Uterine Cancer

What is uterine cancer?

Uterine cancer refers to cancers of the uterus or womb. There are two types of uterine cancer:

• Endometrial cancer: This is a cancer that develops in the inner lining of the uterus, called the endometrium. It is one of the most common cancers of the female reproductive system
• Uterine sarcoma: A rare cancer that develops in the muscle wall of the uterus, known as the myometrium.

What is the uterus?

The uterus forms part of a woman's reproductive system. During pregnancy, the baby will grow in the uterus. It has a top part, called the body, which is where uterine cancerdevelops. The lower part is the cervix cancer that forms here is referred to as cervical cancer.

What isthe endometrium?

The endometrium is the inside layer of the uterus. When pregnancy occurs, the endometrium thickens as the body produces estrogen. If there is no pregnancy, the menstrual cycle causes progesterone to be produced, and the endometrium sheds its lining, causing the menstrual bleed.

Am I at risk of uterine cancer?

Most risk factors for endometrial cancer are related to the balance of the hormones estrogen and progesterone. Things such as morbid obesity, polycystic ovarian syndrome or some estrogentherapies can affect this balance. Lynch syndrome, a genetic disorder, is also a risk factor butis not related to hormones.

Other risk factors can include:

• Age: The risk of uterine cancer increases with age, with most cases occurring in women over 50
• High fat diet: A dietthat is highin fatmay increase the risk of uterine cancer, as well as other types of cancer. A high fatdiet can also lead to obesity, another risk factor for uterine cancer
• Family history: A genetic mutationfor something called hereditary nonpolyposis colorectal cancer (HNPCC) may be inherited which increases the risk of several cancers, including endometrial cancer

Other conditions that increase risk:

• Diabetes: Studies show there may be a link between diabetes and uterine cancer
• Obesity: Fatcan change some hormones to estrogen, which increases the risk of uterine cancer
• Diseases of the ovaries: Ovarian tumors can cause increased estrogen levels, increasing the risk of uterine cancer

Gynecology history

• Early menstruation: When a females ˜menstruation starts before the age of 12, it might increase uterine cancer risk due to prolonged exposure to estrogen
• Late menopause: Menopause after the age of 50 also prolongs exposure to estrogen
• No pregnancy: There is an increased risk in women who haven't had children due to increased estrogen exposure

Treatment for other conditions

• Radiation therapy to the pelvis: If radiation therapy has previously been given, to treatother types of cancer, this can damage cell DNA and increase the risk of another type of cancer
• Estrogen replacement therapy (ERT): If estrogen therapy has been given during the menopause, without receiving progesterone, it can increase the risk for uterine cancer
• Tamoxifen: A treatment for breast cancer, tamoxifen acts like estrogen so can increase uterine cancer risk

How common is uterine cancer?

Uterine cancer is the fourth most common cancer among women in the UAE, and the most common cancer that affects the female reproductive system.

Causes of uterine cancer

The exact cause of uterine cancer is not yet known, butthere a number of risk factors (listed above) that put you atan increased risk. If you think you may be at risk, talk to your doctor to find out whatyou can do to decrease your risk.

Symptoms of uterine cancer

The symptomsof uterine cancer can be s imilar to lots of other conditions, especially those thataffect the reproductive organs. If you have an unusual pain, discharge or bleeding, always talk to your doctor. A timely and accurate diagnosis is very important to ensure you get the right treatment.

Symptoms include:

• Bleeding between menstrual periods
• Spotting or bleeding afterthe menopause
• Pain in the lowerabdomen or a cramping feeling in the pelvis
• Any unusual vaginal discharge in postmenopausal women
• Very long, very heavy or frequent bleeding in women over the age of 40

Diagnosing uterine cancer

If you visit your doctor with any of the symptoms of uterine cancer, they will discuss the symptoms with you in details, and ask aboutany risk factors that you may have, including family history. They will then perform a physical exam, including an exam of your pelvic area.

Diagnostic tests for uterine cancer

There are a number of tests that your doctor may perform to confirm a diagnosis of uterine cancer. These include:

Lab tests:

• Blood test: This will look for the presence of a protein called CA-125, which can indicate cancer

Imaging tests:

• CT scan: A CT scan allows doctors to obtain pictures of the affected area
• MRI scan: Using radio waves and a strong magnet, doctors can obtain detailed images
• Transvaginal ultrasound: A smooth, rounded probe is placed inside the vagina to obtain images of the uterus

Other tests:

• Endometrial biopsy: A thin, flexible tube is inserted through the cervix, into the uterus, where a small amountof the endometrium is removed for analysis
• Hysteroscopy: A long, thin tube with a light and camera, called a hysteroscope, is inserted through the cervix to take images of the uterus
• Dilation and curettage (D&C): A more complex procedure that is done in the operating room, to remove tissue from the uterus. The tissue is then analyzed for s igns of cancer

Please note, a pap test can detect abnormal cells on the cervix only. It cannot screen for, or be used to diagnose, uterine cancer.

Diagnosing the type of uterine cancer

If endometrial cancer is diagnosed, your doctor will need to know which type it is, so they can decide on the best possible treatment.

• Type 1 endometrial cancer: Type 1 is less aggressive and doesn't usually spread to other tissues very quickly
• Type 2 endometrial cancer: Generally, type 2 is more aggressive and more likely to spread to tissue outside of the uterus. It usually requires stronger treatment

Treating uterine cancer

The exact treatment plan for uterine cancer will depend on the type of cancer you have and your overall health. Treatments mightinclude:

• Chemotherapy: The use of strong drugs that kill cancer cells
• Radiation therapy: The use of targeted radiation beams that candestroy cancer cells
• Hormone therapy: Either adding hormones or blocking them to treat the cancer
• Immunotherapy: A treatment that helps your own immune system to fight cancer
• Targeted therapy: The use ofmedication(s) that target specific cancer cells and stop them from multiplying

Surgery for uterine cancer

Most women diagnosed with endometrial cancer will need surgery. This is usually a hysterectomy,

which involves a surgeon removing the uterus and cervix. The main types of hysterectomy procedures are:

• Total abdominal hysterectomy: A surgeon makes a cut in the abdomen so thatthe uterus can be removed
• Vaginal hysterectomy: The uterus is removed through the vagina
• Radical hysterectomy: A radical hysterectomy may be needed if the cancer has spread to the cervix. This involves removing the uterus, tissues next to the uterus, and the top of the vagina, next to the cervix

At the same time as a hysterectomy, a surgeon may also perform two other procedures:

• Bilateral salpingo-oophorectomy (BSO): This procedure removes the ovaries and fallopian tubes, to ensure all the cancer is removed. Removing the ovaries is usually necessary but it means you will go through the menopause (if this hasn't happened already). If you are under the age of 45, your doctor may discuss keeping your ovaries
• Lymph node dissection: A surgeon will remove the lymph nodes to see if the cancer has spread to them

The side effects of surgery for uterine cancer might include infertility and the menopause, along with the symptoms associated with it.

Treatment for uterine sarcoma

Usually, a single procedure is used to diagnose, stage, and treat uterine sarcoma at the same time.

Treatment options are similar to those for endometrial cancer, with most women having a hysterectomy and a BSO (see above).

After treatment for uterine cancer

After any type of treatment for uterine cancer, your doctor will schedule follow-ups. These are important appointments, where your doctor will perform a pelvic exam and ask you about any possible symptoms, to make sure the cancer hasn't returned.

Is uterine cancer preventable?

Uterine cancer can't be prevented but there are things you can do to reduce your risk. These include maintaining a healthy weight and controlling diabetes properly. Oral contraceptives might also offer protection against uterine cancer.

There is no screening test for uterine cancer, but if you think you are at high risk, talk to your doctor about regular checks.

Is uterine cancer curable?

Endometrial cancer is usually diagnosed at an early stage, as women notice the symptoms such as unusual bleeding. If diagnosed early, and the cancer hasn't spread to other organs, it can be cured by removing the uterus.

If you notice anything unusual, such as bleeding or spotting, always talk to your doctor.