Uterus cancer is the most common cancer occurring in a woman's reproductive system. Uterine cancer begins when healthy cells in the uterus change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor can grow but generally will not spread into other tissues.
Cancer of the uterus begins from abnormal cells in the lining of the uterus (endometrium), the muscle tissue (myometrium), or the connective tissue supporting the endometrium (stroma).
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about uterus cancer.
There are a few symptoms that may point to uterus cancer are as follows:
Unusual vaginal bleeding, spotting, or other discharge: About 90% of women with uterus cancer have abnormal vaginal bleeding. This might be a change in their periods, bleeding between periods, or bleeding after menopause. Non-cancer problems can also cause abnormal bleeding. But it's important to have a doctor check out any irregular bleeding right away. Non-bloody vaginal discharge may also be a sign of uterus cancer. Even if you can't see blood in the discharge, it doesn't mean there's no cancer.
Pelvic pain, a mass, and weight loss: Pain in the pelvis, feeling a mass (tumor), and losing weight without trying can also be symptoms of uterus cancer. These symptoms are more common in later stages of the disease.
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A risk factor is anything that raises your chance of getting a disease such as cancer. Different cancers have different risk factors. Many factors affect the risk of developing uterus cancer, including:
Obesity: Obesity is a strong risk factor for uterus cancer and linked to hormone changes. A woman's ovaries produce most of her estrogen before menopause. But fat tissue can change some other hormones (called androgens) into estrogens. This can impact estrogen levels, especially after menopause. Having more fat tissue can increase a woman's estrogen levels, which increases uterus cancer risk.
Use of an intrauterine device (IUD):
Age: The risk of endometrial cancer increases as a woman gets older.
Diet and exercise: A high-fat diet can increase the risk of many cancers, including uterus cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity, which is a well-known uterus cancer risk factor.
Type 2 diabetes: Uterus cancer may be about twice as common in women with type 2 diabetes. But diabetes is more common in people who are overweight and less active, which are also risk factors for uterus cancer.
Family history (having close relatives with endometrial or colorectal cancer): Endometrial cancer tends to run in some families. Some of these families also have a higher risk for colon cancer. This disorder is called hereditary nonpolyposis colon cancer (HNPCC).
Having had breast or ovarian cancer in the past: Women who have had breast cancer or ovarian cancer may have an increased risk of uterus cancer, too. Some of the dietary, hormone, and reproductive risk factors for breast and ovarian cancer also increase uterus cancer risk.
Having had endometrial hyperplasia in the past: Endometrial hyperplasia is an increased growth of the endometrium. Mild or simple hyperplasia, the most common type, has a very small risk of becoming cancer. It may go away on its own or after treatment with hormone therapy.
Treatment with radiation therapy to the pelvis to treat another cancer: Radiation used to treat some other cancers can damage the DNA of cells, sometimes increasing the risk of a second type of cancer such as uterus cancer.
Different types of uterus cancer include:
Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid cancer)
There are many variants or sub-types of endometrioid cancers including: Adenocarcinoma, (with squamous differentiation), Adenoacanthoma, Adenosquamous (or mixed cell), Secretory carcinoma, Ciliated carcinoma, Villoglandular adenocarcinoma
Uterine carcinosarcoma or CS
Other types of cancer in the uterus:
Uterine sarcomas start in the muscle layer (myometrium) or supporting connective tissue of the uterus. These include uterine leiomyosarcomas and endometrial stromal sarcomas.
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Early detection (also called screening) refers to the use of tests to find a disease, like cancer, in people who don't have symptoms of that disease. Early detection tests can help find some types of cancer at an early stage -- when it's small and hasn't spread beyond the place it started.
Medical history and physical exam: If you have any of the symptoms of uterus cancer, you should see a doctor right away. The doctor will ask about your symptoms, risk factors, and medical history. The doctor will also do a physical exam and a pelvic exam.
Ultrasound: Ultrasound is often one of the first tests used to look at the uterus, ovaries, and fallopian tubes in women with possible gynecologic problems. Ultrasound uses sound waves to take pictures of the inside of the body.
Endometrial tissue sampling: To find out exactly what kind of change is present, the doctor must take out some tissue so that it can be tested and looked at with a microscope. Endometrial tissue can be removed by endometrial biopsy or by dilation and curettage (D&C) with or without a hysteroscopy.
Blood tests: Complete blood count: The complete blood count (CBC) is a test that measures different cells in the blood, such as the red blood cells, the white blood cells, and the platelets. Uterus cancer can cause bleeding, which can lead to low red blood cell counts (anemia).
CA-125 blood test: If a woman has uterus cancer, a very high blood CA-125 level suggests that the cancer has likely spread beyond the uterus.
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful the treatment might be.
The system used for staging uterus cancer is TNM staging system which includes:
The extent (size) of the tumor (T): How far has the cancer grown into the uterus? Has the cancer reached nearby structures or organs?
The spread to nearby lymph nodes (N): Has the cancer spread to the para-aortic lymph nodes? These are the lymph nodes in the pelvis or around the aorta (the main artery that runs from the heart down the back of the abdomen and pelvis).
The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs in other parts of the body?
Over many years, CAN-C has excelled in the delivery of top-quality uterus cancer treatment in Bangalore.
There's no sure way to prevent uterus cancer. But there are things you can do that may help lower your risk of developing this disease:
Get to and stay at a healthy weight: Women who are overweight or obese are more likely to get uterus cancer compared with women at a healthy weight. Getting to and staying at a healthy weight is one way to lower the risk of this cancer.
Be physically active: Higher levels of physical activity to lower risks of uterus cancer, so getting regular physical activity (exercise) may also be a way to help lower uterus cancer risk. An active lifestyle can help you stay at a healthy weight, as well as lower the risk of cancer.
Discuss pros and cons of hormone therapy with your doctor: Estrogen to treat the symptoms of menopause is available in many different forms like pills, skin patches, shots, creams, and vaginal rings. If you're thinking about using estrogen for menopausal symptoms, ask your doctor about how it will affect your risk of uterus cancer.
Get treated for endometrial problems: Getting proper treatment of pre-cancer disorders of the endometrium is another way to lower the risk of uterus cancer which most develop over a period of years.
If you've been diagnosed with uterus cancer, it's important to weigh the benefits of each treatment option against the possible risks and side effects. Here, we at CAN-C in Bangalore, provide best uterus treatment and care for all stages. The most common types of treatment for women with uterus cancer are:
Surgery is often the main treatment for uterus cancer and consists of a hysterectomy, often along with a salpingo-oophorectomy, and removal of lymph nodes. In some cases, pelvic washings are done, the omentum is removed, and/or peritoneal biopsies are done. If the cancer has spread throughout the pelvis and abdomen (belly), a debulking procedure (removing as much cancer as possible) may be done. These are discussed in detail below.
1. Hysterectomy: The main treatment for uterus cancer is surgery to take out the uterus and cervix. This operation is called a hysterectomy. When the uterus is removed through an incision (cut) in the abdomen (belly), it's called a simple or total abdominal hysterectomy.
If the uterus is removed through the vagina, it's known as a vaginal hysterectomy. This may be an option for women who are not healthy enough for other types of surgery.
2. Bilateral salpingo-oophorectomy: This operation removes both fallopian tubes and both ovaries. It's usually done at the same time the uterus is removed (either by simple hysterectomy or radical hysterectomy).
3. Lymph node surgery: Pelvic and para-aortic lymph node dissection is an operation done to remove lymph nodes from the pelvis and the area next to the aorta. The nodes are tested to see if they contain cancer cells that have spread.
When only a few of the lymph nodes in an area are removed, it's called lymph node sampling.
Sentinel lymph node mapping: Sentinel lymph node (SLN) mapping may be used in early-stage uterus cancer if imaging tests don't clearly show signs that cancer has spread to the lymph nodes in your pelvis.
4. Pelvic washings (peritoneal lavage): In this procedure, the surgeon "washes" the abdominal and pelvic cavities with salt water (saline). The fluid is then collected (using suction) and sent to the lab to see if it contains cancer cells. This is also called peritoneal lavage. If there are endometrial cancer cells in the fluid, the cancer stage may change (the surgical stage) and the next steps of treatment could be impacted.
5. Tumor debulking: If cancer has spread throughout the abdomen, the surgeon might try to take out as much of the tumor as possible. This is called debulking. Debulking a cancer can help other treatments, like radiation or chemotherapy, work better. So, it might be helpful in treating some types of uterus cancer.
In Bangalore, we provide the highest level treatment for patients with uterus cancer and ensure safety, well-being and recovery.
Radiation therapy uses high-energy radiation (like x-rays) to kill cancer cells. It can be given in 2 ways to treat uterus cancer:
1. Brachytherapy: In this, radioactive materials are put inside the body. This is called internal radiation therapy. Women who have had their uterus (and cervix) removed may have the upper part of the vagina treated with brachytherapy. This is called vaginal brachytherapy. A source of radiation (a radioactive material) is put into a cylinder (called an applicator) and the cylinder is put into the vagina. The size of the cylinder and how much radiation is in it depend on each case. The upper part of the vagina, closest to the uterus, is always treated. With brachytherapy, the radiation mainly affects the area of the vagina in contact with the cylinder. Nearby structures like the bladder and rectum get less radiation exposure. There are 2 types of brachytherapy used for uterus cancer, low-dose rate (LDR) and high-dose rate (HDR).
2. External beam radiation therapy: In this type of treatment the radiation is delivered from a source outside of the body (a machine is used that focuses beams of radiation at the tumor, much like having an x-ray). The skin covering the treatment area is carefully marked with permanent ink or tiny tattoos. A special mold of the pelvis and lower back is custom made to make sure you are in the exact same position for each treatment.
In some cases, both brachytherapy and external beam radiation therapy are used. When that's done, the external beam radiation is usually given first, followed by the brachytherapy. The stage and grade of the cancer are used to help decide what areas need to be treated with radiation therapy and which types of radiation are used.
Radiation is most often used after surgery to treat endometrial cancer. It can kill any cancer cells that may still be in the treated area. If your treatment plan includes radiation after surgery, you will be given time to heal before starting radiation. Less often, radiation might be given before surgery to help shrink a tumor so it's easier to remove. Women who are not healthy enough for surgery may get radiation as their main treatment. Sometimes chemotherapy is given along with the radiation to help it work better. This is called chemoradiation.
Chemotherapy (chemo) is the use of drugs that kill cancer cells. They're given into a vein or taken by mouth as pills. These drugs go into the bloodstream and reach throughout the body. Because of this, chemo is often part of the treatment when uterus cancer has spread beyond to other parts of the body and surgery can't be done.
Chemo is also commonly used for high grade cancers, which grow and spread quickly, and cancer that comes back after treatment. In most cases, a combination of chemo drugs is used. Combination chemotherapy tends to work better than one drug alone.
Chemo drugs used to treat uterus cancer may include: Paclitaxel (Taxol®), Carboplatin, Doxorubicin (Adriamycin®) or liposomal doxorubicin (Doxil®), Cisplatin, Docetaxel (Taxotere®)
Most often, 2 or more drugs are combined for treatment. The most common combinations include carboplatin/paclitaxel and cisplatin/doxorubicin. Less often, carboplatin/docetaxel and cisplatin/paclitaxel/doxorubicin may be used.
For carcinosarcoma, the chemo drug ifosfamide (Ifex®) is often used, either alone or along with either cisplatin or paclitaxel. The targeted drug called trastuzumab (Herceptin®) might be added for carcinosarcomas that are HER2 positive.
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Targeted therapy is treatment with drugs that are made to target certain changes in the cancer cells. Targeted therapy drugs work differently from standard chemotherapy (chemo) drugs. Targeted therapy is used to treat many types of cancer, but it's still fairly new in the treatment of uterus cancer. Only a few of these drugs are in use at this time. These drugs are mostly used to treat high-risk uterus cancers and those that have spread (metastasized) or come back (recurred) after treatment.
1. Lenvatinib: Lenvatinib (Lenvima) is a type of drug known as a kinase inhibitor. It helps block tumors from forming new blood vessels, as well as targeting some of the proteins in cancer cells that normally help them grow.
2. Bevacizumab: Bevacizumab (Avastin) belongs to a class of drugs called angiogenesis inhibitors. For cancers to grow and spread, they need to make new blood vessels to nourish themselves (a process called angiogenesis). This drug attaches to a protein called VEGF (which signals new blood vessels to form) and slows or stops cancer growth.
3. mTOR inhibitors: These drugs block a cell protein known as mTOR, which normally helps cells grow and divide into new cells. These drugs might be given alone or added to chemo or hormone therapy to treat advanced (higher stage) uterus cancers, or those that come back after treatment.
This type of treatment uses hormones or hormone-blocking drugs to treat cancer. It's not the same as the hormone therapy given to ease the symptoms of menopause (menopausal hormone therapy). It's most often used to treat endometrial cancer that's advanced or has come back after treatment (recurred). Hormone therapy is often used along with chemotherapy.
Hormone treatment for uterus cancer can include:
1. Progestins (This is the main hormone treatment used.): The main hormone treatment for uterus cancer uses progesterone or drugs like it (called progestins). The 2 most commonly used progestins are: Medroxyprogesterone acetate (Provera®), which can be given as an injection or as a pill, and Megestrol acetate (Megace®), which is given as a pill or liquid. These drugs slow the growth of uterus cancer cells.
2. Tamoxifen: It is be used to treat advanced or recurrent uterus cancer. Alternating progesterone and tamoxifen are an option that seems to work well and be better tolerated than progesterone alone. The goal of tamoxifen therapy is to keep any estrogens in the woman's body from boosting the growth of the cancer cells.
3. Luteinizing hormone-releasing hormone agonists (LHRH agonists): Most women with uterus cancer have had their ovaries removed as a part of treatment. Some women might have had radiation treatments that made their ovaries inactive. This helps keep the body from making estrogen and may also slow the growth of the cancer. These are drugs that lower estrogen levels in women who still have working ovaries. These drugs "turn off" the ovaries in women who are premenopausal so they don't make estrogen.
Goserelin (Zoladex®) and leuprolide (Lupron®) are drugs that might be used to treat uterus cancer. These drugs are also called gonadotropin-releasing hormone (GNRH) agonists.
4. Aromatase inhibitors (AIs): Even after the ovaries are removed (or are not working), estrogen is still made in fat tissue. This becomes the body's main source of estrogen. Drugs called aromatase inhibitors can stop this estrogen from being made and lower estrogen levels even further. Examples of aromatase inhibitors include letrozole (Femara®), anastrozole (Arimidex®), and exemestane (Aromasin®). They're most often used to treat women who cannot have surgery, but doctors are looking at other ways these drugs could be helpful.
Immunotherapy is treatment with drugs that help a person's own immune system better recognize and kill cancer cells. Immunotherapy can be used to treat certain types of uterus cancer that has spread or come back (recurred). Immune checkpoint inhibitors: An important part of the immune system is its ability to keep itself from attacking the body's normal cells. To do this, it uses "checkpoints" - molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But newer drugs that target these checkpoints hold a lot of promise as cancer treatments.
Pembrolizumab (Keytruda) targets PD-1, a protein on immune system cells called T cells. PD-1 normally helps keep T-cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against cancer cells. This can shrink some tumors or slow their growth.
Pembrolizumab can be used by itself in women with uterus cancers that are MMR deficient (dMMR) or MSI high (MSI-H). Both of these are linked to high numbers of gene mutations (changes) in the cancer cells. Tumors can be tested for these uncommon changes.
Pembrolizumab can also be used along with the targeted drug lenvatinib (Lenvima) in women with advanced uterus cancers that are not MMR deficient (dMMR) or MSI high (MSI-H), typically after at least one other drug treatment has been tried. This immunotherapy drug is given as an intravenous (IV) infusion.
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