Uterine cancer

There are basically two types of cancer originating from the uterus. The first of these is uterine (endometrial) cancer, and the other is uterine sarcomas. In this article, I will basically give information about the much more common uterine endometrial cancer.

Uterine

The uterus is a part of the female reproductive system. It is the organ in which the fetus attaches and grows throughout pregnancy. The size and shape of a normal uterus is about the size of a pear and contains the uterine cavity. Other elements of the female reproductive system are the ovaries, fallopian tubes, cervix, and vagina. There is one fallopian tube and ovary on each side of the uterus. The fallopian tubes are connected to the uterus at the upper level of the uterus. The lower level of the uterus, where it joins the javina, is called the cervix. Although the cervix is ​​a part of the uterus, cervical cancer is diagnosed and treated differently from uterine cancer.

To understand uterine cancer, it is necessary to understand the structure of the uterus.

• The layer that covers the cavity inside the uterus is called the inner wall of the uterus, also known as the endometrium. A great majority of uterine cancers originate from this tissue.

• The muscle layer that makes up most of the uterus wall is called myometrium

• The membrane-like structure that covers it, if it is outside the uterus, is also called the serosa.

Endometrial cancer risk factors

The common point of risk factors for endometrial cancer is that they increase lifelong estrogen exposure. It is an important risk factor for endometrial cancer, especially in the case of obesity, since the conversion of steroids to estrogen occurs in the fat tissue in the body.

There are other rarer but more aggressive types of endometrial cancer. Examples of these include:

• Serous cancers

• Clear cell cancers

• Carcinosarcomas, aka malignant mixed mullerian tumors

When you're diagnosed with cancer, it's natural to have concerns about why and how it happened. Genetic predisposition plays a role in the development of some cancers, that is, inherited from your parents. Certain features of the genes that have been scanned may increase your risk of developing cancer. Environmental factors play a greater role in the development of some other cancers. In general, both genetic and environmental factors play a role in the development of almost all cancers. Factors that play a role in developing cancer are called risk factors.

Most of the risk factors for uterine (endometrial) cancer are related to increased amount of estrogen.

Abstract:

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• The most common cancer in the female genital tract

• It is usually diagnosed after menopause

• The most common symptom is postmenopausal vaginal bleeding

• It develops from the tissue surrounding the inner cavity of the uterus (endometrium)

Planning the treatment in uterine cancer

Your doctor will make the most appropriate treatment plan for you. In order to make the most accurate treatment plan, some tests will be needed.

Biopsy:

If you have findings suggestive of uterine cancer, your doctor may take a uterine biopsy from you. This procedure can usually be performed under outpatient conditions without the need for anesthesia. In the biopsy procedure, a tissue sample is taken from the inner wall of the uterus (endometrium layer) and sent for the evaluation of the pathologist.

Medical history and physical examination:

Your doctor will provide detailed information about your medical condition and past diseases. will question. After that, he will examine both systemically and specifically pelvic examination. In addition, the ultrasound examination to be performed by the gynecological oncology surgeon will provide valuable information about the current status of the disease.

Blood tests:

To help determine the general medical condition, as well as to have an idea about the prevalence of the disease. Some blood tests are requested. Among these, complete blood count, biochemistry values ​​and tumor markers CA-125 can be counted.

Imaging methods

After the diagnosis of uterine (endometrial) cancer, some imaging methods will be applied by your doctor. Chest X-ray, lung Other tomography, abdominal tomography, abdominal MR imaging and PET/CT imaging are some of these.

Your doctor may refer to some or all of these tests to determine the extent of the disease and treatment alternatives.

In uterine cancer. The need for additional treatments after surgery depends on the extent of the patient. The extent of the disease can be determined after the staging procedure performed during surgery. The staging procedure includes the removal of the uterus and ovaries, as well as obtaining intra-abdominal washing fluid, removal of lymph nodes and, when necessary, biopsy from the peritoneum and omentum called the peritoneum.

The main factors determining the stage of the disease are as follows:

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• Amount of invasion of the uterine muscle layer

• Tumor spread in the cervix

• Tumor in the surrounding tissues and ovaries outside the uterus

• Tumor spread in the vagina

• Tumor spread in the lymph nodes

• Tumor spread to distant organs

Treatment of uterine cancer

It is very important to determine the stage and extent of the disease before starting treatment. There are basically three types of scenarios:

• The cancer is confined to the uterus, it has not spread to the cervix

The cancer has also spread to the cervix

• The cancer has spread outside the uterus, to the lymph nodes, or to other organs

Treatment options vary for each condition.

Endometrioid Endometrial Cancer:

It is the most common type of cancer with the best prognosis among uterine cancers.

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If the cancer is confined to the uterus:

Endometrioid endometrial cancers are usually diagnosed at an early stage, and when diagnosed, the disease is confined to the uterus in most patients.

If the uterus is removed, the child It is not possible to own. However, even if uterine cancer is diagnosed in suitable patients, it is possible to continue the treatment by preserving the uterus. You should definitely discuss this with your doctor.

The pelvic (groin) and para-aortic (upper level) lymph nodes may need to be evaluated during the surgery. This process is called surgical staging.

Protection of the ovaries:

The ovaries secrete the hormones estrogen and progesterone. Removal of the ovaries before menopause causes surgical menopause. This situation has short and long term risks affecting life. Hot flashes, sleep problems and psychological effects in surgical menopause are more severe than in natural menopause. Thinning of the vaginal epithelium can cause vaginal dryness, burning and itching. In the long term, the most common effect of surgical menopause is rapid bone loss and bone resorption as a result. If appropriate conditions are provided, ovaries can be preserved during surgery in women diagnosed with uterine cancer before menopause. These conditions are as follows:

• In endometrioid type cancers

• If the cancer is limited to the uterus

• If there is no family history of breast-ovarian cancer

In cases where the ovaries are preserved, the fallopian tubes are still removed.

Fertility preservation:

It is not normally possible to preserve fertility in the surgical treatment of uterine cancer. However, if appropriate conditions are met, some patients can be treated for uterine cancer by protecting the uterus. However, it should be known that in cases where the uterus is preserved, there is a risk of treatment failure and eventually surgical removal of the uterus and ovaries may be required.

Fertility can be preserved in low-risk uterine cancer patients if the following conditions are present:

• The tumor type must be endometrioid type

• Invasion of the tumor into the muscle tissue of the uterus in imaging methods (ultrasound and/or MR imaging) should not be

• The pathological grade of the tumor should be Grade 1

• Patient Must be under 40

• There should be no contraindications for high-dose hormone therapy (coagulation disorder, treatment-resistant hypertension, history of heart attack or stroke)

• It should be followed up with uterine biopsy at certain intervals

Patients in whom fertility preservation is planned should definitely be evaluated together with an IVF specialist.

The mainstay of treatment in patients who are planned to preserve fertility is the administration of high-dose progesterone. Treatment modalities available in Turkey:

• Megestrol acetate- as a daily oral tablet

• Intrauterine device (IUD) system containing levonorgestrel

Hormone After the treatment is started, the success of the treatment is evaluated with a uterine biopsy to be performed at the 3rd or 6th month.

Treatment after surgery

There is no need for additional treatment in early-stage cancers where the tumor is confined to the uterus, while in high-grade tumors (Grade 3 or non-endometrioid tumors), Radiotherapy (radiation therapy) and/or chemotherapy may be required after surgery in tumors that are deeply located in the uterine muscle tissue, in cases with spread to lymph nodes, and in cases where tumoral spread is detected in organs outside the uterus. Decisions should be made in tumor councils that include medical oncologists, radiation oncologists, and pathologists.

Life after treatment for uterine cancer

Patients should be followed closely after the treatment of uterine cancer. The purpose of this follow-up is to detect cancer at an early and treatable stage if it recurs. is in the form. If suspicious findings are detected during the follow-up, the frequency of follow-up can be changed.

When you come to follow-up, your doctor will firstly question your symptoms and complaints. Next comes a detailed physical examination. Physical

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