Table of Content

• Uterine Cancer - An Introduction

• What is the Cause of Uterine Cancer?

• Risk factors for Uterine Cancer

• Symptoms of Uterine Cancer

• Diagnosis

• Staging of Uterine Cancer

• Treatments for Uterine Cancer

• Take-Home Points

• FAQ on Uterine Cancer

Uterine Cancer - An Introduction

Gynecological cancer is a term that represents all the cancers of the female reproductive system and genitals. The uterus, or the womb, is a pear-shaped muscular organ in the female pelvis. Uterine cancer refers to cancer that starts in the uterus and is the most common type of cancer in gynecological cancers. There are two main types of uterine cancers: endometrial cancer or endometrial carcinoma, which develops in the innermost lining of the uterus, known as the  Endometrium, and uterine sarcomas, which form in the middle layer of the uterus, known as the Myometrium.

Endometrial cancer is the most common type, but uterine sarcomas are rare. Uterine cancers can spread to other body parts and thus could be fatal if not diagnosed and treated early.

What is the Cause of Uterine Cancer?

The exact cause of uterine cancers is not known. Generally, cancer forms when a cell develops mutations in its DNA, resulting in the abnormal growth and division of the cell. The divided cells accumulate to form the tumor and invade the healthy tissues resulting in the spread of cancer.

However, certain risk factors could lead to uterine cancer.

Risk factors for Uterine Cancer

1. Age

The chances of developing uterine cancer increase with your age. 

2. Family history

Lynch syndrome, a genetic condition passed from parents to kids, increases the risk of developing uterine cancer.  

3. Diet

High-fat diet could lead to obesity. Being overweight increases the chances of developing uterine cancer. In postmenopausal women who are obese, the adipose tissue is the main source of estrogen biosynthesis. Higher estrogen levels relative to progesterone can increase the risk of endometrial cancer. 

4. Ovarian Diseases

Women with ovarian diseases may have higher estrogen levels putting them at risk of developing uterine cancer.

5. Early Menstruation and late Menopause

Early menstruation and late menopause expose the uterus to estrogen for extended periods, increasing uterine cancer chances.

6. Drugs

Certain drugs like Tamoxifen, a selective estrogen receptor modulator used in breast cancer treatment, act like estrogen in the uterus and increases the risk of uterine cancer.

7. ERT or Estrogen replacement therapy 

To relieve the symptoms of menopause, some people take ERT. ERT without progesterone can lead to uterine cancer.

8. Radiation therapy to the pelvis

Radiation therapy to the pelvis for any other type of cancer could damage the cell DNA and cause secondary cancer in the uterus. 

Symptoms of Uterine Cancer

• Postmenopausal bleeding (vaginal bleeding that occurs after the last menstrual period, after a year or more)

• Irregular menstrual cycles and intermenstrual bleeding in premenopausal women.

• Vague abdominal pain.

• Pelvic discomfort.

• Nausea.

• Dysuria or painful urination.

• Anorexia, weight loss and changes in bladder and bowel habits may occur when cancer has spread to other body parts.

• Pallor (abnormal uterine bleeding can make the patient appear pale).

• Pelvic pressure, postmenopausal bleeding, and ascites (excess abdominal fluid) may be the first presenting complaints of uterine sarcoma.

Diagnosis

• Transvaginal ultrasound is the first-line diagnostic test in postmenopausal women. The normal thickness of the endometrium is less than 4mm. An endometrial biopsy, obtained by dilation and curettage, helps to investigate the endometrium with more than 4mm thickness.

• Endometrial thickness sows variations in thickness during the menstrual cycle. A transvaginal ultrasound may not give accurate results in premenopausal women. Thus, endometrial biopsy should be considered the first-line investigation in premenopausal women.

• Transabdominal or transvaginal ultrasound may detect uterine sarcomas. However, a microscopic examination of the cancer cells is necessary for a definitive diagnosis.

Staging of Uterine Cancer

The International Federation of Gynecology and Obstetrics (FIGO) classifies uterine cancer into four stages.

• Stage I: Cancer confined to the uterus.

• Stage II: Cancer has spread to the cervix.

• Stage III: Cancer has spread to the vagina, ovaries, and/or lymph nodes.

• Stage IV: Cancer has spread to the rectum, urinary bladder, or organs far from the uterus.

Treatments for Uterine Cancer

1. Surgical management

• Stage I cancer

Total abdominal hysterectomy (surgical removal of the uterus) with bilateral salpingo-oophorectomy (surgical removal of both ovaries and fallopian tubes) is the treatment of choice in patients with stage I disease. 

• Stage II cancer

Radical hysterectomy is the treatment of choice in patients with stage II cancer. All ligaments and the half or upper one-third of the vaginal canal are removed along with the uterus. 

• Stage III and IV cancer

Hysterectomy, bilateral salpingo-oophorectomy, and radiation therapy are the treatment of choice in patients with stage III and IV cancer.

Complications of the above procedure include excessive blood loss, infection, bladder rupture, side effects of anesthesia, and ureter damage.

2. Chemotherapy

In certain patients with stage III and IV uterine cancer, chemotherapy adjuvant to external beam radiotherapy is the treatment of choice. 

Chemotherapy uses a combination of two drugs. The most commonly used drugs include carboplatin, paclitaxel, docetaxel, cisplatin, and doxorubicin.

Docetaxel and paclitaxel inhibit cell division. Platinum-based drugs such as cisplatin and carboplatin induce apoptosis (a form of programmed cell death) in cancer cells.

The complications of chemotherapy include hair loss, nausea, vomiting, and bone marrow suppression.

3. Radiation therapy

Radiation therapy is given to uterine cancer patients in two forms: external beam radiation and vaginal brachytherapy.

• External beam radiation

The area of the body marked is radiated with a beam of radiation from an external source for five days a week and continues for at least six weeks.

• Vaginal brachytherapy

The radiation-emitting source is placed inside the body, in the vaginal canal. Vaginal brachytherapy can be of high dose or low dose. 

The high-dose-rate brachytherapy needs less than one hour to complete, but the patient might need multiple appointments in a week. The low-dose-rate brachytherapy requires the patient to get admitted to the hospital as the radiation-emitting device is placed in the vagina for one to four days.

The complications of radiation therapy include skin changes, cystitis, vaginitis, proctitis, narrowing of the vaginal and anal canal (stenosis), fistula, etc.

Take-Home Points

• The most common type of gynecological cancer is uterine cancer, which mainly consists of endometrial or endometrial carcinoma and uterine sarcomas. Uterine sarcomas are rare, but endometrial carcinomas are very common. If not diagnosed and treated early, uterine cancers can spread to other body parts and could be fatal. 

• The exact cause of uterine cancers is not known. However, factors like age, family history, drugs, history of radiation therapy to the pelvis, and high exposure to estrogen for prolonged periods could put one at risk of developing uterine cancer.

• Postmenopausal bleeding, irregular menstrual cycles, intermenstrual bleeding, vague abdominal pain, pelvic discomfort, painful urination, ascites, etc., are some of the symptoms of uterine cancer. A uterine cancer diagnosis needs a physical examination, a transvaginal ultrasound, and an endometrial biopsy. 

• The treatment of uterine cancer includes surgical removal of the uterus and other parts and chemotherapy in adjuvant with radiation therapy. Early diagnosis and treatment are critical to a favorable prognosis.

References

• Uterine Cancer

• Endometrial Cancer

• Uterine Sarcoma