Uterine cancer, also known as endometrial cancer, affects the lining of the uterus. The uterus is a hollow organ located in the pelvis of a woman's body, where a fetus grows during pregnancy. The lining of the uterus called the endometrium, is where uterine cancer usually develops. Uterine cancer is one of the most common gynecologic cancers in women, and it mainly affects women after menopause. However, it can occur in women of any age.

Associated Anatomy

Uterus

Causes

The exact cause of uterine cancer is not known yet, but there are certain factors that are thought to contribute to its development:

• Postmenopause or menopause (after age 55)
• A thickened wall (endometrial hyperplasia)
• Early period (before age 12)
• High blood pressure or diabetes
• Obesity
• Ovarian, uterine, or bowel cancer in the family
• A genetic disorder like Cowden or Lynch syndrome
• Prior ovarian cancer or polycystic ovary syndrome
• Using oestrogen hormone replacement therapy or fertility treatment
• Prior pelvic radiation treatment
• Using tamoxifen to treat breast cancer, the benefits typically exceed the risks

Symptom

Common symptoms of Uterine Cancer are as follows-

• Abnormal vaginal bleeding or discharge occurs in 90% of uterine cancer patients.
• Vaginal discharge ranges from pink and runny to heavy, brown, and foul-smelling.
• Difficult or painful urination.
• An enlarged uterus is seen during a pelvic exam.
• Intercourse pain
• Sudden weight loss
• Weakness, back pain, or leg pain when cancer has spread to other organs.

Possible Treatment

• Hysterectomy Surgeons may perform hysterectomy depending on cancer's extent. Menopausal patients often get a bilateral salpingo-oophorectomy, which removes both fallopian tubes and ovaries.
• Lymph node removal The surgeon may remove nearby lymph nodes during a hysterectomy to check for cancer spread beyond the uterus. A sentinel lymph node biopsy involves injecting dye into the uterus and extracting the dye-accumulating lymph nodes.
• Chemotherapy Chemotherapy uses medications to kill cancer cells by preventing them from growing and dividing—chemotherapy is given following surgery for endometrial cancer. Following initial treatment, consider chemotherapy if endometrial cancer recurs.
• Hormone therapyHormone treatment decreases uterine cancer cell growth. These are adenocarcinomas of grade 1 or 2.
• Targeted therapy Targeted therapy targets cancer genes and proteins and promotes its growth. This medication reduces cancer cell growth and spreads while protecting healthy cells.
• ImmunotherapyBoost immunity to combat cancer. It uses naturally derived materials to boost, target, or restore immune system function.

Risk Factors

The risk factors of Uterine Cancer are as follows-

• Changes in the body's female hormone balance The ovaries produce oestrogen and progesterone—the endometrium changes due to fluctuations in hormone balance. A sickness or condition that raises oestrogen levels but not progesterone may increase the risk of uterine cancer. Taking only oestrogen postmenopausal hormones increases uterine cancer risk. A rare ovarian tumour that produces oestrogen may increase uterine cancer risk.
• More menstruation years Menstruating before the age of 12 or delaying menopause raises the risk of uterine cancer and exposes the endometrium to oestrogen more often than the number of periods had.
• Infertility Not getting pregnant increases the chance of uterine cancer.
• AgeUterine cancer risk rises with age. It usually develops after menopause.
• Obesity Obesity raises uterine cancer risk. It may arise when extra body fat impairs hormone balance.
• Breast Cancer Hormonal TherapyTamoxifen, a hormone medication for breast cancer, increases the risk of uterine cancer. Tamoxifen's advantages typically exceed the risks of uterine cancer.
• Inherited colon cancer syndromeLynch syndrome increases the risk of colon, uterine, and other cancers. A gene mutation passed down from parents causes Lynch syndrome.

Stage

Uterine cancer is typically staged on the basis of the size of the tumour, its invasion into nearby tissues, and whether it has spread to other parts of the body. The stages of uterine cancer are-

• Stage 0: Cancer is only present in the inner lining of the uterus, also known as carcinoma in situ.
• Stage I: Cancer is limited to the uterus, with no spread to nearby lymph nodes or other organs. This stage is further divided into:

  Stage IA: Cancer is limited to the endometrium or inner lining of the uterus.

  Stage IB: Cancer has invaded the inner half of the muscle layer of the uterus.

• Stage II: Cancer has spread into the cervix but not to nearby lymph nodes or other organs.
• Stage III: Cancer has spread to nearby structures apart from the uterus and cervix, such as the ovaries, fallopian tubes, vagina, or lymph nodes in the pelvis. This stage is further divided into:

  Stage IIIA: Cancer has spread to the ovaries or fallopian tubes.

  Stage IIIB: Cancer has spread to the vagina.

  Stage IIIC: Cancer has spread to lymph nodes in the pelvis.

• Stage IV: Cancer has spread to other body parts apart from the pelvis, such as the bladder, rectum, or lungs.

Typical Test

An endometrial biopsy is one of the most common tests used to diagnose uterine cancer. It is considered to be very accurate for postmenopausal women. The test can be easily done in the doctor's chamber. It is done through a thin, flexible tube, which is inserted into the uterus through the cervix. Later, suction is used to remove a small amount of endometrium through the tube.

Primary prevention

• Ask your doctor about the risks of hormone replacement treatment. Replacement of oestrogen may increase uterine cancer risk. Combining oestrogen and progesterone reduces this risk. Hormone treatment has other risks, so discuss them with your doctor.
• Take birth control pills. One year of oral contraception may lower endometrial cancer risk; the risk decreases for years after stopping oral contraceptives.
• Maintain a healthy weight. Increase your exercise and reduce your calorie consumption to lose weight.

Secondary prevention

• Using progestin Secreting intrauterine devices (IUDs) prevents pregnancy.
• Preventing uterine cancer with HRT Particularly oestrogen replacement treatment. HRT with oestrogen and progesterone may help reduce risk.
• Diabetes management Diabetes patients may reduce their risk by frequently checking their blood glucose levels.
• Monitoring Vaginal bleeding You may reduce your risk factors by monitoring any irregular vaginal bleeding.

Expected Prognosis

Uterine cancer patients have an 80% 5-year survival rate. Black women had 5-year survival rates of 84% and 63%, respectively. Endometrial cancer in black women is more aggressive and has a lower survival rate.

Natural Progression

If untreated, within ten years, 8–30% of atypical endometrial hyperplasia and 1–3% of non-typical hyperplasias evolve into cancer. The patient has early signs like abnormal vaginal bleeding, abnormal menstrual cycles, metrorrhagia in premenopausal women, and postmenopausal vaginal bleeding.

Pathophysiology

The pathophysiology of uterine cancer involves several stages:

• Hyperplasia: Hyperplasia is the overgrowth of cells in the endometrium due to increased exposure to estrogen. If left untreated, hyperplasia can progress to atypical hyperplasia, which is a precursor to cancer.
• Invasion: Cancer cells begin to invade the underlying tissue and spread to nearby structures such as the cervix, vagina, and fallopian tubes.
• Metastasis: Cancer cells may spread to other parts of the body through the bloodstream or lymphatic system, leading to the development of secondary tumours.

Possible Complication

The only complication of uterine cancer symptoms is anaemia (low red blood cell count). Fatigue, weakness, and pale skin with a yellow tinge are symptoms of anaemia. Anaemia induced by blood loss causes an iron deficiency in the body.

It's easily curable with a vitamin-rich diet and iron supplements, as well as treating endometrial cancer to stop the bleeding. Consult your oncologist before using supplements.

If you have symptoms of uterine cancer, such as abnormal vaginal bleeding, pelvic pain, or unusual discharge, don't wait. Contact your healthcare provider today to schedule an appointment for an evaluation.