|
|
|
|
Contents How is Cancer of the Endometrium Treated?
Cancer of the Uterus or womb can be broadly divided into two groups, endometrial cancer and uterine sarcoma. This information pamphlet relates to endometrial cancer. A separate summary containing information on uterine sarcoma is also available. The uterus (womb) is the pear shaped organ in the pelvis, at the top of the vagina, in which a baby grows. A layer of tissue called endometrium lines the uterus and it is this lining that bleeds each month causing a menstrual period. Cancer of the endometrium occurs when cancer (malignant) cells are found growing in the endometrium; these cancer cells having come from the endometrium. This cancer is fairly common with some 250 plus cases occurring in Queensland each year. This cancer occurs most commonly in postmenopausal women, i.e., women who have gone through the menopause. The commonest age group for this disease is between 60 and 69 years, however, cases are seen in younger women including women in their 30's. Predisposing factors: This is now the commonest gynaecological cancer in the western world and is becoming more common for a couple of reasons. Firstly, most cancers are to a large extent a disease of aging. As the population ages, the incidence of cancer increases in the population. However, that is not the entire story with respect to endometrial cancer. Endometrial cancer is more common in obese women; fat has a poor ability to convert precursors into oestrogen. With enough fat (obesity) there is enough extra oestrogen to chronically stimulate the development of endometrial cancer in some women. Consequently as our population gets fatter we see a high incidence of endometrial caner. Presentation/Symptoms: The most common presenting problem that these women have is postmenopausal bleeding. Therefore any bleeding from the vagina after the menopause should be investigated to make certain that cancer is not the cause. Furthermore, a doctor should be seen if there are any of the following problems:
Endometrial cancer has also been found in women taking a drug, Tamoxifen, as part of their treatment for breast cancer. If this drug is being taken then any vaginal bleeding, other than normal periods, should be reported to the doctor as soon as possible. Diagnosis: Because cancer of the endometrium grows inside the uterus, it does not usually show up on a Pap smear. For this reason the doctor may also do other tests such as, a 'Pipelle' sampling or hysteroscopy, &/or dilatation & curettage (D&C) to check the inside of the uterus; endometrial sampling or biopsy. While a 'Pipelle' sampling can often be done at the doctor's rooms, such procedures as a hysteroscopy or D&C generally needs admission to hospital and an anaesthetic. A sample of the lining of the uterus is taken and sent to a pathologist for examination to check for the presence of any cancer cells. The chance of recovery or cure (prognosis) and choice of treatment depends on the stage of the cancer, i.e., whether it is just in the endometrium or has spread to other parts of the uterus or other parts of the body. However, over 70% of women have stage I disease when first diagnosed and treated, and this group has an excellent prognosis with 90% still being alive 5 years after treatment. Stage I Cancer is limited to the main part or body of the uterus (it is not found in the cervix). Stage II Cancer cells have spread to the cervix Stage III Cancer cells have spread outside the uterus but not outside the pelvis Stage IV Cancer cells have spread outside the uterus, to other parts of the body, or into the lining of the bladder or rectum. Recurrent Recurrent disease means the cancer has come back (recurred) after it has been treated.
If a patient's cancer has recurred it is NOT re-staged. A patient who
originally had Stage I cancer who develops a recurrence, say in the lungs some
time later, does NOT then have Stage IV cancer; they have recurrent metastatic
Stage I cancer. ___________________________________________________________________________ How is Cancer of the Endometrium Treated? Surgery is the main form of treatment for this type of cancer. The operation involves removal of the uterus, fallopian tubes and ovaries through a cut in the abdomen. The uterus is sent to the pathologist for a frozen section examination during the surgery. Depending on how deeply the endometrial cancer in growing into the wall of the uterus a decision will be made as to whether lymph nodes should be removed. These are small bean-shaped structures that are found throughout the body, usually following the blood vessels. They produce and store infection-fighting cells but may trap, contain and grow cancer cells. Radiation therapy is the use of high energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (a linear accelerator) or it may come from putting material that produces radiation (radioisotopes) through thin tubes into the body (brachytherapy). Radiation if needed is usually used after surgery. Chemotherapy is the use of drugs to kill cancer cells. It may be taken orally in the form of a tablet(s) or given by injection directly into the bloodstream where it can travel through the body and kill cancer sells outside the uterus. Chemotherapy is now being used more commonly in the treatment of endometrial cancer. Hormone therapy is the use of hormones, usually progesterone, to kill cancer cells. Once treatment is completed then follow-up commences. The usual follow-up for patients who have been treated for endometrial cancer is as follows: First two years every 3 months Three to five years every 6 months After 5 years once a year. At the follow-up visit a short history is taken covering the time since the last visit. Then an examination is made of lymph nodes, abdomen and pelvis. Pap smears are rarely done, as they are not useful in following up patients with this cancer.
|
|
WWW design & maintenance palmer.net.au
|
