to treat and prevent breast cancer, has been linked to an increased risk of uterine cancer. The danger is larger in postmenopausal women who have been taking tamoxifen for a long time.

• Race and Ethnicity: Uterine cancer is more prevalent in certain racial and ethnic groups, including white women and African-American women. 

Symptoms of uterine cancer

Uterine cancer symptoms can vary from person to person, and in a few cases, there may be no symptoms at all in the early stages of the disease. However, it is critical to be aware of the frequent signs and symptoms of uterine cancer, particularly in postmenopausal women or those at increased risk. If you encounter any of the following symptoms, you should see a doctor for an evaluation and accurate diagnosis:

1. Abnormal Vaginal Bleeding: The most common and significant symptom of uterine cancer is abnormal vaginal bleeding. This may include:

• Postmenopausal Bleeding

• Irregular or Heavy Periods

• Bleeding or spotting between Periods

2. Abnormal Vaginal Discharge: Some women with uterine cancer may complain of unusual vaginal discharge, which can be watery, bloody, or foul-smelling.

3. Pelvic Pain or Pressure: Persistent pelvic pain, discomfort, or pressure may be associated with cancer as it occurs due to the growing tumour affecting the surrounding tissues.

4. Painful Urination: Some women with uterine cancer may experience pain or a burning sensation while micturating.

5. Pain During Intercourse: Pain or discomfort during sexual intercourse, known as dyspareunia, can be a symptom of uterine cancer.

6. Unintentional Weight Loss: In advanced stages of uterine cancer, some individuals may experience unexplained weight loss.

It is crucial to understand that these symptoms can be caused by various conditions other than uterine cancer. Many of these signs are also common in benign conditions or minor hormonal fluctuations. However, any persistent or concerning symptoms should not be ignored, and medical attention should be sought to determine the cause and receive appropriate care.

Diagnosis of uterine cancer

Early identification of uterine cancer can enhance prognosis and treatment outcomes dramatically. Regular gynecological examinations, particularly for postmenopausal women and those with risk factors, are critical for early detection and intervention.

Uterine cancer is diagnosed through a series of medical examinations and tests that evaluate whether malignant cells are present in the uterus. The following are the modalities used to diagnose the disease:

• Medical History and Physical Exam: The first step is for the healthcare professional to take a thorough medical history, including any symptoms and risk factors. A complete physical examination is then carried out, with a focus on the pelvic region.

• Laboratory Tests: Blood tests may be performed to assess overall health and to check for specific markers that can be associated with certain types of uterine cancer. In the special blood tests, CA-125 assay is done which measures CA-125, a protein. A certain level of CA-125 in the blood can point to cancer in your body.

• Imaging Studies: Depending on the initial findings and the need to determine the extent of cancer spread (staging), additional imaging tests, such as 

1. Computed Tomography (CT) scans

2. Magnetic Resonance Imaging (MRI) scans

3. Positron Emission Tomography (PET) scans

4. Transvaginal Ultrasound may be conducted.

• Other Tests:

1. Endometrial Biopsy - The definitive test for diagnosing uterine cancer is an endometrial biopsy. This procedure involves the removal of a small sample of tissue from the endometrium, which is then examined under a microscope by a pathologist.

2. Dilation and curettage (D&C) - Dilation and curettage (D&C) is a more sophisticated uterine tissue removal technique.

3. Hysteroscopy - A hysteroscope, a long thin tube, is inserted into your vagina and cervix to reach your uterus during hysteroscopy. In this procedure, this small equipment with a light and camera takes comprehensive pictures of your uterus which is then evaluated for abnormalities.

Treatment options for uterine cancer

The treatment of uterine cancer depends on various factors, including the type of uterine cancer, the stage of the disease, the individual's overall health, and their preferences. The primary treatment modalities for uterine cancer include:

1. Surgery

Hysterectomy: The surgical removal of the uterus (hysterectomy) is the most common and definitive treatment for uterine cancer. The cervix, fallopian tubes, and ovaries may also be removed in some circumstances (complete hysterectomy with bilateral salpingo-oophorectomy). Various types of hysterectomies practiced are:

1. Total abdominal hysterectomy.

2. Vaginal hysterectomy

3. Radical hysterectomy

4. Minimally invasive hysterectomy

During a hysterectomy, surgeons frequently do two additional procedures:

• Bilateral salpingo-oophorectomy (BSO) - Bilateral salpingo-oophorectomy (BSO) is a surgical procedure that removes your ovaries and fallopian tubes. Most patients require this extra procedure to ensure that all cancer is gone.

• Lymphadenectomy - Lymph node dissection (lymphadenectomy) is used to remove lymph nodes and determine whether the malignancy has spread.

2. Radiation Therapy

Radiation therapy, also known as radiotherapy, is a popular cancer treatment that employs radiation (typically high-powered X-rays) to kill cancer cells. Radiation therapy can be used alone or in conjunction with other therapies such as surgery or chemotherapy. It is of following two types: 

• External Beam Radiation

• Brachytherapy (Internal Radiation)

3. Chemotherapy 

Chemotherapy involves the use of powerful drugs to kill cancer cells or slow down their growth. It is typically administered intravenously or orally and may be used in various situations, such as before or after surgery to shrink tumors or in more advanced or recurrent cases of uterine cancer.

4. Targeted Therapy

Targeted therapy may be utilised to treat uterine cancer with specific genetic alterations or molecular characteristics in some circumstances. These medications target specific chemicals or pathways involved in the growth and spread of cancer.

5. Hormone Therapy

Hormone therapy may be used in certain cases of uterine cancer, particularly for those with advanced or recurrent cancer. Progestin is the most commonly used hormone therapy for uterine cancer.

6. Immunotherapy 

Immunotherapy is a type of cancer treatment that use your immune system to detect and destroy cancer cells. Your immune system detects and eliminates foreign invaders, including malignant cells.

The choice of treatment and the sequence of therapies depend on the stage and aggressiveness of the cancer, as well as the patient's overall health and preferences. 

Prevention of uterine cancer 

While uterine cancer cannot be prevented, certain lifestyle choices and risk-reduction methods can help reduce the likelihood of developing the disease. Individuals might potentially minimise their risks of having uterine cancer by adopting healthy habits and being proactive in controlling risk factors. Here are some precautions to take:

• Maintain a Healthy Weight: Obesity is a significant risk factor for uterine cancer. Aim to maintain a healthy weight through a balanced diet and regular physical activity.

• Regular Physical Activity: Engage in regular exercise or physical activity, as it not only helps with weight management but also contributes to overall health and well-being.

• Balanced Diet: Consume a well-balanced diet high in fruits, vegetables, whole grains, and lean proteins. Processed and high-calorie foods should be avoided because they might contribute to weight gain and hormone abnormalities.

• Hormone Replacement Therapy (HRT): If you're anticipating using hormone replacement therapy to treat menopausal symptoms, talk to your doctor about the risks and advantages. If HRT is prescribed, it is frequently advised to utilise the lowest effective dose for the shortest possible term.

• Birth Control Pills: Oral contraceptives (birth control pills) can be a preventative factor for women at risk of endometrial cancer due to hormonal imbalances or other risk factors. These pills contain oestrogen as well as progestin, which can assist in balancing the hormonal environment and lower the risk of uterine cancer. Consult your doctor before starting any medication.

• Regular Health Check-ups: Maintain frequent gynaecological check-ups and screenings. Although routine pelvic exams and Pap tests do not explicitly screen for uterine cancer, they can assist in the detection of other gynecologic disorders. Any unusual bleeding or symptoms should be reported to a healthcare physician right once for further investigation.

• Genetic Testing: Consider genetic counselling and testing to assess individual risk if there is a family history of uterine cancer or other inherited disorders associated with an increased risk.

• Education and Awareness: Stay informed about the risk factors, symptoms, and preventive measures associated with uterine cancer. Being aware of potential warning signs can lead to early detection and timely medical intervention if necessary.

Take-Home Points

Uterine cancer is a common type of cancer that mostly affects the uterine endometrium. Women must be aware of the risk factors and symptoms of this disease and seek medical assistance if they encounter any abnormal vaginal bleeding or other related symptoms. Early detection and therapy dramatically enhance the prognosis of uterine cancer patients. Regular check-ups, a healthy lifestyle, and staying at a healthy weight can also help lower the risk of having uterine cancer.