Uterus is a hollow pear shaped pelvic organ located between the bladder and rectum. The uterus is also known as the womb, where the fetus development occurs. The uterus sits in an inverted position within the pelvic cavity of the torso. It is located along the body’s midline posterior to the urinary bladder and anterior to the rectum. The narrow inferior region of the uterus, known as the cervix, connects the uterus to the vagina below it and acts as a sphincter muscle to control the flow of material into and out of the uterus.
- It is responsible for the development of the embryo and fetus during pregnancy.
- It plays a vital role in continuity of life.
The uncontrolled growth of mutated cells in the lining of uterus is called Uterine Cancer. It is also called as endometrial cancer. Uterine Cancer can start in different parts of the uterus.
Types of Uterine Cancer
The walls on the interior of the uterus have 2 layers of tissues - endometrium (inner lining) and myometrium (outer muscles). Based on the affected tissue, cancer is broadly categorized into two types:
- Endometrial Cancer:This is the most common type of Uterine Cancer with 95 % of cases. Most Uterine Cancers start in the endometrium. This is called endometrial Cancer. Most Endometrial Cancers are adenocarcinoma (Cancers that begin in cells that make mucus and other fluids).
- Uterine sarcomas Sarcoma accounts for about 2% to 4% of Uterine Cancers. Uterine sarcoma is an uncommon form of Uterine Cancer that forms in the muscle and tissue that support the uterus.
Anatomy of uterus
Uterine Cancer generally shows the following symptoms but these symptoms might vary or there may not be any prominent initial symptom at all.
- Abnormal vaginal bleeding or discharge.
- Pelvic pain
- Pain, pressure or cramps in the lower abdomen
- Problems during pregnancy, including premature contractions and spontaneous abortion.
There are multiple factors that lead to the development of Uterine Cancer; some of them are controllable while many are beyond one’s control. Here we have listed the major risk factors that lead to the development of uterus Cancer:
- Hormonal Changes – Any imbalance or fluctuations in the levels of two main female hormones namely estrogens and progesterone is a high risk.
- Prolonged menstruation – Early puberty or late menopause increases the risk of Endometrial Cancer. Women having more menstrual cycles in their lifetime have an increased endometrial Cancer risk. This includes starting periods before age 12 and going through menopause after age 50.
- Infertility – Infertility is a major risk for Uterine Cancer. Irregular menstrual cycles and infertility also may be related to imbalances in estrogen and progesterone levels, and this hormone imbalance may increase the risk for Endometrial Cancer.
- Age – Women in later ages tends to develop Uterine Cancer, especially the ones who have undergone menopause.
- Obesity - Excess body fat alters the body's balance of hormones. Fat cells produce estrogen, so obese women are at an increased risk for Uterine.
- Tamoxifen - It acts as an anti-estrogen in breast tissue, but increases estrogen level in the uterus.
- An inherited colon Cancer syndrome - Hereditary non polyposis Colorectal Cancer (HNPCC) is a syndrome that increases the risk of colon Cancer and other Cancers, including endometrial Cancer. HNPCC occurs because of a gene mutation passed from parents to children.
- Family History - Women with a family history of endometrial, colon or Ovarian Cancer may be at a higher risk of developing Endometrial Cancer.
Though most of the causatives of Uterine Cancer are natural and cannot be controlled yet a few precautionary measures might help to lower the risk. Some of them are
- Maintaining healthy diet.
- Exercising regularly and maintaining a fit body.
- Maintaining balanced level of hormones.
- Consulting a doctor for endometrial problems or HNPCC cases.
Staging of Uterine Cancer helps in proper diagnosis and planning for the treatment. It is staged in 4 levels ranging from stage I to IV, the severity increasing with each passed stage. The stages are discussed in details below:
- Stage 0 (Tis, N0, M0):
This stage is also known as carcinoma in-situ. Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below. The Cancer has not spread to nearby lymph nodes or distant sites. This is a preCancerous stage and is not included in the FIGO staging system.
- Stage I (T1, N0, M0)
Cancer is found only in the uterus. The Cancer has not spread to lymph nodes or distant sites.
- Stage IA: In this earliest form of stage I Cancer and it lies in the endometrium only. It has not spread to lymph nodes or distant sites.
- Stage IB: Cancer has spread halfway or more into the myometrium but has not gone beyond the body of uterus.
- Stage II (T2, N0, M0)
Cancer is present in both the uterus and cervix. The Cancer has not spread outside of the uterus. The Cancer has not spread to lymph nodes or distant sites.
- Stage III (T3, N0, M0)
Cancer has spread beyond the uterus, but not beyond the pelvis
- Stage IIIA:
Cancer has spread to the outer layer of the uterus or to the fallopian tubes, ovaries, and ligaments of the uterus. The Cancer has not spread to lymph nodes or distant sites.
- Stage IIIB:
Cancer has spread to the vagina or to the tissues around the uterus. The Cancer has not spread to lymph nodes or distant sites.
- Stage IIIC:
Cancer has spread to lymph nodes in the pelvis and/or around the aorta.
- Stage IIIA:
- Stage IV (T4, any N, M0) or (any T, any N, M1)
Cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of the body.
- Stage IVA:
The Cancer has spread to the inner lining of the rectum or urinary bladder. It may or may not have spread to nearby lymph nodes but has not spread to distant sites.
- Stage IVB:
The Cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or to organs away from the uterus. The Cancer can be any size and it may or may not have spread to lymph nodes.
- Stage IVA:
Some of the ways to detect Cancer at an early stage are:
- Pelvic examination: During pelvic examination doctor carefully observes the outer portion of the vulva. This can be done by inserting fingers through the vaginal opening or by inserting a speculum that opens up the vagina and lets the doctor view the vagina and cervix.
- Ultra sound: Transvaginal ultrasound is used to look at the thickness and texture of endometrium. This is done by inserting the transducer into the vaginal opening and creating a video image of the uterus.
- Heteroscopy: A lens on a special lighted microscope, called heteroscope is inserted through the vagina which allows the doctor to examine the Cancer.
- Biopsy: A sample of endometrial cell/ tissue is removed from uterine line and observed under microscope.
- Dilatation and curettage: When enough information couldn’t be obtained by biopsy then dilatation and curettage is used. In this procedure, the cervix is widened (dilated) so that a curette (a spoon-shaped instrument with a sharp edge) can be inserted into the uterus to remove cells, tissues or growths from the endometrium.
The options for treating endometrial Cancer depend on multiple characteristics of the Cancer, such as the stage, health and root cause etc.
Depending on the spread of the malignant cells, surgery is conducted to remove the uterus, fallopian tubes and ovaries. A hysterectomy causes menopause and infertility.
- Radiation Therapy:
Radiation therapy uses powerful energy beams, such as X-rays and protons, to kill Cancer cells. It reduces the risk of Cancer recurrence after surgery, and helps to shrink a tumour before surgery (down-staging the tumour) and make it easier to remove.
Radiation therapy includes
- External Radiation
- Internal radiation (brachytherapy)
- Hormone Therapy:
This involves taking medications that affect hormone levels in the body. Hormone therapy is used to:
- Increase the amount of progesterone
- Reduce the amount of estrogen
Chemotherapy uses chemicals to kill Cancer cells.
- Supportive (palliative) care:
Palliative care is specialized medical care that focuses on providing relief while undergoing aggressive treatments like surgery, chemotherapy or radiation therapy.
Uterine Cancer, if detected at early stages is easy to cure. Endometrial Cancer can usually be cured while uterine sarcoma is harder to cure. Removing the uterus along with the surrounding affected organs generally aids in curing the Cancer. But at the later stages when the Cancer spreads to distant body parts then different treatments needs to be implemented.
If you encounter any of the symptoms then consulting a doctor is the smartest move though the symptom might not necessarily indicate the presence of the fatal disease.
Endometrial Cancer is often detected at an early stage as it frequently produces abnormal vaginal bleeding, which prompts the patient to see a doctor. But at times, early stages are missed due to negligence or no evident symptoms.