Uterine Cancer

About this information

Anyone who has been diagnosed with cancer of the uterus, cervix or ovaries, gets many considerations:

• How will it go with me?
• The treatment will be successful?
• Will I still feel like “woman”?

The time of diagnosis and treatment will most experienced as a crisis in life. Uncertainty and anxiety is a natural reaction. Being diagnosed with cancer is a very personal experience. Here you will find information about cancer of the uterus. You can also read about the treatment.

The information is directed primarily toward the patient, but we hope that it will be read by the patient’s relatives and other interested parties. It can not give answers to all questions, but it can be a support; it can provide knowledge and perhaps remove misunderstandings.

Cancer of the uterus

Each year approximately 750 South African women, cancer of the uterus. The disease is the fifth most common cancer in women. The majority (about 85%) occurs in women after menopause. Women under 45 years are rarely affected by the disease. For many women get the disease detected early and it provides excellent opportunities for healing.

Cancer of the uterus should not be confused with cervical cancer , which is an entirely different disease.

Cancer of the uterus often causes symptoms such as irregular bleeding or bloody vaginal discharge. In some women become cancerous tumor discovered by accident in connection with a curettage of the uterus.

The uterus

The uterus is the size of a light bulb with a weight between 40 and 70 grams. The wall consists of a highly-centimeter thick muscle layer, and internally by a mucous membrane. It is part of the mucosa, which is ejected by menstruation, and it is in this mucosa, to cancer of the uterus occurs most often. Few cases (1%) occurs in musklvævet. They are called sarcomas and is another type of disease that is not described here.

The cervix is ​​the part of the uterus that opens into the vagina. After menopause shrink the uterus and becomes a lot less.

What causes cancer of the uterus?

The risk of getting cancer of the uterus increases with age. Most women are over age 60 when the disease is discovered. Obesity and diabetes increases the risk of getting cancer of the uterus, as it increases the amount and the effect of the female hormone estrogen on the endometrium.

The risk of cancer of the uterus is also increased if prolonged HRT with estrogen alone. If you get a hormone that consists of both estrogen and another hormone, progestin, the risk of cancer of the uterus is not increased, on the contrary, the risk reduced by a combined therapy.

The risk associated with estrogen-only treatment applicable to common treatment in tablet or patch form. Estrogen Treatment in the form of suppositories in the vagina does not carry any risk, since hormone content is very low and estrogen predominantly acts locally. The use of oral contraceptives reduces the risk of uterine cancer.

Some less common subtypes of uterine cancer is not estrogen-dependent.

Heredity

The majority of cases of cancer of the uterus is not hereditary. Some families have increased incidence of nonpolyposis colon cancer and these women have also slightly increased risk of cancer of the uterus. They are therefore called for regular checks.

Surveys

If your doctor suspects you have cancer of the uterus, you will be referred to a gynecologist or a gynecological ward of a hospital. In order to make a definitive diagnosis, it is necessary to examine the uterine lining.

In an ultrasound scan of the abdomen, which is performed through the vagina, one can see the uterus and endometrium. After menopause lining of the uterus is no longer active, and it will appear as a thin line of a few mm. When cancer or other diseases of the uterus, the mucous membrane may be thicker. To make the final diagnosis, take a sample of the mucosa. This can often be done out-patient by means of a thin plastic tube that is fed into the uterus (endometrial biopsy). It takes only a moment, but can trigger pain in the abdomen, especially if the cervical canal is narrow. In other cases is to perform an curettage in local or general anesthesia (curettage.) Final can be in local or general anesthesia make a keyhole examination of the uterus (hysteroscopy), while taking samples. It udhentede tissue is sent for microscopic examination and go 1-2 weeks before there are answers.

Most often is taken an  X-ray of the chest , partly to investigate whether the disease has spread to the lungs and also to check lung condition before surgery.

The doctor will also conduct a regular gynecological examination to assess whether the disease may have spread. If it is suspected that the disease has spread outside the uterus, other studies be relevant – for example, of the urinary bladder or colon and the rectum. A whole body scan and ultrasound examination of the abdomen or pelvis may also be considered.

What treatment is there?

Operation

Cancer of the uterus is treated in most cases with surgery. By surgery removes the uterus and both fallopian tubes and ovaries. It is called total hysterectomy and bilateral salpingo-oforektomi. The operation may be performed both by a cut in the abdominal wall, but it also will be carried out by using keyhole surgery, drawing out the uterus through the vagina.

If the tumor in the lining of the uterus goes back more than 50% into the underlying uterine muscle, you must also remove lymph nodes in the pelvis. This will often first out in connection with the operation.

The surgery will be performed under general anesthesia. Whether it is a keyhole surgery or open surgery through an incision in the abdominal wall there are risks associated with surgery. There may be bleeding and injury to adjacent organs in the abdominal cavity (urinary bladder, intestine, and fallopian tube), and inflammation that can occur afterwards. The risk of complications is consistently low and is often related to the patient’s general condition. Thus there is a greater risk of obesity and in smokers.

If there is suspicion of spread to the lymph nodes, removes lymph nodes along the large blood vessels in the pelvis. It may be associated with an increased risk of bleeding and subsequent risk of accumulation of lymph in the legs (lymphedema). The legs can be thickened and feels heavy. In addition the accumulation of lymph in the pelvis (lymphocele), which can squeeze inside and be troublesome.

Most go home from the hospital after 2-3 days. One can have ease pain for up to two weeks, and there may be a need for sick leave for 4-6 weeks. However, it is very individual and depends on the individual person and the nature of work.

low risk

After surgery, the removed uterus, fallopian tubes and ovaries as well as any. lymph thoroughly examined microscopically. If cancer cells are not especially virulent, and the tumor has not grown more than halfway into the uterine wall, you belong to the low risk group. This means that you do not usually need through additional treatment, but have been cured by surgery.

High Risk Group

If cancer cells are more malignant, or tumor has grown deeper into the uterine wall, will you at high risk. The same applies if the disease has spread outside the uterus. Women at high risk would be at greater risk of relapse and is generally offered chemotherapy and / or radiation therapy after surgery.

Treatment

Treatment with chemotherapy

Medical treatment with cytotoxic chemotherapy called. In early stages of cancer of the uterus chemotherapy has no effect, but there are studies underway to examine whether chemotherapy in more advanced stages can improve the prognosis.

Radiation treatment

Radiation therapy can kill the cancer cells, which may or may remain after surgery. This reduces the risk that the cancer reappears, but does not increase survival over the long term. The radiation is usually given four or five times a week for four to five weeks. The irradiation, which is centered on the upper part of the vagina and the lymph nodes in the abdomen, is painless and takes only a few minutes each time.

Side effects

For cancer of the uterus removes the ovaries and thus cease their production of hormones. Women who have passed menopause, usually will not notice any difference. Younger women having surgery for cancer of the uterus, the postoperative come in menopause and may contribute to discomfort and inconvenience.

Vaginal dryness is a common side effect of radiation treatment, and may cause harmful effects of sexual life. There can easily be local hormone in the form of suppositories estrogen in the vagina, though there have been cancer of the uterus. It does not increase the risk of relapse. In younger women with severe symptoms due to menopause, in consultation with the gynecologist also given hormone supplements in tablet form, if there is no evidence of spread of the disease

The radiation treatment is given in several small doses. Experience has shown that this gives less side effects than a more potent radiation fewer times. Individual patients may live a normal life during radiation treatment and is not particularly bothered. But be prepared that may arise genes. In most skin will have a pinkish tone, as in a mild sunburn. In some, the skin look tanned, and it can also be thickened. These changes may persist for up to a year or more after treatment. You may also experience diarrhea, abdominal pain, fatigue or nausea associated with treatment. This is because the gut, which is located behind the uterus, while getting rays.

Ask the staff that give you radiation on how best to reduce the inconvenience. They have extensive experience in the field. Many wonder if one becomes radioactive radiotherapy. This is not the case and you do not suspend the other risk because of the treatment.

If the disease has spread

Cancer The tumor in the womb to grow into the cervix or through the uterine wall and can reach veins and lymfeårer. The disease can thus spread to other parts of the body. There may also be direct spread to neighboring organs. If during the operation are obvious signs that the disease has spread, efforts are being made during surgery to remove all disease. This may involve removing a portion of the bladder or part of the intestine. It may be necessary to carry out the intestine through a hole in the abdominal wall as a stoma.

When the disease has spread, there will be a need for follow-up chemotherapy and sometimes radiation therapy. Hormone therapy can in some cases be the right treatment.

Hormone

Hormone therapy with progestin (a synthetic form of the sex hormone progesterone) may be considered if the disease has spread, reappear, or if for some reason do not choose surgery in the first place. The female hormone, estrogen can stimulate tumor in the uterus. Hormone progesterone, which is found naturally in the body, on the other hand can inhibit cancer growth while. Substances having a progesterone-like effect is known as progestogens and are also used in oral contraceptives.

Important with good information

It is important that you understand the reasons for the advice that your doctor provides. Ask questions! Talk to your relatives and ask one of them to take the conversation with the doctor. By getting involved in disease and treatment do you make the best help.

Control After Surgery

Depending on the type, severity and stage of cancer being planned for a test run. The process is individually, and it is agreed between the patient and the doctor contact.

By checking is performed gynecological examination and an ultrasound scan. On suspicion that the disease has come back (relapse), can be made special scans.

Forecast

In the 1960s only about 60% of women are alive five years after diagnosis. Today, more than 80% of women five years after diagnosis. This is an average of all stages and most of those who have a low stage are cured by surgery and therefore do not have a worse prognosis than their peers.