Description

Uterus Cancer Surgery

Overview

Uterus is a part of female reproductive organ, where the embryo-fetus grows and develops throughout the pregnancy. The uterus, which looks like a face-down pear, lies between the bladder and the rectum. It continues with vagina at the caudal side and Fallon tubes that extend to ovaries are located in right and left horns of the womb.

Uterus consists of three layers: endometrium, which lines the uterine cavity and hosts secretory glands;
myometrium, the middle layer of muscles; and the perimetrium, the outermost membrane.

Uterine cancer is also called endometrial cancer, as it originates from the cells of endometrium – the
innermost layer of the uterine wall. There are other types of uterine cancer that originate from tissues forming the uterine wall.

Risk Factors:

It is not clearly known what causes the uterine cancer.

The risk factors of the uterine cancer are as follows:

• Changes in the balance of the female sex hormone,
• Early onset of menstruation,
• Never having get pregnant,
• Age,
• Obesity,
• Hormone therapy for breast cancer
• Genetic factors,
• Some dietary factors

Symptoms:

Possible symptoms of the uterine cancer are as follows:

• Vaginal bleeding after menopause,
• Abnormal bleeding, spotting
• Bleeding between menstrual cycles,
• Vaginal discharge
• Pelvic pain,
• Unknown and unintended weight loss,

Advanced stage uterine cancer, if spreads, may cause more symptoms.

Prevention:

The first step of treatment should be to alleviate risk factors that help onset of the disease. Weight control, healthy nutrition, careful use of hormones after menopause, reasonable use of birth
control pills and regular exercise are preventive measures that should be applied by the patient before getting sick. It is thought that birth control pills reduce the risk. 

Diagnosis:

A woman with symptoms suggestive of uterine cancer should immediately visit her doctor. If health history, family history, physical examination and pelvic examination point to suspicious
finding, further investigation will be planned.

Initially, your doctor may consider a transvaginal ultrasound that uses an ultrasound probe inserted into
the vagina. Thus, it may be possible to collect preliminary information about characteristics and thickness of the endometrium.

Your doctor may employ hysteroscopy to learn the origin of the suspicious findings. A thin and flexible tube is advanced into the uterine cavity through the vaginal canal and the innermost
wall of the uterine cavity is examined after the cavity is filled in with saline. Biopsy specimen
can be collected from areas that leads to suspicion during the procedure.

If the limited hysteroscopic biopsy sample cannot provide definitive information about the diagnosis, tissue specimens are collected from larger areas of the interior uterine wall by a
procedure called dilatation and curettage. Cancer cells are searched by
examining these specimens under microscope.

Treatment:

After the definitive diagnosis is made, the first step to be taken should be to determine the stage of the
cancer (that is, whether it is limited in the uterus or spread to nearby and distant tissues and organs). Your doctor will determine stage (I to IV) of your cancer based on a set of very strict
criteria.  You may think that uterine cancer is very broadly staged as local, limited or regional and
distant.

Generally cancer phases are symbolized with Roman numbers I to IV. Stage IV is the most advanced
stage of cancer. A personalized treatment is planned for each patient by considering stage, age, general health status and personal preferences.

Among the treatment options of the uterine cancer are chemotherapy, hormone therapy, radiotherapy and surgery. While these treatments are used to cure the tumor, they can be used to increase quality of life and to ease the severity of the symptoms in advanced stages. Moreover, the treatment
options can be used together or alone.

Chemotherapy

Chemotherapy uses drugs to cure cancer. The active ingredients in these drugs kill cancer cells. Chemotherapy drugs can be administered intravenously or by mouth. If the drug is administrated
through a vein, a thin tube, called a catheter, is inserted into a large vein and chemotherapy drug is delivered from this catheter throughout the course of the treatment.

One or more chemotherapy medicines may be administered according to the response of the cancer to the treatment and the type of cancer. After chemotherapy is given for a certain period, treatment is paused. After the completion of this defined “break” period, treatment resumes. Each of these periods is called cycle.

In the early stage uterine cancers, chemotherapy may be started before or after the surgery in order to both improve outcomes of surgery and enhance the survival rates.

In the advanced stage cancers, the objective of the chemotherapy is to relieve symptoms, improve quality of life and extend the life as much as possible.

Side effects of chemotherapy are secondary to the chemotherapeutic agent and dose. Most common side effects seen in chemotherapy drugs include; malaise, nausea, vomiting, mouth sores, hair
loss and inflammation in the digestive system. Side effects caused by chemotherapy will also be treated by your doctor. In case of the side effects become severe to threaten your health, your doctor may advise to suspend the treatment or to take another chemotherapy medicine.

Hormone therapy:

The main purpose of the hormone therapy is to administer progesterone to stop the growth of endometrial cancer cells and/or to decrease amount of estrogen in the body in order to
suppress the growth.

Radiotherapy

Radiation therapy aims to kill cancer cells by using high-powered energy beams.

If the radiation source is out of the body and beams are directed to cancer, this treatment is called external radiotherapy.  On the other hand, if the radioactive agent is put into the area that cancer is present by a needle or catheter, method is called internal radiotherapy (brachytheraphy).

Although radiation therapy can also be used as first order therapy of cancer, generally it is used to kill
cells that are not removed by surgery. In the first-line treatment, mostly radiotherapy and chemotherapy are administered together and this treatment is also known as chemoradiotheraphy.

The side effects of radiotherapy take place in a very wide range depending on the body region where
the radioactive rays are transmitted. The risks apply to you will be explained by your doctor.

Surgery:

The surgical approach is based solely on removal of the uterus (hysterectomy) or removal of the cervix, ovaries and fallopian tubes along with the uterus (hysterectomy and bilateral salpingo-oophorectomy).

Removal of the uterus will make impossible to have a child in the future, and once the ovaries are
removed, you will be menopausal.

Lymph nodes are removed by the surgeon at the last phase of the operation. Lymph nodes are examined under microscope to determine the spread of the cancer.

Asking your questions about the treatment of uterine cancer, your life after treatment,
rehabilitation, pain management, clinical studies and all the questions in your
mind about the uterine cancer to your doctor will help you for an informed
participation to your treatment and alleviating your concerns.