Any type of cancer that emerges from the tissue of the uterus.
Uterine cancer is any type of cancer that emerges from the tissue of the uterus. Uterine cancer can refer to several types of cancer, with cervical cancer (arising from the lower portion of the uterus) being the most common type worldwide and the second most common cancer in women in developing countries. Endometrial cancer (or cancer of the inner lining of the uterus) is the second most common type, and fourth most common cancer in women from developed countries. Another type of cancer is uterine sarcomas also known as myometriomas. A very rare type of uterine cancer is called gestational trophoblastic disease.
Cervical cancer
Cervical cancer arises from the transformation zone of the cervix, the lower portion of the uterus and connects to the upper aspect of the vagina. Cervical cancer (Pic. 1) is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body.
Cervical cancer staging is the assessment of cervical cancer to decide how far the disease has progressed. Cancer staging generally runs from stage 0, which is pre-cancerous or non-invasive, to stage 4, in which the cancer has spread throughout a significant part of the body.
As a general rule, Stage 0 is easily cured and Stage 4 is incurable.
Early on, typically no symptoms are seen (Pic. 2). Later symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.
Human papillomavirus (HPV) infection appears to be involved in the development of more than 90% of cases; most people who have had HPV infections, however, do not develop cervical cancer.
Endometrial cancer
Endometrial cancer (Pic. 3) is a cancer that arises from the endometrium. It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body.
Endometrial cancer occurs most commonly after menopause. The most frequent type of endometrial cancer is endometrioid carcinoma, which accounts for more than 80% of cases.
The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination or sexual intercourse, or pelvic pain.
Endometrial cancer is commonly diagnosed by endometrial biopsy or by taking samples during a procedure known as dilation and curettage. A pap smear (a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix) (Pic. 4) is not typically sufficient to show endometrial cancer.
Survival rates of endometrial cancer are based on outcomes of people who've had the disease.
Uterine sarcomas
Uterine sarcomas also known as myometriomas are rare neoplasms comprising 1% of all gynaecologic malignancies and 4–9% of all malignant uterine neoplasms. Myomentrium is the layer of uterus made from muscular tissue. These muscle cells can become cancerous in rare cases and the sarcoma will develop. Uterine sarcomas usually display aggressive clinical behaviour, with a great tendency to local recurrence and even greater to distant spread. Due to their low incidence and the fact that they lack a preinvasive stage, there is no established practice for screening these tumours.
According to WHO (World Health Organization) classification, uterine sarcomas are classified into four main histological subtypes in order of decreasing incidence:
Unusual or postmenopausal bleeding may be a sign of a malignancy including uterine sarcoma and needs to be investigated. Other signs include pelvic pain, pressure, and unusual discharge. A nonpregnant uterus that enlarges quickly is suspicious. However, none of the signs are specific. Specific screening test have not been developed; a Pap smear is not designed to detect uterine sarcoma.
Gestational trophoblastic disease
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy. These tumours are rare, and they appear when cells in the womb start to proliferate (grow) uncontrollably.
There are several different types of GTD. Hydatidiform moles (a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy) are benign in most cases, but sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma, which is likely to spread quickly, but which is very sensitive to chemotherapy, and has a very good prognosis. Gestational trophoblasts are of particular interest to cell biologists because, like cancer, these cells invade tissue (the uterus), but unlike cancer, they sometimes "know" when to stop.
GTD can simulate pregnancy, because the uterus may contain fetal tissue, albeit abnormal. This tissue may grow at the same rate as a normal pregnancy, and produces chorionic gonadotropin, a hormone which is measured to monitor fetal well-being.
While GTD overwhelmingly affects women of child-bearing age, it may rarely occur in postmenopausal women.
If caught early, most types of uterine cancer can be cured using surgical or medical methods. When the cancer has extended beyond the uterine tissue, more advanced treatments including combinations of chemotherapy, radiation therapy, or surgery may be required.
Associated diseases
Approximately 40% of cases are related to obesity. Endometrial cancer is also associated with high blood pressure and diabetes.
Complications
Uterine cancer can be complicated by anemia (decreased amount of red blood cells) due to blood loss. The diagnostics with biopsy (extraction of sample cells/tissues) can cause perforation of uterus.
Also therapy is associated with complication. After postoperative radiotherapy some women can suffer from enterocolitis (an inflammation of the digestive tract, involving enteritis of the small intestine and colitis of the colon) and severe leg edema. Intracavitary brachytherapy (a form of radiotherapy where a sealed radiation source is placed inside or next to the area requiring treatment) is associated with leg edema and smoking strongly correlated with enterocolitis (inflammation of the digestive tract, involving enteritis of the small intestine and colitis of the colon).
Risk factors
Risk factors depend on specific type, but generally obesity, older age, and human papillomavirus infection add the greatest risk of developing uterine cancer. Between two and five percent of cases are related to genes inherited from the parents.
Taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and progesterone in combination, as in most birth control pills, decreases the risk.
Risk factors for endometrial cancer also include diabetes mellitus, breast cancer, use of tamoxifen, never having had a child and late menopause.
Uterine cancer is mostly seen in women after menopause. But in woman of child-bearing age it is primary desirable to preserve uterus and women’s fertility. A more conservation approach is to use hormones rather than chemotherapy or radiation. But not all uterine cancers can be treated with hormonal therapy.
In other cases hysterectomy (removal of uterus) is necessary. It takes away all possibility to conceive a child naturally. The only option is to use surrogacy.
Chemotherapy often follows the surgical treatment or can be only treatment of uterine cancer. The problem is that chemotherapy can damage a woman’s eggs and then the naturally conception is impossible. The cryopreservation of eggs can be the option to preserve future fertility with healthy eggs obtained from women before treatment.
The same problems result from radiation therapy.
Cervical cancer
Pap smear test
Checking the cervix by the Papanicolaou test, or Pap smear, for cervical cancer has been credited with dramatically reducing the number of cases of and mortality from cervical cancer in developed countries. Pap smear screening every 3–5 years with appropriate follow-up can reduce cervical cancer incidence up to 80%. Abnormal results may suggest the presence of precancerous changes, allowing examination and possible preventive treatment.
HPV vaccination status does not change screening rates. Screening can occur every 5 years between ages 30 and 65 when a combination of cervical cytology screening and HPV testing is used and this is preferred.
Liquid-based cytology is another potential screening method. Although it was probably intended to improve on the accuracy of the Pap test, its main advantage has been to reduce the number of inadequate smears from around 9% to around 1% This reduces the need to recall women for a further smear.
Barrier protection
Barrier protection and/or spermicidal gel used during sexual intercourse decreases cancer risk.Condoms offer protection against cervical cancer. Evidence on whether condoms protect against HPV infection is mixed, but they may protect against genital warts and the precursors to cervical cancer. They also provide protection against other STDs (sexually transmitted diseases), such as HIV and Chlamydia, which are associated with greater risks of developing cervical cancer.
Vaccination
Two HPV vaccines (Gardasil and Cervarix) reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93% and 62%, respectively The vaccines are between 92% and 100% effective against HPV 16 and 18 up to at least 8 years.
HPV vaccines are typically given to age 9 to 26 as the vaccine is only effective if given before infection occurs. The vaccines have been shown to be effective for at least 4 to 6years, and they are believed to be effective for longer, however, the duration of effectiveness and whether a booster will be needed is unknown. The high cost of this vaccine has been a cause for concern. Several countries have considered (or are considering) programs to fund HPV vaccination.
Other types of cancer cannot be prevented. The only possible thing is to eliminate the risk factors. Stop smoking, practice of safe sex and maintain healthy lifestyle can reduce the risk of developing cancer.
Traditional Chinese herbal medicine can offer treatment to relive the cancer symptoms. One of them is substance called canelim, which have positive effect in 53-86% patients. Herbalists believe that canelim can also shrink the tumor and then the removal is easier.
Uterine cancer is treated by 1 or a combination of treatments, including hormone therapy, surgery, radiation therapy, and chemotherapy.
Pharmacotherapy
Endometrial cancer
Hormonal therapy is only beneficial in certain types of endometrial cancer. It was once thought to be beneficial in most cases. If a tumor is well-differentiated and known to have progesterone and estrogen receptors, progestins (used most commonly in hormonal birth control and menopausal hormone therapy) may be used in treatment. About 25% of metastatic endometrioid cancers show a response to progestins.
Also, endometrial stromal sarcomas can be treated with hormonal agents, including tamoxifen, hydroxyprogesterone caproate, letrozole, megestrol acetate, and medroxyprogesterone. This treatment is effective in endometrial stromal sarcomas because they typically have estrogen and/or progestin receptors. Progestin receptors function as tumor suppressors (inhibit tumor development) in endometrial cancer cells. Preliminary research and clinical trials have shown these treatments to have a high rate of response even in metastatic disease.
Gestational trophoblastic disease (GTD)
Hydatidiform mole has successfully been treated with systemic (intravenous) methotrexate (cytostatic agent).The treatment for invasive mole or choriocarcinoma generally is the same. Both are usually treated with chemotherapy. Methotrexate and dactinomycin are among the chemotherapy drugs used in GTD.
Only a few women with GTD suffer from poor prognosis metastatic gestational trophoblastic disease. Their treatment usually includes chemotherapy. Women who undergo chemotherapy are advised not to conceive for one year after completion of treatment. These women also are likely to have an earlier menopause. It has been estimated by the Royal College of Obstetricians and Gynaecologists that the age at menopause for women who receive single agent chemotherapy is advanced by 1 year, and by 3 years for women who receive multi agent chemotherapy.
In cases of cervical cancer and uterine sarcomas the adjuvant chemotherapy has little effect on overall survival.
Surgical therapy
Cervical cancer
Microinvasive cancer (any lesion in which cancer cells invade the tissue to a depth of ≤3 mm below the base of the surface, without lymphatic or blood vessel involvemen) may be treated by hysterectomy (removal of the whole uterus including part of the vagina). For microinvasive disease, a cone biopsy (cervical conization) is considered curative (possible to heal) (Pic. 5). For severe stage, the lymph nodes are removed, as well.
If a cone biopsy does not produce clear margins (findings on biopsy showing that the tumor is surrounded by cancer free tissue, suggesting all of the tumor is removed), one more possible treatment option for women who want to preserve their fertility is a trachelectomy (surgical removal of the uterine cervix). This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care, as few doctors are skilled in this procedure.
Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the woman is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the woman has given prior consent. Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.
Endometrial cancer
The leading treatment option for endometrial cancer is abdominal hysterectomy (the total removal by surgery of the uterus), together with removal of the fallopian tubes and ovaries on both sides, called a bilateral salpingo-oophorectomy.
Uterine sarcomyomas
Therapy is based on staging and patient condition and utilizes one or more of the following approaches. Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy.
Gestational trophoblastic disease
Treatment is always necessary. The treatment for hydatidiform mole consists of the evacuation of pregnancy.Evacuation will lead to the relief of symptoms, and also prevent later complications. Suction curettage (the use of a scoopto remove tissue by scraping or scooping) is the preferred method of evacuation. Hysterectomy is an alternative if no further pregnancies are wished for by the female patient.
Other therapy
Cervical cancer
Because cervical cancers are radiosensitive (susceptibility of cells to the harmful effect of ionizing radiation), radiation may be used in all stages where surgical options do not exist. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Women treated with surgery who have high-risk features found on pathologic examination are given radiation therapy with or without chemotherapy to reduce the risk of relapse.
Gestational trophoblastic disease
Radiotherapy can also be given to places where the cancer has spread, e.g. the brain.
Techniques of assisted reproduction can help patients after uterine cancer treatment. In cases of hormonal therapy, chemotherapy or radiotherapy women can freeze her eggs, which can be damaged by therapy. When women decides to became pregnant the physician thaw one or more eggs, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
The intracytoplasmic-sperm injection (ICSI) procedure involves a single sperm carefully injected into the center of an egg using a microneedle.
In cases of hysterectomy this eggs can be also fertilised with partner’s sperms but they are insert in surrogate mother.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
