Uterine cancer is the most common cancer occurring in a woman’s reproductive system.
There are 2 major types of uterine cancer.
Adenocarcinoma makes up more than 80% of uterine cancers and develops from cells in the endometrium. Endometrioid carcinoma is a common type of endometrial adenocarcinoma, whilst less common types of uterine cancers include serous, clear cell, and carcinosarcoma.
Sarcoma accounts for about 2% to 4% of uterine cancers and develops from the uterine supporting tissues or the uterine muscle

Uterine Cancer Treatment In Malaysia



 

Genetics and family history

A higher risk for uterine cancers can be inherited and happens about 5% of the time. Lynch syndrome is most commonly associated with inherited uterine cancer and is also associated with colon, kidney, bladder, and ovarian cancers. Lynch syndrome is associated with DNA mismatch repair defect.

People affected by Lynch syndrome can receive increased screening for Lynch-associated cancers. Affected family members may consider preventive surgery for uterine and ovarian cancer.

Risk Factors

The following factors may raise a woman’s risk of developing uterine cancer:

Age
The average age at diagnosis is 60. Uterine cancer is not common in women younger than 45.
Obesity
Fatty tissue in obese women produces additional estrogen, which can increase the risk of uterine cancer. About 70% of uterine cancer cases are linked to obesity.
Genetics
It is recommended that all women under the age of 60 with endometrial cancer should have their tumor tested for Lynch syndrome, even if they have no family history of colon cancer or other cancers. The presence of Lynch syndrome has important implications for women and their family members.
Other Cancers
Women who have had breast cancer, colon cancer, or ovarian cancer have an increased risk of uterine cancer.
Radiation therapy
Women who have had previous radiation therapy for another cancer in the pelvis have an increased risk of uterine cancer.
Estrogen
Extended exposure to estrogen related to early menarche, late menopause or hormone replacement therapy may increase uterine cancer risk.

 

Symptoms and Signs

  • Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, this includes menorrhagia, which is an abnormally heavy or prolonged bleeding
  • Abnormal results from a Pap Smear Test.
  • Pain in the pelvic area

 

Diagnosis

In addition to a physical examination, the following tests may be used to diagnose uterine cancer.

Pap Smear is done during pelvic examination to look for abnormal glandular cells, which are caused by uterine cancer.

Endometrial biopsy allows removal of a small amount of tissue for examination under a microscope. This allows a definite diagnosis to be made.

Dilation and curettage is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. After endometrial tissue has been removed, during a biopsy or D&C, the sample is checked for cancer cells.

Computed tomography (CT) scan allows a detailed, 3-dimensional image to exclude any abnormalities or tumors.

Magnetic resonance imaging (MRI) uses magnetic fields to produce detailed images of the body.

 

FIGO stages for uterine cancer

Doctors assign the stage of endometrial cancer using the FIGO system.

 
Stage I

The cancer is found only in the uterus or womb, and it has not spread to other parts of the body.

 

  • Stage IA:The cancer is found only in the endometrium or less than one-half of the myometrium.
  • Stage IB:The tumor has spread to one-half or more of the myometrium.

 

 
Stage II

The tumor has spread from the uterus to the cervix.

 
Stage III

The cancer has spread beyond the uterus, but limited to the pelvis.

 

  • Stage IIIA:The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body.
  • Stage IIIB:The tumor has spread to the vagina.
  • Stage IIIC1:The cancer has spread to the regional pelvic lymph nodes.
  • Stage IIIC2:The cancer has spread to the para-aortic lymph nodes.

 

Stage IV

The cancer has metastasized to the rectum, bladder, and/or distant organs.

 

Treatment overview

Talk to our Oncologists at Onco Life Centre about your treatment options. The main treatments for uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. Often the best approach uses 2 or more of these treatment methods. It is important that you understand the goal of your treatment. If a cure is not possible, treatment is aimed at relieving symptoms such as pain.

 

Surgery

Hysterectomy can be simple (removal of the uterus and cervix) or radical (removal of the uterus, cervix, the upper part of the vagina, and nearby tissue). For patients who have been through menopause, the surgeon will typically also perform a bilateral salpingo-oophorectomy, which is the removal of both fallopian tubes and ovaries.

If the ovaries are removed, this ends the body's production of sex hormones, resulting in early menopause. However, the adrenal glands and fat tissues will still carry out some sex hormone production.

Lymph node removal at the vicinity of the tumor will determine if the cancer has spread beyond the uterus.

Radiation therapy

Some women with uterine cancer need radiation therapy after surgery to destroy any remaining cancer cells.

Radiotherapy options include radiation therapy directed towards the whole pelvis and/or applied only to the vaginal cavity, called vaginal brachytherapy.

Systemic therapies

The types of systemic therapies used for uterine cancer include Chemotherapy, Hormonal therapy, Targeted therapy and Immunotherapy.

Chemotherapy is aimed at destroying cancer remaining after surgery or aimed at shrinking the cancer and slowing down the tumor's growth if it recurs after initial therapy.

Advances in chemotherapy during the last 10 years include the development of new drugs for the prevention and treatment of side effects.

Hormone therapy is used to slow the growth of grade 1 or 2 tumors uterine adenocarcinomas. The use of aromatase inhibitors will reduce the amount of the hormone estrogen in a woman's body by stopping tissues other than the ovaries from producing it.

Targeted therapy targets the cancer’s specific genes, proteins, or the tissue environment to block cancer cell growth and spread while limiting damage to healthy cells.

  • Anti-angiogenesis therapy is focused on stopping process of making new blood vessels and “starving” the tumor.
  • Mammalian target of rapamycin (mTOR) inhibitors. In endometrial cancer, mutations in mTOR pathway allow women with advanced or recurrent uterine cancer to be treated with a drug that blocks this pathway.

Immunotherapy is designed to boost the body's natural defenses to fight the cancer. Immunotherapy is approved by the US-FDA for uterine cancers with DNA mismatch repair defect or high microsatellite instability.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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