The uterus, often known as the womb, is a muscular, pear-shaped structure located at the top of the vaginal canal. The endometrium is the womb’s lining, which sheds each month as a period. These periods halt for a certain time during pregnancy, but they usually resume once the woman reaches menopause.
Endometrial cancer is a type of cancer that begins in the lining of the womb and is the subject of this section.
Uterine sarcoma is a form of cancer that begins in the womb’s muscular layers; this type of cancer is addressed in our soft tissue sarcomas section.
The cervix, often known as the womb’s neck, is the bottom section of the womb.
The position of the cervix in relation to the other female reproductive organs
Lymph nodes are clusters of lymph nodes located around the womb. These glands are roughly the size of a bean. The lymphatic system includes lymph nodes. This is a system of glands located throughout the body that are connected by fine ducts through which a colourless fluid called lymph flows and works as a disease defence.
CAUSES OF UTERINE CANCER
The actual reason of womb cancer has yet to be discovered. It most typically affects women between the ages of 50 and 64, as well as those who have gone through menopause. Women under the age of 50 are rarely affected by womb cancer. Overweight people are more likely to acquire womb cancer.
Women who are still on their periods and use the contraceptive pill are thought to have a decreased risk of womb cancer. Women who have gone through menopause and have been using oestrogen-only HRT (hormone replacement treatment) for a long period may be at a slightly increased risk of acquiring the condition. If you are taking HRT and have not had their womb removed should make sure they are in-taking a mix of the hormones oestrogen and progesterone and not only oestrogen. Taking combined oestrogen and progesterone HRT for max 5 years does not raise the risk of womb cancer, but taking it for longer than that increases the risk somewhat.
Intake of Tamoxifen (a hormone medication used to treat breast cancer) is linked to a modest increase in the risk of womb cancer when used for a lengthy period of time. However, because the risk of breast cancer is so small, the advantages of using tamoxifen to treat it are thought to exceed the danger.
Although the majority of womb malignancies are not caused by an inherited defective gene, they may be in certain women. A gene can be found in a limited number of families that increases the risk of bowel or womb cancer in family members. If you have a lot of close relatives with bowel or womb cancer (particularly if it started when they were young), it might be related to an inherited defective gene.
If you’re concerned that additional members of your family may be at risk for cancer, speak with your doctor, who may send you to a family cancer clinic if required.
Women with very uncommon genetic illnesses such as Cowden syndrome and Stein-Leventhal syndrome (cystic disease of the ovary) have a higher risk of womb cancer.
Womb cancer, like other malignancies, is not contagious and cannot be spread from one person to another.
SYMPTOMS OF UTERINE CANCER
Excessive vaginal bleeding is the most common early indication of womb cancer. This can come in multitude of ways, including:
- bleeding between periods
- periods that are heavier than usual (in premenopausal women)
- bleeding that begins after menopause (in post-menopausal women).
Abnormal vaginal bleeding can be caused by a variety of things other than cancer, but you should always consult your doctor.
- Pain in the lower abdomen (tummy), back, or legs may be experienced by some women.
- During sexual intercourse, women may experience pain or discomfort.
DIAGNOSIS OF UTERINE CANCER
Typically, you’ll start by seeing your GP (family doctor), who will assess you and schedule any required tests or x-rays. For these tests, as well as specialised gynaecological advice and treatment, your GP may need to refer you to the hospital.
You may be subjected to one or more of the tests listed below.
To view into the uterus, a thin, flexible tube with a light at the end can be utilised. This enables the gynaecologist to obtain precise tissue samples (see Biopsy, below). Most women experience period-like aches for a day or two after a hysteroscopy, which may be managed with medications.
A gynaecologist or specialist nurse can extract a tiny sample of cells from the uterine lining. This will be done in an outpatient setting without the need of an anaesthetic. A thin tube is inserted into the uterus, and a sample of the lining is removed with mild suction. The sample is transported to the lab to be examined under a microscope.
Dilatation and curettage (D&C;)
Dilatation and curettage (D&C) is a technique that is performed under general anaesthesia. The cervix is extended to allow a gynaecologist to introduce an instrument to collect tissue samples from the uterus’ inner lining. Following that, the samples may be inspected under a microscope.
A image of the interior of the uterus is created using sound waves.
A tiny gadget is inserted into your vaginal canal softly. Sound waves are generated by the gadget, which are then transformed into an image by a computer. Although this may be unpleasant, it should not be painful.
FURTHER TEST FOR THE EXAMINATION OF UTERUS CANCER
If testing reveal that you have womb cancer, your gynaecologist or surgeon will likely order more tests to determine whether the cancer has spread. These tests assist your doctor in determining the appropriate course of treatment for you. Any of the tests listed below might be used.
Blood samples will be obtained to assess your overall health, the amount of cells in your blood (blood count), and the function of your kidneys.
This is done to ensure that your lungs and heart are in good working order.
CT Scan (computerized tomography scan)
A CT scanner produces a three-dimensional image of the inside of the body by taking a sequence of x-rays. Although the scan is painless, it does take longer than an x-ray (from 10-30 minutes).
It can be used to determine the specific location and size of the malignancy, as well as to screen for disease spread.
Having a CT scan
The CT scan is painless, although it will need you to lie motionless for 10–30 minutes. As soon as the scan is completed, you should be allowed to return home.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan, except instead of x-rays, it employs magnetism to create cross-sectional images of your body. To improve their appearance, some people are given a dye injection into a vein in their arm.
During the test, you will be required to lay extremely motionless on a couch for up to an hour within a lengthy chamber. If you don’t enjoy being in enclosed areas, this may be an issue; if so, inform the radiographer.
The MRI scanning procedure is also rather noisy, although you will be provided with earplugs or headphones.
Because the scanner is a strong magnet, you should take off any metal jewellery before entering the room. Because of the magnetic fields, those who have cardiac monitors, pacemakers, or some types of surgical clips are unable to get an MRI.
The results of your tests will most likely take several days to arrive, and this period will undoubtedly be stressful for you. If you can find a close friend or relative with whom you can discuss your concerns, it may be beneficial.
TREATMENT OF UTERINE CANCER
The majority of womb cancers are found early (before they have progressed beyond the womb) and are treated with a hysterectomy (surgical removal of the womb). Because this therapy is so effective for so many women, further treatment is not normally necessary.
If your surgeon believes there is a chance the cancer will return after the procedure, radiotherapy may be offered. If the cancer cannot be removed surgically or if you are not in good enough health to undergo surgery, radiotherapy may be administered instead. Radiotherapy can be used to decrease a tumour before surgery and can also be utilised if the cancer returns (recurs) in the pelvic region.
Treatment with progesterone, a female hormone, may be able to reduce the cancer and manage symptoms if it has spread to other regions of the body. Chemotherapy is occasionally administered in this case, and it can help shrink the cancer and slow its progression for a while.
A multidisciplinary team will care for you if your testing reveal that you have uterine cancer. This is a group of professionals that specialise in the treatment of gynaecological cancer as well as providing information and support. In most cases, it will include:
- gynaecological surgeons
- expert nurses who can provide knowledge and assistance
- oncologists – doctors with experience treating gynaecological cancer with chemotherapy, radiation, and (hormonal) therapy
- radiologists who assist with x-ray analysis
- pathologists who determine the kind and degree of the cancer
Other professionals, such as physiotherapists, counsellors and psychologists, and social workers, will be present to assist you if necessary.
Giving your consent
Doctor will normally ask you to sign a paper stating that you grant the medical personnel your permission (consent) to treat you. No medical treatment can be given without your consent.
If you don’t understand something, tell the staff right immediately so they can explain it to you again.
Patients sometimes believe that medical personnel are too busy to answer their inquiries, yet it is critical that you understand how the therapy will affect you. If you have any queries, the staff should be glad to answer them.
If you feel you are unable to make a choice about the therapy after it has been described to you, you may always ask for extra time to consider it.
Benefits and disadvantages of treatment
Because of the potential for adverse effects, many people are afraid about undergoing cancer treatments. Some folks wonder what would happen if they weren’t treated at all.
Although treatments like radiation might have negative effects, they can typically be managed with medication.
Treatment can be offered for a variety of reasons, and the possible advantages will vary based on the circumstances.
Early-stage womb cancer
Surgery is frequently performed on women with early-stage endometrial cancer with the goal of curing the cancer, which is usually achieved. After surgery, further therapies like radiation may be administered to lower the chances of the cancer returning.
Advanced womb cancer
If the cancer has progressed or returned (recurred), therapy may only be able to manage it, resulting in a reduction in symptoms and a higher quality of life. For some patients in this condition, however, therapy will have no effect on the cancer, and they will suffer the negative effects without receiving any benefit.
Making Decisions About Womb Cancer Treatment
It may not be difficult to decide whether or not to accept therapy if you have beginning-stage cancer and have been given diagnosis that attempts to diagnose it. It may be more difficult to determine whether to proceed if you have a more advanced cancer and the therapy is being administered to manage the malignancy for a length of time.
Making treatment selections in these situations is often challenging, and you may need to explore your options with your doctor in detail before proceeding. You can still receive supportive (palliative) care with drugs to manage any symptoms if you don’t want to.
Some women find it reassuring to have a second medical opinion before making a treatment decision. If you believe it will be beneficial, most doctors will gladly recommend you to another specialist for a second opinion. A second medical opinion, on the other hand, may take some time to organise and may cause a delay in the commencement of your therapy, so you must be certain that it will be beneficial to you.
TREATING UTERINE CANCER THROUGH SURGERY
The procedure of surgical treatment for womb cancer is the removal of the womb (hysterectomy) and is carried out. Usually, both ovaries and the fallopian tubes will also be removed.
Lymph nodes around the womb are sometimes removed as well. A Wertheim’s hysterectomy is the name for this procedure. The purpose of this additional operation is to remove as much cancer as feasible while also letting the pathologist to check for cancer cells in the lymph nodes. In many cases, a gynaecologist can remove all cancer with this procedure, eliminating the need for additional therapy.
If the cancer cannot be entirely removed, your surgeon may suggest that you have radiation treatment following the procedure. Even if the entire tumour has been removed, radiation may be used to lessen the chances of the cancer returning. Your surgeon will send you to a clinical oncologist if radiotherapy is required.
TREATING CANCER THROUGH RADIOTHERAPY
If your doctor believes there is a chance the cancer will return post-surgery, radiotherapy may be prescribed. If the cancer has advanced to the region around the womb, it may be performed instead of surgery. It is sometimes used to shrink a tumour prior to the surgery. It might potentially be performed if the cancer returns in the pelvic region in the future. External or internal radiotherapy, as well as a combination of the two, can be used to treat womb cancer.
Your clinical oncologist, who is in charge of your treatment, will be able to assist you with any issues or worries you may have.
TREATING CANCER THROUGH HORMONAL TREATMENT
Your doctor may suggest hormonal therapy with progesterone if there is a threat of the cancer returning or if it returns after surgery in some cases. This therapy may reduce the odds of cancer recurrence. Progesterone may reduce a womb cancer and manage symptoms if it is advanced. Hormonal therapy may also be used to treat endometrial malignancies that have grown to other regions of the body by the time they are discovered.
Progesterone is a natural female hormone. Your doctor can prescribe artificial progesterone in the form of pills or injections.
Progesterone has a small number of adverse effects. Despite the fact that some women may feel a little unwell, most women find that progesterone makes them eat more. This might cause them to gain weight. Some women experience minor muscular cramps as well.
TREATING CANCER THROUGH CHEMOTHERAPY
If the cancer returns or spreads to other places of the body and does not respond to hormonal treatment, chemotherapy may be employed. Chemotherapy may help to shrink the cancer and reduce symptoms in some patients. The medications can be taken as pills or capsules, or they can be injected into a vein (intravenously).
Chemotherapy is the treatment of cancer cells with anti-cancer (cytotoxic) medicines.
Chemotherapy medicines diminish the quantity of normal cells in the blood momentarily.
You are more prone to catch an infection and fatigue easily if your blood count is low. Your blood will be examined on a regular basis throughout chemotherapy, and you will be given antibiotics to combat infection if necessary. If you are anaemic, blood transfusions may be required.
Tiredness, nausea, vomiting, and hair loss are all possible adverse effects. Anti-sickness medications may now effectively reduce nausea and vomiting. Some chemotherapy medications also induce mouth ulcers and sores. Mouthwashes should be used on a regular basis, and nurses will explain you how to do it effectively. You may complement your diet with nutritional liquids or soups if you don’t feel like eating meals. These beverages come in a variety of flavours and can be purchased at most pharmacies.
EFFECT OF TREATMENTS ON FERTILITY
Many women are worried about having sex right after cancer treatment, although it is completely safe. Sex will not cause cancer, and your partner will not catch cancer from you. To assist the vagina relax, many women discover that they need to spend longer time during intercourse. It may also help if your partner is gentle at initially, allowing your vagina to stretch gradually. Regular, gentle sex can help the vagina become responsive again, and after a few weeks of radiation, you should be ready to resume your normal sex life.
Womb cancer treatment from surgery and radiation will make it nearly impossible for you to have children in the future.
Younger women, especially those wishing to have a family or expand their family, may be particularly unhappy if they have had to have a hysterectomy or had their ovaries destroyed by radiation.
After a womb cancer procedure, women who have reached menopause may experience a profound feeling of loss. Some women believe that having their womb removed takes away a part of their femininity and makes them feel less feminine. Allowing yourself plenty of time to grieve or mourn for any children you may have had might be beneficial, since the loss of the womb can leave many women feeling bereft.
A professional gynaecological oncology nurse or a counsellor who is properly educated to listen and give support may be beneficial.