Uterine cancer

What is uterine cancer (endometrial carcinoma)?

Cancer of the uterus, also known as endometrial carcinoma, refers to a malignant cell change of the lining of the uterus. This type of cancer occurs mainly in post-menopausal women and is regarded as one of the most common forms of cancer in females.

Causes: How does uterine cancer develop?

There are several causes for the occurrence of uterine cancer. Endoemetrial carcinomas are medically classified into two types, each associated with different risk factors.

• Type 1 endometrial cancer is dependent on the amount of estrogen that circulates in the body. This means that it specifically affects women who have had high levels of estrogen in their blood over a long period of time. Reasons for high estrogen levels include early first menstruation and late menopause, polycystic ovary syndrome (PCOS), obesity, low number of pregnancies, and estrogen replacement during menopause.

• Type 2 endometrial cancer is estrogen-independent; therefore, its development is largely unrelated to hormone levels. One reason for the development of this tumor is, for example, prior irradiation of the uterus. 

• Another important risk factor for both types of uterine cancer is advanced age. The peak incidence of this condition is between 75 and 80 years of age.

Symptoms: How is this tumor noted?

The major symptom of uterine cancer is vaginal bleeding independent of the menstrual cycle. Because the tumor occurs mostly in women after menopause, any vaginal bleeding that occurs from the beginning of menopause must always be ruled out as uterine cancer.

For younger women who have not yet gone through menopause, bleeding is also the primary symptom of the disease. Such bleeding is often different from menstrual bleeding in that it occurs beyond the usual time pattern of bleeding or is associated with new-onset abdominal pain. An unusually strong menstrual bleed should also be investigated medically.

How is uterine cancer diagnosed?

Diagnosis of uterine cancer is relatively quick. In case it is suspected, the first step is a gynecological examination, during which other causes of bleeding are ruled out.

Then, an ultrasound examination can verify the presence of gross structural abnormalities of the uterus.

Should the suspicion of uterine cancer persist, then a hysteroscopy is performed, during which a sample of tissue from the lining of the uterus is collected. This involves inserting a camera into the uterus under general anesthesia and extracting tissue with specialized instruments.

The tissue collected is then examined microscopically to detect malignant changes.

Treatment and therapy of uterine cancer 

Treatment of uterine cancer always involves surgery to remove the entire uterus. Besides, the fallopian tubes and ovaries, along with adjacent lymph nodes, are also removed in most cases.

Moreover, radiation therapy and chemotherapy may be applied in addition, based on the stage of the disease. Radiotherapy is usually performed after surgery and is either local, that is, through the vagina, or classic, through the skin.

For advanced cases of uterine cancer, radiotherapy may be used without prior surgery. This, however, is only done if the cancer has already spread to surrounding tissues making it inoperable.

Uterine cancer surgery: procedure and duration;

To perform uterine cancer surgery, an incision is first made in the lower abdomen so that the lower abdomen can be opened. This provides the surgeons with a direct view of the uterus and its associated structures. Next, the ligaments of connective tissue that anchor the uterus and fallopian tubes to the ovary in the abdomen are separated. According to the procedure, the fallopian tubes and ovary may then be removed, followed by the uterus and cervix.

This surgery puts special focus on the nearby blood vessels, some of which need to be cut.

Once all relevant structures have been removed, the remaining vagina is sealed at the upper end (that is its original connection to the uterus), so that only an opening to the outside remains.

As an alternative, this operation can be performed laparoscopically, without opening the lower abdomen. This, however, is determined on an individual basis.  

The duration of this operation is approximately one to two hours and patients remain in the hospital for a few days for medical monitoring.

Chances of cure & prognosis 

Overall, uterine cancer has a very good prognosis. The five-year survival rate for low-stage tumors ranges from 80 to 85 percent, depending on the source.

This is due to the fact that these tumors are noticeable early on by bleeding. Because uterine cancer presents with this early symptom, there is no traditional cancer screening. In general, once the potential causes of bleeding are investigated, this tumor is quickly detected.

Any abnormal uterine bleeding calls for urgent evaluation by a doctor, regardless of the age of the patient.

Which doctors & clinics specialize in uterine cancer?

In most cases, a gynecologist is the doctor responsible for examining and treating the female reproductive organs. In the event of any abnormalities in the menstrual cycle, these doctors should be the first point of contact. During the gynecological examination, the initial suspicion of the tumor is then established. The above-mentioned ultrasound scan is mostly also performed during the initial gynecological visit.

Hysteroscopy with tissue sampling is necessary to confirm the diagnosis. It is also performed by gynecologists, but usually requires a clinic visit because of the need for general anesthesia. This procedure is often performed by specially trained gynecologists who are experts in gynecological surgery. Surgical removal of the uterus also is done during a clinic visit and it is performed by gynecology surgeons, too.

If additional radiation and / or chemotherapy are required, oncology specialists may also be brought in to assist with the therapy.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of uterine cancer and are looking forward to your inquiry or wish for treatment.

Sources

• next.amboss.com/de/article/0O0eIT

• www.ncbi.nlm.nih.gov/books/NBK536910/

• www.amboss.com/de/wissen/Operative_Verfahren_der_Hysterektomie/