Uterine Cancer - Symptoms And Treatment
Alternative names :-
Adenocarcinoma of the endometrium/uterus; Cancer - uterine; Cancer - endometrial; Endometrial cancer
The most common gynecologic cancer, uterine cancer (cancer of the endometrium) typically afflicts post, menopausal women between ages 50 and 60. It's uncommon between ages 30 and 40 and rare before age 30. Most premenopausal women who develop uterine cancer have a history of anovulatory menstrual cycles or other hormonal imbalances. About 33,000 new cases of uterine cancer are reported annually; of these, approximately 5,500 are fatal.
You can increase the chances that endometrial cancer will be found early by having any unusual bleeding checked by your doctor right away. Endometrial cancer can almost always be treated successfully if it's caught early.
Uterine cancer appears to be linked to several predisposing factors:
- low fertility index and anovulation
- history of infertility or failure of ovulation
- abnormal uterine bleeding
- obesity, hypertension, diabetes, or
- familial tendency
- history of uterine polyps or endometrial hyperplasia.
- prolonged estrogen therapy without use of progesterone.
In most patients, uterine cancer is an adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and brain, by way of the blood or the lymphatic system. Lymph node involvement can also occur. Less common uterine tumors include adenoacanthoma, endometrial stromal sarcoma, lymphosarcoma,mixed mesodermal tumors (including carcinosarcoma), and leiomyosarcoma.
Complications of uterine cancer include intestinal obstruction, as cites increasing pain, and hemorrhage.
Signs and symptoms of Uterine Cancer
The patient history may reflect one or more predisposing factors. In the younger patient, it may also reveal spotting and protracted, heavy menstrualperiods.The postmenopausal woman may report that bleeding began 12 or more months after menses had stopped. In either case, the patient may describe the discharge as watery at first, then blood-streaked, and gradually becoming bloodier. In more advanced stages, palpation may disclose an enlarged uterus.
Endometrial, cervical, or endocervical biopsy confirms cancer cells. Fractional dilatation and curettage identifies the problem when the disease is suspected but the endometrial biopsy is negative. Positive diagnosis requires the following tests to provide baseline data and permit staging:
- multiple cervical biopsies and endocervical curettage to pinpoint cervical involvement
- Schiller's test, the staining of the cervix and vagina with an iodine solution that turns healthy tissues brown (cancerous tissues resist the stain)
- computed tomography scan or magnetic resonance imaging to detect metastasis to the myometrium, cervix, lymph nodes, and other organs. excretory urography and, possibly, cystoscopy to evaluate the urinary system
- proctoscopy or barium enema studies, which may be performed if bowel and rectal involvement are suspected . blood studies, urinalysis, and cytologic examination of the urine may also help in evaluating the disease and assessing complications of the therapy.
STAGING UTERINE CANCER
|The International Federation of Gynecology and Obstetrics defines uterine (endometrial) cancer in five stages, as outlined below.
Carcinoma in situ
Carcinoma confined to the corpus
- Stage 1A - length of the uterine cavity 8cm or less.
- Stage 1B - length of the uterine cavity more than 8cm.
Stage 1 disease is sub-grouped by the following histologic grades of the adenocarcinoma :
G1 - highly differentiated adenomanomatous carcinoma with partly solid, areas.
G2 - moderately differentiated adenomatous carcinoma.
G3 - predominantly solid or entirely undifferentiated carcinoma.
Carcinoma involving the corpus and the cervix but not extending outside the uterus.
Carcinoma extending outside the uterus but not outside the true plevis.
Carcinoma extending outside the true pelvis or obviously involving the mucosa of the bladder or rectum.
- Stage 4A - spread of the groWth to adjacent organs.
- Stage 4B-spread to distant organs.
Treatment of Uterine Cancer
Depending on the cancer's extent, treatment may include one or more of the following measures:
- Surgery usually involves total abdominal hysterectomy, bilateral salpingo-oophorectomy or, possibly, omentectomy with or without pelvic or paraaortic lymphadenectomy. Total pelvic exenteration removes all pelvic organs, including the rectum, bladder, and vagina, and is only performed when the disease is sufficiently contained to allow surgical removal of diseased parts. This surgery seldom is curative, especially in nodal involvement.
- Radiation therapy is used when the tumor isn't well-differentiated, intracavitary radiation, external radiation, or both may be given 6 weeks before surgery to inhibit recurrence and lengthen survival time.
- Hormonal therapy, using antiestrogenies such as tamoxifen, shows a response rate of 20% to 40%.
- Chemotherapy, including cisplatin and doxorubicin, is usually attempted when other treatments have failed.
Special considerations and Prevention
- Listen to the patient's fears and concerns She may be fearful for her survival and concerned that treatment will alter her lifestyle or prevent sexual intimacy. Encourage her to use available support systems to cope with loss of fertility, if applicable. Remain with the patient during periods of severe stress and anxiety.
- Administer pain medications as necessary. Patients who require pain medications for this disease are commonly in the later stages. Encourage the patient to identify actions that promote comfort and then be sure to perform them as often as possible. Provide distractions and help her perform relaxation techniques that may ease her discomfort.
- Prepare the patient for surgery as indicated.
- Find out whether the patient will have internal or external radiation or both. Usually, internal radiation therapy is used first.
- Provide supportive care for adverse effects of radiation therapy or chemotherapy.
- Depending on the patient's condition and the therapies and treatments selected, she may require a dietitian to help maintain nutritional needs and a physical therapist to help maintain joint mobility and ambulation. In addition, a pain care specialist can help control discomfort and provide options for pain relief. The patient may also benefit from speaking with a spiritual counselor or pastoral care representative.
- Monitor the patient's complete blood count (including differential) regularly for signs of immunosuppression caused by radiation therapy and chemotherapy. Also assess regularly for signs and symptoms of infection, bleeding, and anemia and monitor vital signs.
- Emphasize that prompt treatment significantly improves a patient's likelihood of survival. Discuss tests to diagnose and stage the disease and explain treatments, which may include radiation therapy, surgery, hormonal therapy, chemotherapy, or a combination of these.
- All women should have regular pelvic exams and Pap smears beginning at the onset of sexual activity (or at the age of 20 if not sexually active) to help detect signs of any abnormal development.
- If the patient is premenopausal, explain that removal of her ovaries will induce menopause.
- As appropriate, explain that, except in total pelvic exenteration, the vagina remains intact and that once she recovers, sexual intercourse is possible.
- Describe the procedure for radiation therapy to the patient. Answer the patient's questions and counsel her about radiation's adverse effects. Advise her to rest frequently and maintain a well-balanced diet.
- To minimize skin breakdown and reduce the risk of skin infection, tell the patient to keep the treatment area dry, avoid wearing clothes that rub against the area, and avoid using heating pads, alcohol rubs, or irritating skin creams. Because radiation therapy increases susceptibility to infection (possibly by lowering the white blood cell [WBC] count), encourage her to avoid people with colds or other infections.
- Explain chemotherapy or immuno therapy to the patient and her family and be sure they understand what adverse effects to expect and how to alleviate them. If the patient is receiving a synthetic form of progesterone, such as bydroxyprogesterone, medroxyprogesterone, and megestrol, tell her to watch for depression, dizziness, backache, swelling, breast tenderness, irritability, and abdominal cramps, instruct her to report signs and symptoms of thrombophlebitis, such as pain in the calves, numbness, tingling, or loss of leg function.
- Advise the patient receiving chemotherapy that WBC counts must be checked weekly, and reinforce the importance of preventing infection. Assure her that hair loss is temporary, and discuss alternative options such as scarves.
- If the patient is employed and is undergoing chemotherapy, point out that continuing to work during this period may offer an important diversion. Advise her to talk with her employer about a flexible work schedule or working at home as energy permits.