Uterine Cancer - Signs, Causes, Risk Factors, and Treatment

What Is Uterine Cancer?

Uterine cancer, otherwise called endometrial cancer, is a cancer that originates in the cells that line the uterus (endometrium). The uterus is an inverted-pear-shaped hollow female reproductive organ present in the pelvis where the fetus's development occurs. The buildup of cancer cells in uterine cancer can be benign or noncancerous, or it can be malignant or cancerous and spread to other parts of the body.

The exact cause of tumor formation seen in uterine cancer is not understood. But, endometrial hyperplasia, obesity, women who have never given birth, menarche before 12 years of age, menopause after 55 years of age, etc., are some known risk factors. This cancer is often detected early as it results in abnormal vaginal bleeding. And when it is detected early, removing the uterus is the best option.

The National Cancer Institute estimates 3 in 100 women get diagnosed with uterine cancer. Almost 80 % of women who have uterine cancer survive for five years or longer after being diagnosed.

What Are the Signs of Uterine Cancer?

Abnormal vaginal bleeding is the most obvious and commonly seen symptom of uterine cancer. The abnormality in uterine bleeding include:

• The menstruation length and flow changes. There might be prolonged periods with heavy flow.
• Spotting or vaginal bleeding between menstrual periods.
• Vaginal bleeding even after menopause.

The other possible symptoms of uterine cancer are:

• Vaginal discharge that is watery or blood-tinged.
• Pelvic pain (pain in the lower abdomen).
• Painful urination.
• Pain during sexual intercourse.

Always consult the doctor if one experiences any of the symptoms of uterine cancer. Remember that the presence of these symptoms does not necessarily mean uterine cancer, but at the same time, it is essential to determine the underlying cause. Abnormal vaginal bleeding can also be seen before menopause, hormonal imbalance, uterine polyps, fibroids, and other noncancerous conditions. But sometimes, it is a sign of uterine cancer, vulvar cancer, and other types of gynecological cancer.

What Causes Uterine Cancer?

The cause of endometrial cancer is still unknown. Doctors believe that certain factors result in mutation in the DNA of the endometrial cell. This mutation results in endometrial cells to grow, multiply, and die at abnormal rates. Such abnormal cells multiply and grow exponentially in an uncontrolled way and do not die at a set time, resulting in the accumulation of cells and tumor formation. Cancer cells from uterine cancer can spread to nearby tissues and elsewhere in the body (metastasis).

What Are the Possible Risk Factors of Uterine Cancer?

The following factors increase the risk of uterine cancer:

1. Hormonal Imbalance - The ovaries release two female hormones, estrogen, and progesterone. Any changes in the levels of either of these hormones can result in an imbalance and cause changes in the endometrium. An increase in estrogen levels makes you prone to uterine cancer. Estrogen levels are high in polycystic ovary syndrome (PCOS), diabetes, obesity, and women taking Estrogen pills after menopause.

2. HRT After Menopause - Hormone replacement therapy (HRT) using only Estrogen pills increases the risk.

3. Tamoxifen - Hormone therapy using Tamoxifen to prevent or treat breast cancer increases the risk of developing uterine cancer.

4. Early Menarche - Menarche is the first occurrence of periods. Women who started menstruating before 12 years of age or menopause after 55 years of age, resulting in more years of menstruation, are at risk of uterine cancer. The more periods a woman has in her childbearing years; the more effect estrogen has on the endometrium.

5. Older Women - As uterine cancer is commonly seen after menopause, older women are more at risk.

6. Overweight or Obese Women - Obesity increases the risk of uterine cancer because the excess fat in the body alters the hormonal balance.

7. Diabetes - A study found diabetic women to be twice as likely to develop uterine cancer.

8. Nulliparous Women - Women who have never been pregnant are also at a higher risk of uterine cancer than someone with at least one pregnancy.

9. Lynch Syndrome - It is an inherited colon cancer syndrome, which is also known as HNPCC (hereditary nonpolyposis colorectal cancer). This condition increases the risk of colon cancer, uterine cancer, and other cancers. It is a hereditary syndrome.

10. Endometrial Hyperplasia - Here, the endometrium thickens, increasing the risk of cancer growth.

11. Family History - The chances of uterine cancer increase if one's immediate family member or members are diagnosed with it.

How Is Uterine Cancer Diagnosed?

The gynecologist might perform the following tests to diagnose uterine cancer if the patient complains of abnormal vaginal bleeding:

1. Pelvic Examination - While examining the pelvis, the doctor inspects the vulva (the outer portion of the genitals) and then inserts two fingers into the vagina and presses on the abdomen to feel the uterus and ovaries. The doctor might open the vagina and cervix for examination using a device called a speculum.

2. Transvaginal Ultrasound - Transvaginal ultrasound uses sound waves to provide images of the uterus. The doctor can look at the endometrium's thickness and texture by inserting the probe of the ultrasound into the vagina. Any abnormality in the uterine wall can be diagnosed.

3. Hysteroscopy - A thin and flexible tube called a hysteroscope is placed into the uterus through the vagina and cervix. The camera attached to the scope allows the doctor to see the endometrium and examine the uterus.

4. Biopsy - The doctor might remove some tissue from inside the uterus to examine the cells under the microscope to see any cancerous changes. Sometimes, if the biopsy results are inconclusive, the doctor will scrape off the uterus lining through dilation and curettage (D&C) and then send the tissue for examination.

What are the Stages of Uterine Cancer?

Once the doctor diagnoses uterine or endometrial cancer, the cancer is staged based on how much it has spread:

• Stage 1 - Cancer cells do not spread beyond the uterus.
• Stage 2 - Cancer cells have spread from the uterus to the cervix.
• Stage 3 - Cancer cells have reached the ovaries, vagina, fallopian tubes, or lymph nodes, but not to the rectum or bladder.
• Stage 4 - Cancer has spread farther than the pelvic area to the bladder, rectum, or distant organs.

How Is Uterine Cancer Treated?

The treatment options for uterine cancer are:

1. Surgery - Hysterectomy or surgical removal of the uterus is the treatment of choice. The fallopian tubes and ovaries (salpingo-oophorectomy) are also usually removed. If the patient is not menopausal, a hysterectomy will make future pregnancies impossible, and the patient will experience menopause if the ovaries are removed.

2. Radiotherapy - This is the use of high-energy beams like X-rays or protons to kill cancer cells. Radiation can be used after surgery to prevent uterine cancer from recurring, or it can be used prior to surgery to reduce the tumor's size.

3. Medications -The medications for uterine cancer include the following:

• Chemotherapy - Intravenous or oral drugs are used to destroy cancer cells. The doctor might prescribe one drug or a combination of two or more drugs. Same to radiation, chemotherapeutic drugs can be given before or after the surgery.
• Hormone-Blocking Drugs - These drugs lower the hormone levels in the body. As cancer cells grow with the help of hormones, blocking them will prevent growth, and the cells might die.
• Targeted Drug Therapy - These drugs block specific weaknesses within the cancer cells, resulting in cell death. This is usually used in combination with chemotherapy.
• Immunotherapy - These drugs help the immune system fight cancer.

4. Supportive Care- Medicines are given to relieve pain and other associated symptoms. Some patients might need mental support.

Can Uterine Cancer Be Prevented?

As the exact cause is unknown, uterine cancer cannot be prevented, but the risk can be lowered by:

• Avoiding Estrogen pills.
• Using combination birth control pills.
• Maintaining a healthy weight.

Conclusion

Uterine cancer also called endometrial cancer affects the uterine lining (endometrium). The exact cause of the condition is not known. Symptoms are mostly present in the form of abnormal vaginal bleeding, pelvic pain, pain during urination and intercourse, and abnormal blood-tinged vaginal discharge. In case of any symptoms, it's always best to consult a gynecologist as early as possible.