|
|---|
UTERINE CANCER
|
|
|---|
UTERINE CANCER
Uterine, or "endometrial" cancer is very common in the U.S.A., and great strides have been made in curing this disease. While historic treatment used surgery only, newer approaches combine therapies to increase the length of survival and chance of cure.
What Causes or Increases the Risk for Uterine Cancer?
As with any cancer, the exact reason why one woman gets uterine and another does not is unknown . However, there are well-recognized risk factors which increase a woman's chance of developing it. These have much in common with breast cancer risks, since both cells in the uterus and breast respond to hormone stimulation:
1) Obesity is linked to a 10 times greater risk of getting uterine cancer. Thus, other conditions associated with being too fat, such as diabetes and high-blood pressure are also linked to uterine cancer. The reason why obese woman get more uterine cancer is thought due to hormone changes caused by fat cells. Specifically, fat cells cause more estrogen to be produced, which builds up the uterine lining more than normal. The more this lining is built up, the more chance that one of the lining cells will become cancerous. In fact, anything that increases the amount of a woman's estrogen over time increases her risk for both breast and uterine cancer.
2) Older Age (after menopause) is a factor for developing uterine cancer. The average age of a uterus cancer patient is 60 years old. Only about 10% of patients are less than 40 years old.
3) Childless women are more likely to get uterine (and breast) cancer, since they have more "unopposed estrogen stimulation of the uterus." This means that a woman's uterine lining has a period of "rest" during pregnancy, estrogen levels are low and progesterone levels are high. Anything that stops the estrogen level from being high, even for a while, lowers the risk of uterine cancer.
4) Birth Control Pills containing only estrogen stimulate the uterine lining and thus increase the risk of cancer. That is why modern birth control pills are not pure estrogen (as they once were) but contain progesterone which allows the uterine lining a monthly "rest." Giving supplemental estrogen after menopause helps keep proper bone density and heart disease risk low, but slightly increases the risks to develop uterine and breast cancer.
5) Heredity-- Women who's mothers or maternal aunts have uterine or breast cancer are at increased risk. There are certain "family cancer syndromes" that raise the risk of uterine, breast, ovarian and colon cancer. Also, certain rare genetic diseases like "Stein-Leventhal" syndrome (cystic disease of the ovary) increase estrogen and thus the risk of uterine cancer.
6) Hyperplasia (thickening) of the uterine lining, especially when the cells look abnormal, can raise the chance of getting uterine cancer to 20%.
7) Radiation Exposure is a rare, but possible cause of uterine cancers, especially those arising from the muscular wall of the uterus ("sarcomas").
***Alcohol and Tobacco use do not increase the risk of uterine cancer.
What are the Symptoms of Uterine Cancer?
1) Bleeding out the vagina is the most common symptom of uterine cancer, and is very suspicious for cancer in a woman after her menopause. Uterine bleeding is seen in over 90% of patients and is why the disease is usually caught early.Of woman with new onset vaginal bleeding after menopause, 30% will have cancer, with the chance of it being uterine or cervical about equal. In women still having periods, abnormal spotting or changes in the cycle are seen. These abnormalities may be increased bleeding ("menorrhagia"), or at the wrong time ("metrorrhagia"). The bleeding may both be increased and at the wrong times ("menometrorrhagia"). There may also be a foul discharge suggestive of infection, or sloughed-off tumor. Infection may be the first indication of a cancer problem.
2) Abnormal Pap Smear may be seen in uterine cancer, and this usually suggests a more advanced uterine cancer. It is uncommon in the absence of bleeding. The Pap smear is about 80% accurate for detecting cervical cancer, but only about 40% accurate for picking up uterine cancer.
3) Advanced Disease Symptoms from a large tumor include pelvic pain, and change in bowel and bladder habits (since the uterus is sandwitched between the rectum and bladder in the female pelvis). Also seen are increasing abdominal girth, and swelling in the groin from spread to lymph glands, and signs of distant spread to bone, lung, liver and brain. This distant spread is rare unless the cancer is large.
How Does Uterine Cancer Spread?
The vast majority of uterine cancers start on the inner lining ("endometrium"). In fact, the disease is also called endometrial cancer. As the cancer grows, it penetrates into the muscular wall of the uterus. When it penetrates deeply, the cancer is said to show "deep myometrial invasion." At this point it becomes more likely to spread to the local lymph glands in the pelvis and groin. When these lymph glands are invaded by cancer, they enlarge. The cancer can further grow into the fallopian tubes, cervix and vagina, or into the bladder or rectum. Sometimes, it can escape through the outer lining ("serosa" ) of the uterus or out the fallopian tubes to "seed" into the abdomen, and grow multiple tumors upon it's inner membrane lining, called the "peritoneum." The larger the cancer is, the more chance it has to migrate locally and shed cells distantly, spreading to the pelvic organs, lymph glands, abdomen, bone, lung, liver and brain.
What are the Types of Uterine Cancer?
1) Adenocarcinoma is the most common type of uterine cancer, it arises from the glands of the endometrium. About 80% of uterine cancers are adenocarcinomas, and they have varying aggressiveness. The pathologist assigns a "grade" to this cancer, which basically says how cancerous it looks under the microscope. While "Grade I" looks a lot like normal uterine tissue and can be very indolent, "Grade III" looks very cancerous and will probably be aggressive. "Grade II" is intermediate in looks and behavior. About 40% of adenocarcinomas are "Grade I," 20% are "Grade II," and 40% are "Grade III." There may be a mixture of grades or even cancer types in the tumor.
2) Adenosquamous Carcinoma is about 10% and are a combination of 2 types of malignant cells, both the glandular ("adeno") and the cervical ("squamous") type. They need not involve the cervix, but tend to be more advanced at presentation and were once though less curable, but this is now disputed.
3) Papillary Serous Carcinoma is the worst type since it is very aggressive and tends to come back even when caught early. It represents 5% of uterine cancers.
4) Clear Cell Carcinoma is an aggressive cancer accounting for about 2% of uterine cancers. It is associated with a woman's mother having used a hormone called DES while pregnant, and is getting less common with DES no longer used.
5) Sarcomas of the uterus arise from its muscle wall.There are many subtypes and they tend to spread through the bloodstream to the lungs. They can contain muscle, cartilage and bone, and their treatment is different from the above types.
How is the Extent of Uterine Cancer Gauged?
Like all cancers, the extent of uterine cancer is given by the "Stage." The system used most commonly is called the"FIGO" staging, it goes like this:
