A malignancy anywhere in the uterus or its lining is referred to as uterine cancer. However, the major forms are distinguished from each other by their site of origin and types of malignant cells. Cancer arising in the endometrium, the lining of the uterus, is now the most common gynecologic cancer in the United States, with about 33,000 new cases and 6,000 deaths a year. (In the early 1900s, cervical cancer was the most prevalent form of cancer of the reproductive organs, but widespread use of the pap smear to detect precancerous changes has greatly diminished this malignancy.) Most endometrial cancers are classified as adenocarcinomas, malignancies derived from glandular tissue. Many of these cancers are heralded by an overgrowth of endometrial tissue, a condition called hyperplasia . Much less common are uterine sarcomas, cancers made up of a type of connective tissue. Typically, endometrial and other forms of uterine cancer develop following menopause; more than 75 percent of patients are over age 50 compared to 4 percent who are 40 or younger. The cause is unknown, but estrogen is thought to be an important factor, as it stimulates growth of the endometrium. Before menopause, the levels of estrogen, progesterone, and other hormones fluctuate during the menstrual cycle, resulting in shedding of the endometrium during menstruation. But if it is exposed only to estrogen, the endometrium grows unchecked. The resulting hyperplasia is believed to set the stage for cancer. Studies conducted in the 1960s and 1970s found that postmenopausal women who took estrogen replacement alone had a greatly increased incidence of endometrial cancer, as did women who had entered menopause late, those who had never had a baby, and those with polycystic ovaries and hormonal disorders resulting in high estrogen production. Obesity is another major risk factor; women who are 50 or more pounds overweight have a nine fold increase in uterine cancer, compared to women of normal weight. Here, too, estrogen is important, as it can be produced in fat tissue, even after menopause. Genetics also may playa role, because uterine cancer tends to run in families. Early uterine cancer does not usually produce symptoms, but as the tumor grows, it may cause bleeding. Women with unexplained vaginal bleeding after menopause should be examined for possible endometrial or cervical cancer.
Diagnostic Studies And Procedures
An abnormal pap smear indicates the possibility of cancer, but it is more helpful in detecting cervical than endometrial cancers. A physician may use a long, slender cannula to collect cells from inside the uterus, but a definitive diagnosis usually requires a biopsy of tissue removed during a D&C (dilation and curettage). When cancer is diagnosed, blood tests, scans, and other tests will be ordered to determine whether it has spread to other organs.
Early uterine cancer has a very high cure rate. A radical hysterectomy, which entails removal of the uterus, fallopian tubes, and ovaries, is the standard procedure for uterine cancer. Also, a sampling of pelvic lymph node5 are tested for cancerous cells. In all but very early, localized uterine cancer, a postoperative series of radiation treatments is recommended. External beam radiation is generally used, but in some instances, radioactive seeds may be implanted in the pelvic cavity temporarily. Chemotherapy may be added to the regimen as well, especially if the cancer has spread. Progesterone is also used sometimes, particularly in cases of recurrent cancer.
No alternative therapies can cure uterine cancer, but techniques such as meditation and self hypnosis may help ease the pain of advanced cancer.
It takes four to six weeks to recover from a hysterectomy, although some women have reported that it took six months or longer to regain their former energy. Some feel depressed, especially if their surgery has abruptly brought on symptoms of menopause. If the cancer precludes hormone replacement therapy, a patient must find other means of controlling these symptoms . Following a hysterectomy, some women experience reduced interest and pleasure in sexual activity. In the past, doctors rejected the notion that sexual function was affected, but a number of studies confirm that it can have a detrimental effect, especially for women who previously experienced deep, or internal, orgasms. Also, a hysterectomy that shortens the vagina may make intercourse uncomfortable, a problem that is compounded by vaginal dryness due to a lack of estrogen. Experimenting with different positions during lovemaking and using a water based vaginal lubricant are usually helpful. Androgens can help restore libido, but they can also produce side effects, such as growth of facial hair, deepening of the voice, and acne. To reduce these adverse results, European and Canadian doctors some times implant a pellet that releases small amounts of testosterone under the skin in the hip area, but this treatment is not used in the United States.
Other Causes of Uterine Symptoms
Abnormal vaginal bleeding may be due to fibroids and other benign uterine growths, infection, and trauma.