Dr. Vivek Sukumar

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What is uterine cancer?

Uterine cancer is a general term to describe cancer of the uterus. There are two types of cancers.
  • Endometrial cancer develops in the endometrium, the inner lining of your uterus, which is the most common type of uterus cancer.
  • Uterine sarcoma develops in the muscle of the uterus (myometrium).

Risk factors

There are several risk factors for endometrial cancer.
Conditions associated with an imbalance between estrogen and progestrones such as obesity, polycystic ovarian syndrome ( PCOS ) or hormone replacement therapy.
A few genetic disorders such as Lynch syndrome is associated with increased risk of uterine cancers along with colonic cancers.
Other risk factors include :
  • Older Age
  • Obesity
  • High fat diet
  • Nulliparity
  • Long menstrual span ( Early menstruation and Late menstruation )
Previous therapy such as radiation to the pelvis for other cancers and use of tamoxifen in breast cancer treatment are associated with increased risk of uterine cancer.

Symptoms

Symptoms of endometrial cancer or uterine sarcoma include:
  • Post-Menopausal bleeding
  • Lower abdominal pain
  • Vaginal discharge

Diagnosis

When patients present with classical symptoms of uterine cancer, a ultrasound of the abdomen and pelvis is taken. If then is classical uterine ( endometrial cancer ) there will be a thickened endometrium which is then sampled by a dilatation and currattage or endometrial biopsy. The biopsy will confirm the diagnosis, following this MRI of the pelvis is performed to assess extent of the disease and PET CT to determine the extent of the spread of disease.
Once the stage has been determined using imaging,the uterine cancer is staged from stage I to stage IV :

cancer hasn’t spread beyond your uterus.

cancer has spread to your cervix.

cancer has spread to your vagina, ovaries and/or lymph nodes.

cancer has spread to your bladder or other organs far away from your uterus.

How is uterine cancer treated?

Early stages are treated by surgery and occasionally followed by radiation therapy. More advanced stages undergone a staging procedure followed by chemotherapy and radiation. Metastatic disease is treated with Chemotherapy. Palliative surgery may be required in this stage to alleviate symptoms such as bleeding and pain.

Treatment

Minimally invasive surgery can be performed in early stages of uterine cancer. This would include hysterectomy and bilateral ovaries, Pelvic Lymphadenectomy, Para-aortic Lymphadenectomy and Infracolic Omentectomy

Does everyone need a Pelvic lymph node dissection?

If the cancer involves more than half of the myometrium then pelvic lymph node dissection is performed and sent for a frozen section to determine if the nodes are positive. If the pelvic nodes are positive then Retroperitoneal lymph node dissection is performed.