Uterine Cancer Treatment in Mumbai, India

Uterine cancer is a type of cancer involving the malignant growth of cells in the uterine tissue. There are two types of uterine cancer:

• Endometrial cancer (most common)
• Uterine sarcoma (rare).

Associated Anatomy

Uterine cancer occurs in the uterus or the womb.

Uterine Cancer Symptoms

• Excessive blood flow during menstruation and bleeding between menstrual cycles.
• Spotting or prolonged bleeding in postmenopausal women.
• Abnormal vaginal discharge in postmenopausal women.
• Painful cramps in the pelvic region.
• Painful and blood-tinged urination.
• Difficulty in bowel movement.
• Frequent pain in the lower back and legs.
• Discomfort during sexual intercourse.
• Sudden, unexplained weight loss.
• Lack of appetite.

Uterine Cancer Causes

• Mutations in the DNA of endometrial cells

Sudden changes in the DNA sequence cause healthy uterine cells to multiply abnormally, turning into malignant cells. They accumulate to form a tumor. This tumor metastasizes to nearby organs.

• High estrogen levels

Estrogen regulates the growth of uterine tissue. Abnormal estrogen levels can trigger the unusual proliferation of endometrial cells. It leads to excessive thickening of the uterus, which causes malignancy.

Uterine Cancer Stages

• Stage I - Cancer is restricted to the uterus.

• Stage II - Cancer has spread to the cervix tissue.

• Stage III - Cancer has spread to the fallopian tubes, ovaries, vagina, and lymph nodes. It is still confined to the pelvic region.

• Stage IV - Cancer has spread to the urinary bladder, rectum, and remotely situated organs such as the liver or lungs.

Uterine Cancer Diagnosis and Tests

The preliminary diagnosis includes a pelvic examination. Symptoms are assessed based on the risk factors. To confirm, the following tests may be advised:

• Transvaginal ultrasound

• Hysteroscopy

• Endometrial biopsy

• Dilation and curettage (D & C)

• CT scan and MRI scan

• CA-125 assay

• Complete blood count

Uterine Cancer Treatment

Uterine cancer treatment depends on the stage, type, and health of the patient, but it generally involves a combination of surgery, radiation therapy, hormone therapy, and chemotherapy. Here’s an overview of the most common treatments:

Surgery

• Hysterectomy: is performed, followed by the removal of fallopian tubes and ovaries. The entire procedure is performed in a minimally invasive way using laparoscopic and robotic-assisted surgical methods.
• Lymph Node Dissection: Lymph nodes in the pelvic area may be removed to check for the spread of cancer.
• Oophorectomy: The ovaries may be removed in certain cases, especially if the cancer is likely to spread or if the patient is post-menopausal.

Radiation Therapy

Radiation Therapy involves the use of high-energy radiation. It is recommended in the advanced stages of the tumor. It prevents the recurrence of cancer.

Chemotherapy

Chemicals are injected into the bloodstream, intravenously or orally, to kill the cancer cells. Chemotherapy is used before surgery to shrink the tumor size and after surgery to prevent the recurrence of the tumor.

Hormone Therapy

Hormone Therapy is attempted before hysterectomy to control cancer growth by regulating the hormones. The introduction of high-dose progesterone counters the effect of estrogen. This reduces the multiplication of cancer cells.

Targeted Therapy

Targeted Thearapy involves the use of drugs that specifically pinpoint and attack cancerous cells. It is used in combination with radiation therapy and chemotherapy.

Immunotherapy

Immunotherapy may be an option for patients with specific types of genetic changes in their cancer.

Palliative Care

This is all about learning to live with the condition in the best possible way. It mainly aims to control the symptoms and prevent the recurrence of cancer.

Uterine Cancer Risk Factors

• Age: Women aged above 45.
• Hereditary Aspect: Women having a family history of endometrial, breast, or colorectal cancer.
• Obesity: Having a BMI >25 (stimulates the overproduction of estrogen).
• Irregular Menstrual Cycles: Early menarche, late menopause, and erratic periods.
• Diabetes: Type 2 diabetes and high blood pressure (often linked to obesity).
• History of Disease: Women who have had ovarian, colon, breast cancers, and PCOS.
• Diet: High-fat diet coupled with physical inactivity.
• Hormone Levels: Menopausal estrogen therapy and use of tamoxifen (a drug used to treat breast cancer), which increases estrogen levels.
• Previous Radiation Therapy: Radiations causing DNA damage in the cancer cells.

Uterine Cancer Possible Complications

Uterus perforation is a complication that may arise during the D & C or endometrial biopsy tests. Another possible complication associated with excessive blood loss is anaemia. Also, radiation therapy may lead to vaginal atrophy and bladder fistula.

Uterine Cancer Preventions

Primary Prevention

• Weight control: Maintaining a healthy weight and having a BMI below 25.

• Diet: Include vegetables in the daily diet and consume low-fat food.

• Lifestyle: Avoiding a sedentary lifestyle to reduce the chances of lifestyle diseases like diabetes (linked to obesity and other risk factors).

• Regulation of estrogen levels: Use of oral contraceptive pills and progestin-enriched IUDs, which are proven to reduce estrogen levels.

• Breastfeeding: Hormones released while breastfeeding reduce estrogen levels.

Secondary Prevention

• Regular Checkups: Early detection based on symptoms is necessary. Women with conditions like PCOS or abnormal vaginal bleeding during periods must undergo ultrasounds to rule out any risk factors.

• Hereditary Factors: For someone with a family history of gynaecological cancers, it is advisable to undergo a hysterectomy (after having children) and get the fallopian tubes, uterus, and ovaries removed. This rules out the possibility of developing uterine cancer later.

Uterine Cancer Diagnosis

• In pre-menopausal women

Fibroids, endometriosis, adenomyosis, and ovulatory dysfunction.

• In post-menopausal women

Endometrial atrophy, endometrial hyperplasia, atrophic vaginitis, and cervical polyps.

Uterine Cancer Prognosis

Expected Prognosis

The five-year survival rate was 93% for women with localized tumors and 85% for women with non-localized tumors. Survival rates range from one year to more than 10 years based on the stage at which it is diagnosed.

Natural Progression

If left untreated, cancer in the uterus spreads to nearby organs such as the urinary bladder and rectum. Later, it progresses to distant organs. Even though the spread is gradual, mortality and morbidity rates can rise if there is no intervention.

Epidemiology

• Occurrence

Uterine cancer is the sixth most commonly occurring cancer among women worldwide. In India, its prevalence is low, as compared to Western countries.

• Rate of incidence

It was found to be 4.3 per 100,000 in Delhi.

Pathophysiology

Changes in the DNA sequence and secretion of certain proteins may lead to endometrial hyperplasia and adenocarcinoma. Mutations in the FGFR2 protein (important for bone growth) have been associated with around 12% of cases of uterine carcinoma.

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