Uterine cancer

Uterus and Uterine Cancer

The Uterus:

The uterus, also known as the womb, is a pear-shaped, hollow organ located in the pelvis between the bladder and rectum. It is the largest organ in the female reproductive system. The uterus is composed of three parts:

1. The Cervix: The narrow, lower part of the uterus.
2. The Isthmus: The middle, larger portion of the uterus.
3. The Fundus: The topmost part of the uterus shaped like the base of a “fundus.”

The uterus has three layers:

• Endometrium: The innermost layer of the uterus.
• Myometrium: The middle layer made of thick muscles.
• Serosa: The outermost layer.

What is Uterine Cancer?

Uterine cancer, also called Endometrial Cancer, is the most common cancer of the female reproductive organs. It occurs when cells in the uterus grow uncontrollably, forming a tumor. This tumor can either be benign (non-cancerous) or malignant (cancerous).

Non-cancerous growths in the uterus include:

• Fibroids: Lumps found in the muscles of the uterus.
• Benign Polyps: Lumps found in the lining of the uterus.
• Endometriosis: A condition where tissue similar to the endometrium grows outside the uterus.
• Endometrial Hyperplasia: An abnormal increase in the number of cells and glands in the endometrium. These cells may be healthy or atypical, and the glands may be simple or complex. If there are more atypical cells or complex glands, the risk of cancer is higher.

Types of Uterine Cancer:

There are two main types of uterine cancer:

1. Adenocarcinoma: The most common type, originating from the cells of the endometrium.
2. Sarcoma: A rare cancer that develops from the tissues surrounding the glands or from the muscle layer (myometrium) of the uterus. Sarcomas account for 2-4% of uterine cancers.

Genetic and Family History of Uterine Cancer:

Uterine cancer risk can be inherited and passed down from one generation to the next. About 5% of uterine cancers are inherited, often through a condition called Lynch Syndrome.

Statistics:

According to Globocan 2020, uterine cancer ranks third among cancers affecting women in India, following breast cancer. Each year, approximately 123,907 women are diagnosed with uterine cancer, and 77,348 die from the disease, making it the second leading cause of cancer death among women.

Survival Rates:

The chances of survival are highest when uterine cancer is detected and treated early. The 5-year survival rates for different stages are as follows:

• Stage I: 83.5%
• Stage II: 80.6%
• Stage III: 66.0%
• Stage IV: 37.1%

Risk Factors for Uterine Cancer:

A risk factor is anything that increases the likelihood of developing cancer. Some of the risk factors for uterine cancer include:

1. Age: Most cases of uterine cancer occur in women over the age of 50.
2. Obesity: Excess body fat produces estrogen, increasing the risk of uterine cancer. Around 70% of women with uterine cancer are overweight or obese.
3. Race: Uterine cancer is more common in Caucasian women than in women of other races.
4. Genetics: Lynch Syndrome and similar genetic conditions increase the risk of uterine cancer in families.
5. Diabetes: Type 2 diabetes increases the risk, often due to the association with obesity.
6. Other Cancers: Women who have had breast, ovarian, or colorectal cancer are at a higher risk of developing uterine cancer.
7. Tamoxifen: This drug, used in the treatment of breast cancer, increases the risk of uterine cancer, though its benefits generally outweigh this risk.
8. Radiation Therapy: Radiation to the pelvic area for the treatment of other cancers increases uterine cancer risk.
9. Diet: A diet high in animal fat increases the risk of uterine cancer.
10. Estrogen: The longer a woman is exposed to estrogen, the higher the risk of uterine cancer. This includes starting menstruation before age 12, having late menopause, or undergoing Hormone Replacement Therapy (HRT). Women who never have children are also at increased risk.
11. Hair Straightening Products: The regular use of chemicals in hair relaxers may increase the risk of uterine cancer.

Prevention of Uterine Cancer:

Factors that may reduce the risk of uterine cancer include:

• Birth Control Pills: Long-term use of oral contraceptives that contain both estrogen and progesterone can reduce the risk of uterine cancer by preventing excessive growth of the uterine lining.
• Intrauterine Device (IUD): Using an IUD that releases progestin can lower the risk.
• HRT: Using a combination of estrogen and progesterone (instead of estrogen alone) during hormone replacement therapy can reduce the risk of uterine cancer but may increase the risk of breast cancer.
• Weight Management: Maintaining a healthy weight can reduce the risk.
• Diabetes Control: Managing diabetes helps lower the risk of uterine cancer.

Symptoms of Uterine Cancer:

Common symptoms of uterine cancer include:

• Abnormal vaginal bleeding
• Vaginal bleeding after menopause
• Bleeding after sexual intercourse
• Persistent lower back pain

Diagnosis of Uterine Cancer:

1. Pelvic Examination: A doctor examines the uterus to detect abnormal growths or bleeding. A Pap smear test may also be performed.
2. Endometrial Biopsy: A small sample of tissue is taken from the uterus and examined under a microscope to detect cancerous cells.
3. Dilation and Curettage (D&C): A procedure used to collect a sample from the uterus for biopsy.
4. Transvaginal Ultrasound: A detailed scan of the uterus.
5. CT Scan and MRI: Imaging tests to assess the extent of cancer.

FIGO Stages of Uterine Cancer:

• Stage IA: Cancer is limited to the endometrium or the inner half of the myometrium.
• Stage IB: Cancer extends into the outer half of the myometrium.
• Stage IIIA: Cancer has spread to the serosa of the uterus, ovaries, or fallopian tubes but not to other organs.
• Stage IIIB: Cancer has spread to the vagina or nearby tissue (parametrium).
• Stage IIIC1: Cancer has spread to pelvic lymph nodes.
• Stage IIIC2: Cancer has spread to para-aortic lymph nodes.
• Stage IVA: Cancer has spread to the bladder or rectal mucosa.
• Stage IVB: Cancer has spread to distant organs.

Treatment for Uterine Cancer:

1. Surgery: The primary treatment for uterine cancer involves removing the uterus and surrounding tissue. The types of surgery include:
• Hysterectomy: There are two types. A simple hysterectomy removes the uterus and cervix, while a radical hysterectomy also removes the upper part of the vagina and surrounding tissues. In postmenopausal women, the ovaries and fallopian tubes are also removed.
• Lymph Node Removal: During hysterectomy, nearby lymph nodes are also removed.
Common side effects of surgery include pain, fatigue, nausea, difficulty urinating, and bowel issues. Women who have their ovaries removed may experience menopausal symptoms like hot flashes and vaginal dryness.
2. Radiation Therapy: Radiation can be used externally (External Beam Radiation Therapy) or directly into the uterus (Brachytherapy). Radiation is often used after surgery to destroy any remaining cancer cells. In some cases, chemotherapy is given alongside radiation.
Side effects include fatigue, skin changes, difficulty urinating, and diarrhea.
3. Chemotherapy: Chemotherapy may be used after surgery to destroy any remaining cancer cells, to shrink large tumors before surgery, or to treat cancer that has spread to other parts of the body.
Common chemotherapy drugs for uterine cancer include:
• Paclitaxel
• Carboplatin
• Doxorubicin
• Cisplatin
Side effects of chemotherapy include nausea, vomiting, hair loss, mouth sores, fatigue, and increased risk of infection.
4. Hormone Therapy: Some uterine cancer cells have hormone receptors, and hormone therapy is used to slow their growth. High doses of progesterone are typically used, particularly for grade 1 or 2 adenocarcinoma.
Side effects of hormone therapy include water retention, increased appetite, insomnia, muscle pain, and weight gain.
5. Targeted Therapy:
• Anti-angiogenesis therapy
• mTOR inhibitors are used to treat advanced cases.
6. Immunotherapy:
• Pembrolizumab (Keytruda)
• Lenvatinib (Lenvima) combined with pembrolizumab
• Dostarlimab (Jemperli)

Follow-up for Uterine Cancer:

After completing treatment, regular follow-up tests are crucial

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