What
is the uterus?
The uterus, also called the womb, is a hollow,
pear-shaped organ located in a woman's lower
abdomen, between the bladder and the rectum.
The
parts of the uterus include:
- cervix - the narrow, lower
portion of the uterus
- corpus - the broader, upper
part of the uterus
- myometrium - the outer
layer of the corpus; the muscle that expands
during pregnancy to hold the growing fetus
- endometrium - the inner
lining of the uterus
What
is uterine cancer?
Cancers that occur in each part of the uterus
have their own names, such as cervical cancer
or endometrial cancer, but are sometimes broadly
defined as uterine cancer because the structure
is part of the uterus. Cancer of the uterus spreads
through the bloodstream or lymphatic system.
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Cancer of the endometrium, the lining of the
uterus, is called endometrial cancer and is the
most common cancer of the female reproductive
organs.
What
are non-cancerous conditions of the uterus?
Some conditions in the uterus, caused by abnormal,
rapid, and uncontrolled division of cells, are
not cancer. Three of these benign conditions
include:
- Fibroid tumors are common
benign tumors of the uterine muscle that do
not develop into cancer. Fibroid tumors of
the uterus are very often found in women in
their forties. And, although single fibroid
tumors do occur, multiple tumors are more common.
Symptoms of fibroid tumors, which depend on
size and location, include irregular bleeding,
vaginal discharge, and frequent urination. For
fibroids that press against nearby organs and
cause pain, surgery may be necessary. Many times,
however, fibroids do not cause symptoms and do
not need to be treated. After menstrual periods
cease, fibroid tumors may become smaller and
may disappear altogether.
- Endometriosis is a benign
condition of the uterus that is common among
women in their thirties and forties, especially
women who have never been pregnant. Tissue
that looks and acts like endometrial tissue
begins to grow in unusual places, such as on
the surface of the ovaries, on the outside
of the uterus, and in other tissues in the
abdomen.
- Hyperplasia is an increase
in the number of normal cells lining the uterus.
Although it is not cancer, it may develop into
cancer in some women. The most common symptoms
are heavy menstrual periods, bleeding between
periods, and bleeding after menopause.
What
are the risk factors for uterine cancer?
The following have been suggested as risk factors
for uterine cancer:
- age 50 or over
- history of endometrial hyperplasia
- estrogen replacement therapy (ERT)
- being overweight
- diabetes
- hypertension (high blood pressure)
- history of other cancers
- history of taking tamoxifen for breast cancer
treatment or prevention
- Caucasian women
Additional risk factors for endometrial
cancer include:
- early menarche - starting monthly periods
early - before the age of 12
- late menopause (after the age of 52)
- infertility (inability to become pregnant)
- never having children
- diet high in animal fat
- age 40 or over
- family history of endometrial cancer or
colon cancer (hereditary nonpolyposis colon
cancer (HNPCC)
- prior radiation therapy for pelvic cancer
What
are the symptoms of uterine/endometrial cancer?
The following are the most common symptoms of
uterine/endometrial cancer. However, each individual
may experience symptoms differently. Symptoms
may include:
- unusual vaginal bleeding or discharge
- post-menopausal bleeding
- difficult or painful urination
- pain during sexual intercourse
- pain and/or mass in the pelvic area
- weight loss
Cancer of the uterus often does not occur before
menopause. It usually occurs around the time
menopause begins. The occasional reappearance
of bleeding should not be considered simply part
of menopause. It should always be checked by
a physician.
The symptoms of uterine/endometrial cancer may
resemble other conditions or medical problems.
Always consult your physician for a diagnosis.
How
is uterine/endometrial cancer diagnosed?
Diagnosis includes a medical history and physical
exam, including a pelvic exam to feel the vagina,
rectum, and lower abdomen for masses or growths.
A Pap test may be requested as part of the pelvic
exam. Several additional tests may be used to
diagnose endometrial cancer, including:
- internal pelvic examination -
to feel for any lumps or changes in the shape
of the uterus
- Pap test (also called Pap smear) -
a test that involves microscopic examination
of cells collected from the cervix, used to
detect changes that may be cancer or may lead
to cancer, and to show noncancerous conditions,
such as infection or inflammation. However,
because cancer of the endometrium begins inside
the uterus, problems may not be detected using
a Pap test. Therefore, in some cases, an endometrial
biopsy will be performed.
- endometrial biopsy - a
procedure in which an endometrial tissue sample
is obtained by using a small flexible tube
that is inserted into the uterus. The tissue
sample is examined under a microscope to determine
if cancer or other abnormal cells are present.
The procedure is often performed in a physician’s
office.
- dilation and curettage (also called
D & C) - a minor operation in
which the cervix is dilated (expanded) so
that the cervical canal and uterine lining
can be scraped with a curette (spoon-shaped
instrument). The pathologist examines the
tissue for cancer cells.
- transvaginal ultrasound (also called
ultrasonography) - an ultrasound
test using a small instrument, called a transducer,
that is placed in the vagina. The physician
may perform a biopsy if the endometrium looks
too thick.
When cancer cells are found, other tests are
used to determine if the disease has spread from
the uterus to other parts of the body. These
procedures may include:
- blood tests
- chest x-rays
- computed tomography (CT or CAT) scans of
various sections of the abdomen
- an ultrasound to view organs inside the
body
- special exams of the bladder, colon, and
rectum
Treatment for uterine/endometrial cancer:
Specific treatment for uterine/endometrial cancer
will be determined by your physician(s) based
on:
- your overall health and medical history
- extent of the disease
- your tolerance for specific medications,
procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
The choice of treatment depends on the stage
of cancer - whether it is just in the uterus/endometrium,
or has spread to other parts of the body. Generally,
treatment for patients with cancer of the uterus/endometrium
includes one or more of the following:
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