UTERUS CANCERS

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There are two types of uterine cancer, those that develop from the lining of the uterus (endometrium) and those that develop from the uterine wall (uterine sarcoma).

A. Cancer of the inner lining of the uterus (endometrium):

It is the most common female organ cancer in developed countries. It accounts for approximately 6% of all cancers in women. Most common between the ages of 55-70 (menopause Although it is seen after age, it can also be seen rarely between the ages of 35-40. It accounts for 95% of uterine cancers.

What are the risk factors that increase the occurrence of uterine cancer?

We can list the main risk factors as not giving birth, entering menopause at a late age, obesity, diabetes, using the drug tamoxifen for breast cancer, uncontrolled use of estrogen therapy, and the presence of cellular changes in the lining of the uterus, which we call atypical hyperplasia. All these factors are situations that increase the effect of the estrogen hormone.

Reduces the effect of estrogen birth control pillsHaving multiple births, breastfeeding, and smoking are factors that reduce the risk of this cancer.

What are its main findings?

The most important and early finding is abnormal bleeding. It is most commonly seen as postmenopausal bleeding. Abnormal bleeding in the pre-menopausal age should also be examined seriously. Sometimes there may be a complaint in the form of bloody discharge. If a woman consults a physician as soon as she complains of post-menopausal bleeding or non-menstrual bleeding, we have a very high chance of detecting endometrial cancer early. In advanced stages of the disease, continuous bleeding and lower abdominal pain occur. For early diagnosis, women with risk factors should be examined by a gynecologist at least once a year. In this way, the thickness of the inner lining of the uterus and its regularity are evaluated by ultrasonography.

How is the diagnosis made?

People with risk factors need especially close follow-up. The golden rule for women who have extramenstrual bleeding after menopause and after the age of 35 is to take a tissue sample from the uterus and send it to pathology. This is done either with a simple plastic syringe (Pipelle) or a metal curette. No anesthesia is required for sampling using a pipette.

In addition, if the inner lining of the uterus is found to be excessively thick and irregular during the control ultrasonographic examination, sampling should be performed again.

The smear test performed for cervical cancer screening in women has no place in the diagnosis of endometrial cancer. However, if intrauterine cells are seen in the Pap smear test of postmenopausal women, a biopsy should be performed.

In the early stages of uterine cancer, the tumor can be directly seen with hysteroscopy and a biopsy can be performed.

After diagnosis is made by biopsy, further radiological examinations (tomography or MRI) are performed to determine the extent of the disease.

How is the treatment?

The main treatment method for the disease is surgery. With surgery, cancerous structures are removed and the extent (stage) of the disease is determined. Depending on the stage of the disease, radiation therapy (radiotherapy), hormone therapy or drug therapy (chemotherapy) may be given after surgery. Patients caught at an early stage have a very high chance of survival after treatment.

B. Uterine Sarcoma:

It constitutes about 5% of uterine cancers. It is mostly seen in post-menopausal women. Bleeding may not occur as early and frequently as cancer of the inner lining of the uterus (endometrium). Therefore, early diagnosis is not always possible. Patients who cannot be diagnosed early do not have a good chance of living long. On examination, the uterus is usually found enlarged. A mass hanging from the cervix may be observed. In suspicious cases, a biopsy should be performed and sent to pathology. Once diagnosed, the primary treatment is surgery. Additionally, radiation therapy (radiotherapy) and drug therapy (chemotherapy) are applied.