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Introduction
 The uterus, or womb, is a small, pear-shaped organ located in the
pelvis, consisting of the cervix, or neck of the uterus, and the corpus
or main body of the uterus. The uterus is the organ in which the
fertilized egg attaches itself and develops during pregnancy.
The two common forms of uterine cancer
are cervical (from the neck of the uterus) and endometrial (from the
lining of the corpus or body of the uterus). The cells covering the
cervix usually go through mild to severe changes called dysplasia before
becoming cancer. Similarly tissue lining the corpus goes through mild to
severe changes called hyperplasia before becoming cancer.
These pre-cancerous conditions do not
necessarily lead to cancer. It is important, however, that any woman
with such a condition be treated and then examined by a physician at
regular intervals.
The earliest stage of uterine cancer is
called carcinoma in situ (Cancer confined to its original site). If not
detected and treated properly, cancer cells penetrate into deeper layers
of the uterus, then spread to neighboring organs such as the vagina,
bladder or rectum and eventually metastasize to other parts of the body.
Risk Factors
At higher risk of cervical cancer are women who have unusual bleeding or
vaginal discharge between periods, had frequent sex before age of 20 or
sex with many partners, and women with poor genital hygiene. The highest
incidence occurs in women aged 40-49.
Most cases of endometrial cancer are
diagnosed in women between the age of 50 and 64. It rarely occurs in
women under 40. At higher risk are women who, during or after menopause,
have unusual bleeding or discharge have estrogen therapy during or after
menopause, had a late menopause (after 55); have diabetes, high blood
pressure and an overweight problem.
Signs And Symptoms
The earliest warning signs of cervical cancer are irregular bleeding or
vaginal discharge charge. Warning signs of endometrial cancer include
bleeding between menstrual periods, excessive bleeding during periods,
and bleeding after menopause.
Any of these signs should be reported
promptly to a physician.
Diagnosis
Cancer Of The Cervix
The Pap test is highly accurate in detecting cervical cancer at an early
stage. It can also show cell changes that could develop into cancer.
The Pap test takes but a few minutes,
is painless, and can be done in the physician's office. It is the
examination under a microscope of cells normally shed from the body of
the uterus and from the cervix, These cells collect in the vaginal fluid
and can be collected, along with cells taken from the surface of the
cervix, on a cotton swab or stick.
If the cell samples reveal any
abnormality, additional diagnostic techniques may include:
1. Colposcopy-the visual examination of
the vagina and cervix with a magnifying instrument called the colposcope
to check tissue for abnormality.
2. Biopsy- the surgical removal, for
microscopic examination, of a piece of tissue from a suspected area.
This is the only way to positively determine if cancer cells are
present.
3. Conization-a surgical procedure to
remove a cone-shaped specimen of tissue from the cervical canal. This
provides a larger tissue sample than is removed for a biopsy.
Cancer Of The Endometrium
The Pap test is only about 40 percent effective in detecting endometrial
cancer. More effective diagnostic techniques are:
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Dilation and Curettage (D and C)- Removal of tissue samples from the
body of the uterus, by a scraping technique while the patient is
anesthetized. It is done in the hospital and the tissue samples can be
studied microscopically for cell changes characteristic of cancer.
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Aspiration Curettage-This provides samples of tissue from the walls of
the body of the uterus, through suction with a small instrument inserted
through the cervix. The procedure is painless and can be performed in a
physician's office. The tissue samples are then studied under the
microscope for abnormal cell changes.
Treatment
Uterine cancer is generally treated by surgery or radiation, or by a
combination of the two. In the pre-cancerous stages:
1. Cervical changes may be treated by
cryotherapy which is the destruction of tissue by extreme cold, or by
electrocoagulation, the destruction of tissue through intense heat
delivered by electric current-in some very early cases, childbearing
function can be maintained .
2. Endometrial changes may be treated
with the hormone, progesterone.
Surgery
Surgery is the treatment of choice when the cancer has not spread beyond
its original site. The purpose is to remove all malignant tissue. The
surgical procedure is hysterectomy- removal of the uterus.
Radiation
Therapy
The basic principle of radiation therapy is to bombard a
cancer with rays which damage or destroy the cancer yet produce only
minimum damage to surrounding normal tissues.
Radiation can be used alone or in
combination with surgery to help cure uterine cancer; to control tumor
growth; or to alleviate pain.
Following surgery, radiation therapy
may be used to kill cancer cells that could not be removed by the
operation.
When radiation therapy is combined with
surgery, it should not- always be assumed that the disease is
necessarily any worse than it is for patients who have surgery alone.
Each case of uterine cancer is different and requires individual
treatment.
Radiation may be beamed from an outside
source such as the X-ray or cobalt machine; or it may be applied
directly to the cancerous growth, through inserting in the uterus a
capsule of radioactive material, such as radium. Fortunately most
cancerous tissue of the uterus is more sensitive to radiation than is
normal tissue.
Skin reactions, nausea, vomiting, a
feeling of tiredness can be side effects of radiation. Rest and good
nutrition will help the body recover more quickly.
Chemotherapy
Drugs and hormones are used in treating some cases of advanced uterine
cancer. Such treatment, termed chemotherapy, may be used either alone or
in combination with surgery or radiation.
These anti-cancer drugs produce more
injury to cancer cells than to normal cells, but the physician maintains
a delicate balance between dose and frequency by giving enough
chemotherapy to kill cancer cells without destroying too many healthy
ones. Chemotherapeutic drugs work in several different ways but they
usually interfere with cell division and growth. Rapidly growing cells,
both normal and cancer, are most vulnerable to chemotherapeutic drugs.
Most chemotherapy is given in the
doctor's office or the outpatient department of hospitals. For some
patients, however; short periods of hospitalization may be necessary to
monitor treatment.
Certain common side effects may occur.
They include nausea and vomiting: diarrhea, hair loss, anemia, reduced
blood clotting ability, susceptibility to infections, and mouth sores.
Individuals tolerate drugs differently and when treatment is stopped,
side effects disappear; hair grows back, for example,· or anemia is
corrected. Any unexpected side effect should be reported to the
physician.
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Patient Education
