It is the abnormal growth of cells anywhere within the reproductive organs of the uterus and cervix in a female.
Uterine cancers are of two main types. Those which arise from the outer lining of the uterus called the endometrium (Endometrial Cancer) and those which arise from the inner muscular layer of the uterus called the myometrium. Out of the two, endometrial cancers are the commonest, and account for up to 90% of all uterine cancers. Around 380,000 new cases of endometrial cancer are being diagnosed every year and the five year survival rate for those diagnosed with uterine cancer is around 83%.
Cervical cancer is by far the commonest gynecological cancer to affect women world over. There are two types of cervical cancers namely, Squamous cell carcinoma ( which arises in the flattened squamous cells which line the lower part of the cervix, and account for 80% of cases diagnosed with cervical cancer) and Adenocarcinoma (which arises from the glandular epithelium that lines the upper part of the cervix). More than 500,000 new cases of cervical cancer have been reported annually, with a five year survival rate of 73%.
What Are the Symptoms of uterine and cervical Cancer?
Both these conditions rarely have symptoms during the early stages. Symptoms during the late stage of the diseases include:
- Post-menopausal bleeding or intermenstrual vaginal bleeding
- Menstrual bleeding which is heavier than normal and lasts for a long period of time
- Post coital bleeding
- Pain following sexual intercourse
- Foul smelling vaginal discharge
- Lower back pain
- Easy fatigability
- Loss of weight and loss of appetite
If you have developed any of these symptoms and you are worried, then you should definitely see your doctor at the earliest.
What causes uterine and cervical cancer?
Almost all reported cases of cervical cancer have been due to infection with certain types of the Human Papilloma Virus (HPV). Although about 1 in 8 women will get infected with this virus during their lifetime, not all of them will go on to develop cervical cancer. Only certain strains of the virus have been identified to carry the risk. Smoking is also thought to be a risk factor associated with the development of cervical cancer.
Although an exact cause cannot be identified for the development of uterine cancer, associated risk factors which increase the likelihood are:
- Being in the post-menopausal age group
- Nulliparity
- Early menarche
- Obesity
- Family history of gynecological cancer
- Past history of Polycystic Ovarian Syndrome
- Undergoing hormone replacement therapy
- Being on treatment with tamoxifen for breast cancer
What tests are used to diagnose uterine and cervical cancer?
Diagnosis of uterine and cervical cancers are done through evaluation of the patient’s medical history, a complete physical examination and diagnostic investigations. During the physical examination, the doctor will want to examine your cervix and uterus using a speculum and colposcope. During the procedure your doctor might even take a biopsy from the cervix to be viewed under the microscope for the presence of cancer cells.
If this type of biopsy is not possible then your doctor might suggest doing a Large Loop Excision of the Transitional zone, which is done under local anesthesia, and is also considered a form of treatment when a patient is thought to have a precancerous lesion in the cervix. A cone biopsy can also be done in similar circumstances.
The diagnostic investigations for uterine cancer include:
- Trans-vaginal ultrasound scan – which is done by inserting the ultrasound probe through the vagina, and it helps assess the size of the uterus, the thickness of the endometrium and any abnormalities with the ovaries.
- Hysteroscopy and biopsy – which is the gold standard investigation when uterine cancer is suspected. Your doctor will insert a thin, flexible tube fitted with a camera through your vagina and into the uterus, which will allow him to visualize the insides of the uterus. During this procedure a biopsy can also be taken if any abnormal areas are detected.
- Other imaging procedures such as CT and MRI are done in order to assess the spread of cancer to other parts of the body.
What is the treatment for uterine and cervical cancer?
In the case of uterine and cervical cancer, you need to stage the disease first in order to plan the treatment. Therefore your doctor will assess the extent of the cancer, depending on the size of the tumor and how far out into other parts of the body it has spread, using the TNM system, and give it a stage between 1-4.
Once the stage of the disease has been determined, a team of medical professionals including your GP, a Gynecologist, Gynecological Oncologist, Medical Oncologist, Radiation Oncologist, cancer nurses as well as other healthcare professionals such as dietician, social worker, physiotherapist and counselor, will decide on the treatment plan for you. The treatment options available are:
- Surgery – for cervical cancer, sometime even a cone biopsy or LLETZ may suffice, but in the case of widespread disease a hysterectomy may be required. For uterine cancer, hysterectomy plus bilateral salpingo-oophorectomy is required.
- Radiotherapy – is used in the case of uterine cancer following surgery to destroy any cancer cells which may have been left behind. It is also used as a treatment alone when surgery is not possible.
- Hormone therapy – is again used following surgery to prevent the recurrence of cancer, or if surgery is not possible.
What is the Prognosis of uterine and cervical cancer?
The outcome of uterine and cervical cancer is dependent on many factors such as the stage of the cancer and the type of cancer. The general health condition of the patient such as age, level of fitness and medical history also play a role in determining the outcome of the disease.
Most cases of cervical and uterine cancer have a good prognosis if detected early on. Something to keep in mind before commencing treatment is the fertility wishes of the patient.
Screening for and prevention of uterine and cervical cancer
There are no specific screening methods available for the early detection of uterine cancer, and no proven methods of prevention as well.
An effective screening program is in place for cervical cancer, which is the PAP smear that women between the ages of 21-75 are requested to undergo once every 3 years.
Prevention of cervical cancer can be achieved through administration of the HPV vaccine, which significantly reduces the risk. Even though you have had the vaccine, you should undergo the screening tests from the appropriate age.