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Uterine cancer

Uterine cancer
Uterine cancer is the disease that develop as a result of uncontrolled growth of cells of the uterus. When uterine cells start to grow out of control will lead to development of mass called tumor. Tumor can either be benign or malignant. Benign tumor is the one that remain enclosed and cannot spread to other parts of the body. Examples of benign tumor (non-cancerous conditions) of uterus includes;

• Fibroids: These are noncancerous tumors that develop in the muscles of the womb.
• Endometriosis: In this the inner lining of the womb (endometrium) is outside (comes outside of the womb).
• Endometrial hyperplasia: Number of cells and grandular structures in the lining is larger than normal.
• Benign polyps: These are abnormal growths in the uteral lining.

Malignant tumors are not enclosed and normally tend to spread to other parts of the body. Malignant tumors are also called cancers. To understand well about uterine cancers, it is important to have knowledge of structure of the uterus.

Uterus
Uterus or womb is apart of the female reproductive system in which the fetus grows and develops. The system includes organs like ovaries, fallopian tubes, cervix and vagina. Its is pear shaped and its size is normally about 7.6 cm long, 4.5 cm broad and 3cm in thickness.It is located in the lower abdomen between rectum and bladder. It connects to the vagina by cervix. Uterus is divided into three main parts;

• Fundus. It is a dome shaped top of the uterus, above the entry point of the uterine tubes.
• Body. This is the broad section of the uterus. Embryo implantation occurs here.
• Cervix. It is a lower part of the uterus connecting it to the vagina. It is also known as neck of the uterus. Cervix is structured and functions differently to the rest of the uterus.

Although cervix is technically part of the uterus, it is normally not discussed as part of uterine cancer. Cancer of cervix is discussed in different section. Uterine cancers involve cancers that affect body of the uterus.Body of the uterus is mainly made up of two layers;

• Myometrium. This is the outer layer of muscle tissue. This makes up most of the uterus.This thick layer ofmuscle is needed to push the baby out during birth.
• Endometrium. It is the inner layer or lining.

Types of uterine cancer
• Uterine sarcomas. This type of uterine cancer that develop in the supporting tissues of the uterine glands or in muscular layer of the uterus (myometrium). These include uterine leiomyosarcomas andendometrial stromal sarcomas.
• Endometrial carcinomas. These start in the cells of the inner lining of the uterus (the endometrium). This is the most common type of uterine cancer.

Risk factors
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but it does not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. The following factors may increase your risk of developing uterine cancers.

• Age. Uterine cancer is more common to women with the age of 45 and above.
• Diet. Women who eat foods high in animal fat have an increased chance of developing uterine cancer.
• Obesity.Obesity is a result of too much fat in the body which cause a person to become overweight. Having too much fat in the body, will increase chance for a woman to develop uterine cancer because excess fat in the body can lead to increased level of estrogen hormone which increases the risk of uterine cancer.
• Family history. A woman in a family with the history of uterine cancer, has slightly increased risk of developing uterine cancer. The risk is also high to those families with the history of breast cancer, colon cancer and ovarian cancer.
• Pregnancy. Hormonal balance shifts toward more progesterone during pregnancy. So havingmany pregnancies protects against endometrial cancer. Women who have never beenpregnant have a higher risk, especially if they were also infertile.
• Genetics.Women in families with Lynch syndromehave a higher risk for uterine cancer. It is recommended that all women under the age of 45 with uterine (endometrial) cancer should have their tumor tested for Lynch syndrome even if they have no family history of bowel cancer or other cancers.
• Estrogen. Women who take estrogen replacement therapy alone (without progesterone) have higher risk of developing uterine cancer. The risk of developing uterine cancer is also slightly higher to those who had their first period (menstruation) before the age of 12 and those who had late menopause.
• Tamoxifen. Women who take tamoxifen drug to treat breast cancer are said to be at increased risk of developing uterine cancer. The drug is still used because the benefits outweighs the risks.
• Radiation therapy. The risk of developing uterine cancer is slightly high to those who had radiation therapy of pelvic region at some point of their life.
• Other health conditions of uterus. The risk of developing uterine cancer is also slightly higher to those having untreated uterine conditions such as endometrial hyperplasia.

Prevention
To prevent something you need first to know what causes it. Since the specific cause of uterine cancer is still unknown, currently there is no known way of completely preventing development of uterine cancer but there are some ways that may help reduce the risk of developing it. The following are some ways that may help reduce the risk of uterine cancer.

• Chose more healthy life style choices such as not taking too much animal fats and doing physical exercises to avoid being obese.
• Using birth control pills. Some researches indicate that, using birth control pills may help reduce the risk of developing uterine cancer. However, it isimportant to look at all of the risks and benefits when choosing a contraceptive method.
• Seeking medical treatment for uterine conditions such as endometrial hyperplasia.
• To those with diabetes, proper management of the disease such as regular monitoring blood glucose level will help to reduce the risk of developing uterine cancer.

Early detection and screening
When it comes to cancer, early detection normally provide better treatment outcome. When uterine cancer is found early, chances for better treatment outcome are very high. For most cancers, early detection has been greatly contributed by the presence of screening processes.
Screening is the process of running some tests to someone with no symptoms of a certain disease with the intention of determining presence or absence of that disease. Unfortunately, there till now, there is no widely recommended screening tests for uterine cancer.
Despite absence of screening tests for this cancer, most of uterine cancers are found much early before they reach advanced stage through signs and symptoms, such as abnormal vaginal bleeding.

Signs and symptoms
People with uterine cancers tend to experience certain signs and symptoms, although those body changes may sometimes be caused by other medical conditions different to cancer, hence it is advised to see the doctor upon experiencing any of those symptoms. Signs and symptoms of uterine cancer include the following;

• Unusual vaginal bleeding. This include bleeding between periods or after menopause. • Vaginal smelly, watery discharge.
• Unexplained weight loss
• Abdominal pain
• Pelvic pain
• Difficulty or pain when urinating
• Pain during sexual intercourse.

Diagnosis
Medical diagnosis simply means identification of nature of an illness by elimination of the symptoms. Normally people don`t go to hospital knowing they have cancer but during diagnostic procedures is when doctors detect the disease.
Following suspicion of the disease, doctors normally run combination of tests to determine whether there are cancerous cells in the body or not and if there are cancer cells, how far have they spread. Along with thorough medical history and physical examination, doctors normally use combination of the following tests to diagnose cancer.

Laboratory tests. Laboratory tests are important in ruling out other conditions and confirming diagnosis. For cancer diagnosis laboratory tests normally include blood tests, urine tests, tumor markers and other body fluids tests.

• Blood tests. Blood tests help to reveal level of different substances in the blood which will help doctors to know if there is anything wrong in the body. From blood tests doctors can see complete blood count which indicates number, size and maturity of blood cells. Also from the blood tests doctors can analyze if kidney and liver are working properly.
• Urine tests. Urine tests (urinalysis) involve laboratory examination of urine to check presence of blood, proteins, and other substances such as drugs. For instance blood in the urine may be an indication of benign condition, infection or other health problem.
• Tumor markers. These are biomarkers (proteins) that can be produced by both cancer cells and normal body cells in response to cancer. Tumor markers are released into the blood or urine. Although studies are still conducted to determine role of these markers in diagnosing cancer because sometimes people with benign condition will have elevated level of these proteins. Also not all tumors have their markers and some markers are not specific to one type of tumor.
• Other body fluids. Despite being rarely used, sometimes body fluids can be tested in the lab during diagnosis of cancer. For instance the use of cerebral spinal fluid (CSF) and pleural fluid. CSF is used in diagnosis of brain tumors while pleural fluid for lung cancer.

Diagnostic imaging. Diagnostic imagings involve tests that create pictures of inside the body that help the doctor to see if there is tumor or not. There are several imaging tests used in cancer diagnosis depending on the type and location of cancer suspected. These imaging tests include;

• Computed tomography (CT) scan. CT scan machine is a donut-shaped scanner that uses x-rays to create series of pictures of body organs from different angles. This machine is linked to a computer where those series of pictures taken will be combined to create a 3D- image of inside the body. During the scanning process patient will lie still on the table which will slide into the scanner. In order to get a clear image, sometimes the doctor will inject the patient with a contrast material before scanning. From the images the doctor will be able to differentiate between healthy and unhealthy tissues.
• Magnetic resonance imaging (MRI). MRI is an imaging technique that uses powerful magnet and radio waves to take series of pictures of body organs and create a 3D image in a computer linked to a machine. Just like in CT, during MRI procedure the patient will lie on a table that will slide into a long round chamber. Also during this procedure the doctor may inject the patient with a contrast material for clear image view.
• X-ray. This is an imaging technique that is uses low dose of radiation to create pictures of inside your body. Technician will position the patient and direct the x-ray beam to the intended part of the body. • Ultrasound. Ultrasound is a diagnostic imaging procedure that uses high energy sound waves to produce images of organs inside the body. During the examination, a patient will lie on the table while the technician will slowly move a device called transducer on the skin over the part of the body that is being examined.
• PET scan. Positron emission tomography (PET) scan is an imaging test that uses radioactive glucose to create 3-D images of areas inside the body. Radioactive glucose is used for this test because cancer cells tend to absorb more glucose than normal body cells, so the scan will show which areas of the body has more glucose than others. Before the scan, doctor will inject the patient with tracer called radioactive glucose then during imaging the patient will be asked to lie on the table that will be moving back and forth through the scanner.
• Bone scan. Bone scan is used to examine bones. When it comes to cancer, bone scan is used for diagnosis of bone cancer or cancer that has metastasized into the bones. Before the test, patient will be injected with small amount of radioactive material that tends to collect more on abnormal parts of the bones. Then pictures that will be taken by a scan will indicate the distribution of those radioactive materials in the bones throughout the body.

Biopsy. Biopsy is a diagnostic procedure that involves removing a tissue sample from the body and examines it under microscope in the laboratory. Examination in the laboratory is normally done by a pathologist who will check if the cells in the tissue are cancerous or not. In most cancer cases, biopsy is considered to be the confirmatory test. Depending on the location and type of cancer, biopsy can be obtained in different ways. Some of them include;

• Using needle. By using a thin needle, doctors can draw same tissue or fluid for examination under microscope. This method can be used to draw some fluid (spinal tap), bone marrow (bone marrow aspiration), blood or small amount of tumor from the suspected organ such as liver and breast (fine needle aspiration).
• Surgery. Abnormal tissue samples are obtained while the doctor is performing the surgery. Tissues are then sent to the lab for examination during the surgery. If the surgeon removes just a portion of abnormal area it is called incisional biopsy while when the entire tumor (abnormal site) is removed it is called excisional biopsy.
• Using endoscope. Endoscope is a thin, lighted tube with a camera (focusing telescope) at the end. It is used for viewing inside the body through natural openings like mouth and anus. During an examination if the doctor sees any abnormal tissue, then endoscope can also be used to take sample for that tissue. There are different kinds of endoscopy exams depending on the site of the body being examined. Some of the exams include colonoscopy (for rectum and colon), bronchoscopy (for trachea, bronchi and lungs) and esophagogastroduodenoscopy EGD (for esophagus, stomach and duodenum)

In addition to medical history and physical examination, diagnosis of uterine cancer involves the use CT scan, MRI scan, Blood tests, Urine test, Biopsy and Ultrasound (Abdominal and transvaginal) Ultrasound.

Staging of uterine cancer
Staging is a standard way used by cancer care team to explain how far the cancer has grown or spread. Staging also enables the oncology team to decide on the suitable treatment option. In this process of staging doctors normally use systems in order to describe the stage of cancer. For uterine cancer, FIGO (Federation Internationale de Gynecologie et d’Obstetrique) staging system is preferred. Stages of uterine cancer by using FIGO staging system are as follows;

Stage I: Tumor is in the uterus only.

• Stage IA: Tumor is in the endometrium only or has invaded less than one-half of the myometrium.
• Stage IB: The tumor has spread to the myometrium.

Stage II: The tumor has invaded the cervix but not other organs of the body.

Stage III: The cancer has spread beyond the uterus/cervix to other structures like ovaries, Fallopian tubes,vagina and there may be nearby lymph nodes involvement.

• Stage IIIA: Tumor has invaded the serosa of the uterus. Also it may have invaded tissues of the fallopian tubes and ovaries but not other organs.

• Stage IIIB: The tumor has invaded the vagina.

• Stage IIIC: Tumor has invaded the regional pelvic lymph nodes. It may have invaded the para-aortic nodes with or without involving regionalpelvic nodes.

Stage IV: Tumor has spread tothe inside of the bladder or rectum, throughout the abdomen, to other parts of the body such as the bones or lung, or to distant lymph nodes

• Stage IVA: Tumor has reached the mucosa of the rectum or bladder.

• Stage IVB: Tumor has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs.

Treatment
Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps.

After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option.

Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored.

In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials.

If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time

Treatment options Treatment of uterine cancer requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. But generally multidisciplinary team for treatment of uterine cancer includes, surgical oncologist, gynecological oncologist, medical oncologist, radiation oncologist, radiologist, pathologist and other health care professionals like oncology nurses, women`s health physiotherapist and palliative care team. Treatment options include the following;

Surgery Surgery is the treatment option that involves removing the tumor and some surrounding healthy tissue by operation. For treatment of uterine cancer, surgery can be done in the following ways depending on the location and stage of the disease. These type of surgery include the following;

• Hysterectomy. Cancer of the uterus is usually treated by an operation to remove the uterus and cervix (a total hysterectomy), along with both fallopian tubes and ovaries (a bilateral salpingo-oophorectomy). The ovaries are usually removed as they produce estrogen, a hormone that may cause the cancer to grow, hence removing them reduces the risk of the cancer coming back.
• Lymphadenectomy. Lymphadenectomy involve removing nearby lymph nodes. At the same time as hysterectomy, pelvic and para-aortic (areas next to aorta) lymph nodes may be removed to see if they contain cancer cells thathave spread from the endometrial tumor.

Side effects of surgery Side effects of surgery will depend to the extent of surgery. Some of the possible side effects include the following;
• Feeling pain
• Tiredness
• Experiencing symptoms of menopause such as hot flashes and vaginal dryness as a result of removing ovaries.
• Lymphedema. If you have a lymphadenectomy, you may develop lymphedema. Removing lymph nodes from thepelvis may prevent lymph fluid from draining, causing swelling inthe legs.

Radiation therapy

Radiation therapy an option that involve using high energy x-rays or other radiation particles to destroy cancer cells. There are mainly two types of radiation therapy, internal radiation therapy and external beam radiation therapy. The most common type used for treatment of uterine cancer is external beam radiation therapy. External beam radiation therapy is the type of radiation therapy which involve directing radiation beam to the tumor from the source (machine) which is outside the body.
Sometimes internal radiation therapy (brachytherapy) is used. Brachytherapy is a way of delivering targeted radiotherapy directly to the tumor from inside your body.Brachytherapy for uterine cancer involve inserting a cylinder containing radioactive material into the vagina. This cylinder is connected to a machine using plastic or metal tubes. These tubes move the radiation from the machine into your body.


Side effects of Chemotherapy
Side effects of radiation therapy depend on the dose of radiations given. Some of the possible side effects include the following;

• Mild skin reactions
• Fatigue
• Upset stomach
• Loose bowel movement
• Apparent loss of appetite
• Hair loss (public hair).

Chemotherapy Chemotherapy is the use of drugs to destroy cancer cells or stop its growth. This treatment is given by a specialized doctor known as medical oncologist or gynecological oncologist. Type of chemotherapy used for treatment of uterine cancer is known as systemic chemotherapy. In systemic chemotherapy drug gets into the bloodstream to reach cancer cells throughout the body.
Generally chemotherapy is can be given through injection into vein (intravenously) by using a needle or given as a pill or capsule that is swallowed (orally). Chemotherapy can sometimes be given in combination with radiation therapy.

Side effects of chemotherapy Side effects of chemotherapy depend on the type of drug used, amount of dose given and periodic time by which the dose has been used. Some of the possible side effects of chemotherapy include the following;

• Hair loss
• Nausea and/or vomiting
• Mouth sores
• Risk of infections due to decreased white blood cells.
• Easily bruised and bleeding due to decreased platelets
• Tiredness due to decreased red blood cells.
• Diarrhea

Hormone therapy
Hormone therapy is the treatment option that involvesusing hormone-blocking drugs to treat cancer. The drugs will slow the growth of tumor cells. This treatment option can be used for those who cannot have surgery or radiation therapy. It can also be used in combination with other treatment options. Common hormone treatments that are used in this treatment option include Progestin, Tamoxifen, Luteinizing hormone-releasing hormone agonists and Aromatase inhibitors. This kind of therapy is different to that used for post menopause symptoms.

Side effects of hormone therapy
The common side effects of hormone treatment depend on the type of drug used and dose given. Some of the possible side effects includes, breast tenderness, headaches, tiredness, nausea, menstrual changes, and bloating. In high doses, progesterone may increase appetite and cause weight gain.

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