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Uterine Cancer: What Are The Best Treatments Available?

Uterine Cancer or Endometrial Cancer is the sixth most common gynecological cancer and 15th most common cancer worldwide with 380,000 women diagnosed in 2018. As these cancers are more common in women, let’s start with one of the patient’s stories who was diagnosed with uterine cancer and how she survived it. 

Her name is Lynn, and she was diagnosed at the age of 32 which is not too old though. She was certain that she will have any type of cancer since there were a lot of cancers in her family. Her dad and uncle had cancers two times, her first cousin had a second bout of throat cancer, three cousins had breast cancer and her aunt had uterine cancer. So, because of her family history, she was watching for something.

In 1997, she had the first pain of her life in her stomach. She thought it was appendicitis. She ignored it in the first place and after a few days, she felt nauseous, but she thought it was stress for a new job. Then she had periods and started feeling crampy. On her date, she started bleeding and her date was working in emergency response and took her to the emergency room when the bleeding didn’t stop. She was supposed to see her doctor the following week and luckily, he was there at the hospital delivering a baby. He helped him to stop her bleeding. 

Uterine Cancer Patient Image
Uterine cancer

She went to see him next week and he did Curettage [C] and Dilation[D] procedure to scrape and collect tissue from inside the uterus. Dilation is widening of the cervix to let instruments into the uterus and curettage is the scraping of the walls of the uterus. It turned out to be uterine cancer, so her doctor sent her to an oncologist. The oncologist decided to operate first and later decide on whether to go for chemo or radiation. They found out that it was a rare case of uterine cancer called as clear cell sarcoma. This type of cancer arises in the muscle of the uterus and usually occurs after menopause.

For the first 30 days, she had radiation and in April 1999, she had a cold and was losing weight. She also had swelling in her lymph nodes, so she had CT. The CT showed there were two spots on her lungs which show that cancer has recurred. She had chemo and more surgeries to take out the bottom right lobe of her lungs. Since then, she has been cancer-free. From her experience, she would tell other women to listen to their bodies – it does tell you things. It’s all about knowing yourself, once you know, you can fight it.

A patient herself said that it is important to know your body so that you can fight the disease, it is very important to know about uterine cancer and how to prevent yourself from it. Hence in this article, we will talk about Uterine cancer – types, symptoms, causes, diagnosis, and treatments available that will help you to make better decisions and prevent yourself from the disease. So, let’s, get started.

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What is Uterine Cancer?

Uterine cancer or endometrial cancer starts when cells in the inner lining of the uterus called endometrium start to grow out of control. It is often detected at an early age since it produces abnormal vaginal bleeding. According to National Cancer Institute, 3 in 100 women will be diagnosed with uterine cancer at some point in their lives. Hence early detection is the key to preventing it.

What is Uterine Cancer
Types of Uterine Cancer

Types of Uterine Cancer

  • Endometrioid adenocarcinoma – It is the most common form of uterine cancer which takes up to 80% of all uterine cancers that are formed in the endometrium glands.
  • Uterine papillary serous carcinoma – It is a rare and more aggressive form of uterine that forms in the lining of the uterus and tends to return even when diagnosed early.
  • Uterine clear cell carcinoma – It is seen in 5% of cases and tends to be a rare form of uterine cancer.
  • Uterine carcinosarcoma – It is another rare case that makes up to 5% of cases.
  • Uterine sarcoma – It develops in the muscle wall of the uterus called the myometrium and it is found to be more aggressive than any other type of uterine cancer.

symptoms

Uterine Cancer Symptoms

  • Abnormal vaginal bleeding or discharge
  • Painful urination
  • Enlarged uterus
  • Pain during intercourse
  • Weight loss
  • Bleeding between periods
  • Pelvic pain
uterine cancer symptoms

Uterine Cancer Stages

The cancer is found in the uterus and does not spread to other parts of the body.

  • Stage IA – The cancer is found only in the endometrium or less than half of the myometrium.
  • Stage IB – Cancer has spread to more than one-half of the myometrium.

The tumor has scattered to the cervical stroma from the uterus but not to other parts of the body.

The tumor has spread beyond the uterus but is still in the pelvic area.

  • Stage IIIA – Cancer has scattered to the serosa in the uterus and the tissue of the fallopian tubes and ovaries.
  • Stage IIIB – Cancer has scattered to the vagina
  • Stage IIIC1 – The tumor has spread to regional pelvic lymph nodes.
  • Stage IIIC2 – The tumor has spread to para-aortic lymph nodes with or without the spread to regional pelvic lymph nodes.

The tumor has spread to the rectum, bladder, and/or to distant organs.

  • Stage IVA – The tumor has spread to the mucosa of the rectum or bladder
  • Stage IVB – The tumor has scattered to lymph nodes in the groin area and has spread to distant organs such as bone or lungs.
Causes of uterine cancer

Causes

Uterine Cancer Causes

  • Reaching menopause after age 55
  • A thickened wall lining
  • Never having a children
  • Starting periods before age 12
  • High blood pressure or diabetes
  • Being overweight
  • Family history of uterine cancer
  • Previous radiation therapy in the pelvis

diagnosis

Uterine Cancer Diagnosis

The doctor might check for swelling in the abdomen.

In this ultrasound, the transducer is moved over the skin in the lower part of the abdomen to get pictures of the uterus, ovaries, and fallopian tubes.

In this ultrasound, the transducer is put into the vagina to see if the uterus contains a tumor or if the endometrium is thicker than usual.

In this test, a small amount of tissue is removed for examination under a microscope. Though other tests can also suggest if the cancer is present, a biopsy is the only definite diagnosis.

In this process, a sample from the uterus is removed to check for cancer cells, endometrial hyperplasia, and other conditions.

It takes pictures inside the body using x-rays from different angles that show any abnormalities or tumors.

It uses magnetic fields to produce complete images of the body. It is often used in women with low-grade uterine cancer to see how far cancer has grown into the uterus wall.

In this procedure, the doctor puts a telescope into the uterus through the cervix to get a better view of the inside lining of the uterus. During the procedure, tissue can also be removed (biopsy) and sent for testing.

treatment

Treatment for Uterine Cancer

It is the most common and the first treatment used for uterine cancer where tumors and some surrounding healthy tissues are removed. Before the surgery, talk with your doctor about any possible side effects. There are two types of surgery for uterine cancer that include:

  • Hysterectomy – This is the most common surgical procedure to treat uterine cancer. Depending on the level of cancer, the surgeon will perform either a simple or radical hysterectomy. In simple hysterectomy, removal of uterus and cervix is performed whereas, in radical hysterectomy, removal of cervix, uterus, the upper part of the vagina, and nearby tissues is performed. Regular screening and testing are recommended to check for cancer return.
  • Removal of lymph node – During a hysterectomy, the surgeon can remove lymph nodes near the tumor to determine if cancer has spread beyond the uterus or not. This may be done through lymph node biopsy or lymphadenectomy in which a group of lymph nodes is removed. 

Side effects after surgery may include pain, tiredness, nausea, vomiting, and bowel movements. After surgery, women’s diet may be restricted to liquids followed by a steady return to other foods.

In this therapy, x-rays are used to kill the cancerous cells. It is either given externally where radiation is directed at cancer and surrounding tissue, or from inside the body, where radioactive material is put in the thin tubes and placed near the cancer cells. It usually consists of a specific number of treatments given for a particular period.

Some women need both surgery and radiation therapy. Radiation therapy is most often given after surgery to destroy the remaining cancer cells. It is occasionally given prior to surgery to shrink the tumor. Radiation therapy is recommended to a few women if they cannot undergo surgery. 

For some women, radiation therapy is the best option to prevent the return of cancer. These include those with grade 3 cancers. It can also be considered for women with grade 1 or 2 depending on the age and whether cancer has spread to the blood or lymphatic vessels.

Side effects will depend upon the extent of radiation given and may include fatigue, mild skin reactions, stomach upset, bowel movements. Though the side effects will go away after the treatment is over.

This therapy is used to slow the growth of specific types of uterine cells. It usually involves the use of a high dose of the sex hormone progesterone in the form of a pill. This helps to shrink some cancers or control some symptoms. It can also be used for women who cannot have surgery or radiation therapy. It can also be used in combination with other types of treatment.

Side effects of hormone therapy may include fluid retention, insomnia, increase in appetite, and weight gain. Talk with your doctor about the side effects and how to prevent them.

It is a type of therapy where the drug is injected into a vein to control cancer and relieve symptoms. It usually consists of a specific number of cycles given for a particular period. The goal of chemotherapy is to destroy cancers that are left after surgery or to shrink cancer and slow the growth of the tumor if it recurs.

Side effects of chemotherapy depend on the individual, and the type of chemotherapy done. They include fatigue, infection, nausea, vomiting, hair loss, loss of appetite, and diarrhea. These side effects go away once the treatment is done. 

Other potential side effects of chemotherapy are the inability to become pregnant and experiencing early menopause. Some drugs may cause hearing loss and kidney damage. Hence patients can be given extra fluid to protect their kidneys. Talk with your doctor about the side effects and how they can be prevented.

It is also called biologic therapy which is intended to boost natural defense to fight against cancer. It uses materials to restore immune system function. Different types of immunotherapies cause different side effects that include skin reactions, diarrhea, and weight changes. Talk with your doctor about possible side effects and see how to prevent or manage them.

Target therapy is a type of treatment where specific genes, proteins, or tissues are treated that contributes to cancer growth and survival. This treatment prevents the growth of cancerous cells and restricts the damage to healthy cells. Not all tumors have the same target for treatment.

Hence doctors, run tests to identify the genes, proteins, and other factors in the tumor to better match each patient with the effective treatment. There can be different side effects for each treatment, hence talk to your doctor and prevent or manage it.

Uterine cancer treatment cost in India

Treatment cost of Uterine cancer in India

The cost of uterine cancer treatment in India ranges from $4000 – $6000 depending upon the quality of treatment and the hospital.

Uterine cancer treatment cost
survival rate

Survival Rate

Uterine Cancer Survival Rate

The 5-year survival rate for women with uterine cancer for white and black women is 84% and 63% respectively.

Conclusion

Uterine cancer remains the most common gynecologic cancer in the world hence improving the knowledge about the disease will allow to get the right treatment at an early stage or prevent it from getting worse.

Frequently Asked Questions and patient concerns:

Is Uterine Cancer curable?

Uterine cancer is curable since its symptoms occur in its early stage.

Does Uterine Cancer spread quickly?

Type 1 uterine cancer grows slowly which is often found inside the uterus but type 2 uterine cancer is less common but spreads rapidly to other parts of the body.

Where does Uterine Cancer spread first?

Uterine Cancer starts in the uterus and spreads to other parts of the body. In general, it spreads to the rectum or bladder, and other areas where it can spread include the vagina, ovaries, and fallopian tubes. This form of cancer grows slowly and can be detected before it has spread to other parts of the body.

How does Uterine Cancer occur?

It arises when the cell of the endometrium starts to grow rapidly due to which the lining of the uterus thickens in certain places. These linings form a mass of tissue called a tumor.

Who is most likely to get Uterine Cancer?

It occurs most often in women over 50 and the average age of diagnosis is 60.

What foods prevent Uterine Cancer?

  • Tomatoes
  • Garlic
  • Citrus Fruits
  • Carrots
  • Wholegrains

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