Treatment of Uterine Cancer

Treatment of Uterine Cancer

Uterine cancer is the fourth most common cancer in women, affecting approximately 2–3% of women. It primarily occurs in older women, especially around the age of 70, though it can appear earlier, even before the age of 50. Most cases of uterine cancer are diagnosed after menopause, though some cases occur earlier.

Causes and Risk Factors for Uterine Cancer

1. Age:
   While most cases occur around the age of 70, 25% of cases are diagnosed in younger women.
2. Diet:
   Diets high in animal fats increase the risk.
3. Obesity:
   Excess weight leads to higher estrogen production, which increases the risk of uterine cancer.
4. Estrogen Therapy:
   Using estrogen therapy for menopause symptoms or contraception without balancing it with progesterone increases the risk.
5. Late Menopause:
   Menopause after age 55 increases estrogen exposure over time, raising the risk.
6. Nulliparity (No Pregnancy):
   During pregnancy and breastfeeding, estrogen exposure is reduced. Women who have never given birth are at higher risk due to prolonged estrogen exposure.
7. Polycystic Ovary Syndrome (PCOS):
   This condition causes increased estrogen levels, heightening the risk.
8. Diabetes and High Blood Pressure:
   Both are linked to a greater likelihood of uterine cancer.
9. Lynch Syndrome:
   This genetic condition predisposes individuals to several cancers, including uterine and colon cancer.
10. Tamoxifen:
    This breast cancer medication may slightly increase the risk of uterine cancer with long-term use.
11. Family History:
    Having close relatives with uterine cancer increases the likelihood of developing the disease.

Prolonged exposure to estrogen often leads to endometrial hyperplasia (thickening of the uterine lining), which can progress to uterine cancer.

Symptoms of Uterine Cancer

Uterine cancer may be asymptomatic or present with symptoms. The most common symptom is abnormal vaginal bleeding.

1. Before Menopause:
   • Abnormal bleeding between periods.
   • Excessive bleeding during menstruation.
2. After Menopause:
   • Any vaginal bleeding is considered abnormal and a potential symptom.

The intensity of bleeding can vary from light spotting to heavy bleeding. Vaginal bleeding is a significant concern, but only 5–10% of such cases are due to uterine cancer.

Other less common symptoms include:

• Pelvic or Abdominal Pain: Can range from mild to severe and may resemble cramping.
• Urinary Symptoms: Frequent urination or difficulty emptying the bladder if the cancer presses on nearby organs.
• Uterine Enlargement: Detected in advanced stages, often during a physical exam.

Diagnosing Uterine Cancer

1. Medical and Family History:
   Assessment of symptoms and risk factors.
2. Physical Examination:
   • Palpation of the uterus to detect enlargement.
   • Vaginal examination to locate the bleeding source or detect infections.
   • Rectal examination to check for tumor spread to the rectum.
3. Key Diagnostic Tests:
   • Blood Tests:
     • Complete Blood Count (CBC) to identify anemia caused by chronic bleeding.
     • Tumor markers like CA-125, which may be elevated in uterine cancer.
     • Liver enzyme tests to assess spread to the liver.
     • Glucose tests to detect diabetes (a risk factor).
   • Endometrial Biopsy:
     A simple procedure in which a small sample of the uterine lining is taken for microscopic examination.
   • Dilation and Curettage (D&C):
     Performed under local or general anesthesia, this involves scraping the uterine lining to obtain a more comprehensive sample if biopsy results are inconclusive.
   • Imaging Tests:
     • Chest X-ray (CXR): Checks for lung metastasis.
     • Hysteroscopy: Visualizes the uterine cavity using a camera. A biopsy can also be performed during the procedure.
     • Ultrasound: Used to monitor high-risk patients or evaluate uterine abnormalities.
       • Transabdominal or transvaginal ultrasound can be performed.
     • CT Scan: Assesses tumor size, lymph node involvement, and metastasis.
     • MRI: Similar to a CT scan but less commonly used.

Management of Uterine Cancer

Treatment plans depend on the cancer stage, patient health, and other factors. Common approaches include:

1. Surgery:
   • Hysterectomy (removal of the uterus) with or without removal of surrounding tissues and lymph nodes.
2. Radiation Therapy:
   Used for localized control or as an adjunct to surgery.
3. Hormone Therapy:
   Effective in hormone-sensitive cancers, especially in patients unable to undergo surgery.
4. Chemotherapy:
   Used for advanced or recurrent cancer.
5. Targeted Therapy and Immunotherapy:
   Newer treatments for specific genetic profiles of cancer.