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Uterine (Endometrial) Cancer Treatment in India

Uterine Cancer

The pear-shaped uterus is hollow and located in the pelvis of a woman between the bladder and rectum. The uterus is also known as the womb, where a baby grows when a woman is pregnant. It has three sections: the narrow, lower section called the cervix, the broad section in the middle called the isthmus, and the dome-shaped top section called the fundus.

Endometrial cancer is the growth of abnormal cells in the lining of the uterus . The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.Endometrial cancer usually occurs in women older than 50

There are two major types of uterine cancer:

Adenocarcinoma. This makes up more than 80% of uterine cancers. It develops from cells in the lining of the uterus called the endometrium. This cancer is also commonly called endometrial cancer. A common type of endometrial adenocarcinoma is called endometrioid carcinoma, and treatment varies depending on the grade of the tumor, how far it goes into the uterus, and the stage or extent of disease. A less common type is called endometrial serous carcinoma, and this form is treated in a fashion similar to ovarian cancer which is also commonly of the serous type.

Sarcoma. This type of uterine cancer develops in the supporting tissues of the uterine glands or in the myometrium, which is the uterine muscle. Sarcoma accounts for about 2% to 4% of uterine cancers. Sarcomas are treated differently than adenocarcinomas in most situations.  Types of endometrial cancers with some elements of sarcoma include leiomyosarcoma, endometrial stromal sarcoma or carcinosarcoma.

Symptoms of Uterine Cancer

The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding during or after menopause is often a sign of a problem.

  • Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, menorrhagia, or abnormal uterine bleeding (AUB).
  • Difficulty or pain when urinating
  • Pain during sexual intercourse
  • Pain in the pelvic area

Causes of Uterine Cancer

  • Being obese. Fat cells make extra estrogen, but the body doesn’t make extra progesterone to balance it out.
  • Taking estrogen without taking a progestin.
  • Taking tamoxifen. Tamoxifen reduces your risk for breast cancer but can increase your risk for endometrial cancer.
  • Polycystic ovary syndrome. This can cause you to produce too much estrogen and not enough progesterone.
  • Having naturally high levels of estrogen. This can cause women to start their periods before age 12 and delaymenopause until after they are 52.

Other things that increase your risk include:

Stages of Uterine Cancer

Stage 0: The tumor is called carcinoma in situ, which means it is very early stage cancer. It is found only in one layer of cells and has not spread (Tis, N0, M0).

Stage I: The cancer is found only in the uterus or womb, and it has not spread to other parts of the body (T1, N0, M0).

Stage IA: The cancer is found only in the endometrium or less than one-half of the myometrium (T1a, N0, M0).

Stage IB: The tumor has spread to one-half or more of the myometrium (T1b, N0, M0).

Stage II: The tumor has spread from the uterus to the cervical stroma but not to other parts of the body (T2, N0, M0).

Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area (T3, N0, M0).

Stage IIIA: The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body (T3a, N0, M0).

Stage IIIB: The tumor has spread to the vagina or next to the uterus (T3b, N0, M0).

Stage IIIC1: The cancer has spread to the regional pelvic lymph nodes (T1 to T3, N1, M0).

Stage IIIC2: The cancer has spread to the para-aortic lymph nodes with or without spread to the regional pelvic lymph nodes (T1 to T3, N2, M0).

Stage IVA: The cancer has spread to the mucosa of the rectum or bladder (T4, any N, M0).

Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs (any T, any N, M1).

Diagnosis of Uterine Cancer

An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) to be looked at under a microscope.

Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily done to evaluate for cervical cancer.  However, sometimes a Pap test may occasionally find abnormal glandular cells, which are caused by uterine cancer

Other tests may include:

Treatment of Uterine Cancer

reatments include:

Surgery to remove the uterus (and cervix), ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy). Common surgical procedures for uterine cancer include:

Hysterectomy. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, the upper part of the vagina, and nearby tissues)

Lymph node dissection. At the same time as a hysterectomy, the surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus.

Sentinel lymph node biopsy. Sometimes a sentinel lymph node biopsy is performed. A sentinel lymph node biopsy is a procedure that helps the doctor find out whether cancer has spread to the lymph nodes

  • Radiation therapy to kill cancer cells.
  • Progestin hormone therapy to block cancer growth.
  • Chemotherapy to kill cancer cells.
  • Hormone therapy: Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them. These tumors are generally adenocarcinomas and are grade 1 or 2 tumors.  Hormone therapy for uterine cancer often involves the sex hormone progesterone, given in a pill form