Uterine cancer

Uterine cancer represents abnormal cell growth comprising the uterine tissue (Pic.1).

There are two main types of uterine cancer:

• endometrial cancer refers to the abnormal growth which starts in the lining of the uterus (endometrium)
• uterine sarcomas which develop in the smooth muscle tissue (myometrium)

Endometrial cancer counts about 75 % of all cases of uterine cancer. Uterine sarcomas, such may be for example uterine leiomyosarcoma (ULMS), are rarer forms of the uterine cancer, however in most cases more agressive ones and prognosis after their treatment is usually poorer than for endometrial cancer. 

It is not clear exactly what causes the uterine cancer. Endometrial cancer usually occurs in women older than 50 years, uterine sarcomas affect the women at the age between 40 and 60 years old in average.

The hormone imbalance seems to be one of the most important risks for uterine cancer, especially when having higher levels of estrogen in comparison to the hormone progesterone. The hormone imbalance causes the thickening of the uterus lining. When the lining is built up and stays that way, cancer cell may start to growth. This hormone imbalance may be caused primary by hormone-replacement therapy in menopausal women but also by obesity or diabetes mellitus. There is also small increase in the risk at long-term use of tamoxifen – the drug used when treating the breast cancer.

However, in most cases, the cancer is found in its early stage, before it spreads outside the uterus. The testing to confirm the uterine cancer includes physical examination, transvaginal ultrasound, blood and urine tests and hysteroscopy (device is inserted through the vagina to see inside the uterus) and biopsy. The uterine cancer stages (0 to IV; Table 1) are then determined by biopsy, chest X-ray, and/or CT (computed tomography)or MRI (Magnetic resonance imaging) scans.

The most common treatment of the uterine cancer is hysterectomy – the surgical removal of the uterus. Depending on the stage of the cancer, either only the uterus is removed or the ovaries, fallopian tubes or cervix and part of vagina may be removed as well. Other treatments include hormone therapy, radiation therapy and chemotherapy. Radiation therapy may be by external radiation or by internal radiation – called brachytherapy. Chemotherapy requires the administration the drugs which circulates in blood and they are supposed to kill cancer cell. Most chemotherapy treatments need to be done in repeated cycles. As the most uterine cancer is caused by hormone imbalance, hormone therapy serves to balance the levels of hormones estrogen and progesterone.

Symptoms

Abnormal vaginal bleeding or postmenopausal bleeding is the most common symptom of the uterine cancer. Also vaginal discharge, often with an offensive smel and pelvic pain are following symptoms.

Among the other symptoms, the pain with urination or during the sex may be present. Other symptoms such as weight loss, fatigue, weakness, lethargy and fever are generally associated with any type of cancer.

Associated diseases

• cervical cancer
• ovarian cancer
• uterine sarcoma
• uterine leiomyosarcoma (ULMS) - aggressive uterine sarcomas which develop in the smooth muscle tissue
• breast cancer

Complications

• being menopausal or reaching the menopause
• estrogen-only hormone replacement therapy in / after menopause
• heavy bleeding
• irregular bleeding between the periods
• pelvic / abdominal pain
• high blood pressure
• diabetes mellitus
• being overweight or obese
• taking tamoxifen at breast cancer treatment
• never having children or being infertile
• endometrial hyperplasia (thickened uterine wall lining)
• family history of ovarian, uterine, breast or bowel cancer
• previous ovarian tumours or polycystic ovary syndrome (PCOS)

Prevention

If the uterine cancer is confirmed, the therapy have to start. Usually, the most common way how to treat uterine cancer and remove the tumour is hysterectomy – the surgical removal of the uterus (and sometimes also of the ovaries, fallopian tubes, cervix or part of vagina).

When undergoing the hysterectomy, a woman is not able to get pregnant and carry the child anymore.

However, oocyte cryopreservation technique (laboratory technique used to long-.term storage of female of the female gametes) is possible; the cryopreserved oocytes of such patient can be later artificially fertilized with partner’s sperm and the resulting embryo is then transferred into the gestational carrier’s uterus.

The prognosis is usually byased on individual person’s disease history. The prognostic and predictive factors for uterine cancer are:

• type of cancer – endometrial cancer / uterine leiomyosarcoma
• grade – which describes how much cancer cells look like healthy cells when viewed under a microscope. Grade for uterine cancer varies from GX (cells cannot be evaluated) to G3 (cells cannot be differentiated)
• stage – stage may vary from stage 0 to stage IVB. Cancers have a less favourable prognosis if they have spread outside of the uterus 
• metastases - describes whether the cancer has spread to other parts of the body
• nodes – describes how much the regional lymph nodes (near the uterus) or distant lymph nodes (in other parts of the body) are affected
• type of tumour
• myometrial invasion - how far the tumour has grown into
• age - younger women tend to have a better prognosis than post-menopausal women
• obesity
  
  

At recurrent cancer, the uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen or another part of the body. Approximately 70% of recurrent uterine cancer may happens within 3 years of initial treatment. Some symptoms might be similar to those experienced when the disease was first diagnosed. 

As the hysterectomy is the first option of treatment the uterine cancer, a woman is not able to get pregnant and carry a child. However, there are some methods and techniques of assisted
reproductive technology which can be used to have a baby.