A tumor of the uterus or endometrial cancer (endometrial carcinoma, corpus carcinoma) is the most common cancer of the female reproductive organs and is the fourth most common cancer in women after breast cancer, lung cancer and colon cancer.
Fortunately, it is also one of the cancers that can be treated best.
The uterus is a muscular organ located in the pelvis. On the inside of the uterus, it has a cavity lined with mucous membrane (endometrium).
Until menopause, the mucous membrane of the uterus renews itself every month and is rejected during menstruation.
A tumor of the uterus can develop when the cells of the uterine lining change in the last years of menopause or after.
Uterine cancer should not be confused with cervical cancer, which is another disease.
Cancer of the uterus
The human body consists of thousands of billions of living cells. The normal cells of the body grow, divide and die in an organized and controlled manner.
In the first years of a person’s life, cell division occurs faster so that the newborn can grow. When the child becomes an adult, most cells divide only to replace worn or dead cells or to repair injuries.
Cancer begins when cells in one part of the body multiply in an unnatural way.
The growth of cancer cells is different from normal cell growth.
Instead of dying, the tumor cells continue to multiply and form new pathological cells.
Tumor cells can also invade other tissues, normal cells cannot.
A tumor is benign if it does not spread, malignant if it infiltrates other tissue structures of the body.
The uncontrolled growth and incursion into other tissues make a cell a cancer cell.
Cells become tumor cells due to DNA damage.
DNA is the genetic material contained in every cell that controls all cell activities.
If the DNA is damaged, a normal cell will repair the damage or die.
In tumor cells, DNA damage is not repaired, but the cell does not die as it should, but multiplies.
The new cells all have the same damaged DNA.
Carcinomas of the uterus
The tumors of the uterine lining begin in the cells lining the uterus and belong to the group of carcinomas.
Endometrial carcinomas are tumors of the cells that form the glandular tissue of the uterine lining. They are called adenocarcinomas.
The most common form of endometrial cancer is the so-called adenocarcinoma of the endometrium.
Rarer types are squamous cell carcinomas and undifferentiated carcinomas.
More than 80% of tumors of the uterine lining are typical adenocarcinomas, they are called endometrioid adenocarcinomas.
Adenocarcinoma consists of glandular cells that are very similar to those of the normal uterine lining (endometrium).
Some of these tumors contain squamous cells.
These are flat, thin and can occur on the outside of the cervix, as well as the glandular cells.
If the glandular cells under the microscope have a cancerous appearance, but the squamous cells have benign differentiation, the tumor is called adenocathoma.
If the squamous cells and also the glandular cells show malignant (malignant) changes, the tumor is called adenosquamous carcinoma.
Causes and risk factors for uterine cancer
The cause of the malignant degeneration of the uterine lining is not clearly understood, but the risk factors that increase the likelihood of cancer are known.
A malignant uterine tumor is more common in postmenopausal women. Younger women have a much lower risk.
For uterine sarcoma, treatment by irradiating the pelvic area may increase the risk in some women.
Researchers have identified several risk factors for endometrial cancer, including:
- the absence of pregnancies and births,
- first menstruation before the age of 12 and onset of menopause after the age of 50,
- estrogen therapy,
- personal or family case of breast
or ovarian cancer,
- Taking tamoxifen, a drug used to treat breast cancer.
As far as risk billing for uterine cancer is concerned, it should be borne in mind that some women at increased risk will never have uterine cancer, while others who are not at risk may well develop uterine cancer.
What symptoms cause endometrium cancer? How does it make itself felt?
In most cases, the tumor first makes itself felt by vaginal bleeding:
- Bleeding after menopause. The intensity can vary and ranges from a few drops to heavy bleeding. It is the most common symptom of endometrial cancer.
- Bleeding after sexual intercourse (postcoital).
- Bleeding outside the menstrual period, also known as intermenstrual bleeding (before menopause).
In some cases, the following symptoms appear first:
The symptoms described can also be caused by various other diseases.
If any of these symptoms occur, it is necessary to consult a doctor.
Note: Cervical cancer screening does not help with cancer of the lining of the uterus.
Over time, as the cancer spreads to other parts of the body, other symptoms can also be produced.
Diagnosis of endometrial cancer in uterine cancer
If, based on the symptoms, there is a suspicion of uterine cancer, a medical examination is carried out and a blood analysis is taken.
In addition, the following examinations are possible:
The doctor examines the uterus, vagina and nearby tissues for outgrowths and changes in shape and size.
The ultrasound device uses sound waves that are inaudible to humans. The sound waves produce an echo when they are reflected by the organs lying in the pelvis.
Based on the echo, an image of the uterus and the surrounding tissue structures can be created.
The images may show a uterine tumor.
For a better representation of the uterus, the transducer can be inserted into the vagina (transvaginal ultrasound).
In a biopsy, a tissue sample is taken, which is examined for the presence of tumor cells.
A thin tube is inserted into the uterus through the vagina. The doctor performs a scraping and suction to take the tissue sample.
A pathologist examines the tissue under the microscope for tumor cells. In most cases, biopsy is the only safe method to determine if cancer is present.
But even the biopsy is not always reliable, because only an insufficient amount of tissue is taken.
Hysteroscopy is a diagnostic procedure in which the inside of the uterus can be viewed with the help of a thin instrument with a tiny camera (hysteroscope).
The hysteroscope is inserted through the vagina (transvaginal), dilators or spreaders are not necessary.
Before examining the uterus, liquid or gas (physiological saline or carbon dioxide) is injected into the uterus to stretch the uterine walls.
With the camera, the doctor can analyze the uterine lining without taking tissue samples.
Stage of the disease
The stage indicates how far the tumor tissue deviates from normal tissue.
It may give an idea of how quickly the tumor is developing.
Tumors in advanced stages tend to grow faster than in earlier stages.
A tumor in the 3rd/4th stage is more likely to spread. For doctors, the stage of the disease, along with other factors, is a criterion for determining the best method of treatment.
In most cases, surgery is necessary to determine the stage of uterine cancer.
The surgeon removes the uterus (hysterectomy) and can take tissue samples from the pelvis and abdomen. After removal of the uterus, the tumor is checked to determine how far it has penetrated into the depth.
In addition, the tissue samples taken are examined for tumor cells.
Uterine cancer can be divided into the following stages:
Phase 0: The altered cells are only superficially located on the inner lining of the uterus. This early stage is called “carcinoma in situ” by doctors.
Phase I: The tumor has grown beyond the inner lining into the uterine lining, the myometrium may be infiltrated.
Phase II: The tumor has spread to the cervix.
Phase III: The tumor has grown beyond the uterus and has reached the surrounding tissues, such as the vagina and lymph nodes.
Phase IV: The tumor infiltrates the bladder or intestine or the tumor cells have spread far from the uterus, into the liver, lungs or bones.
What are the treatment options for endometrial cancer?
The most important treatment measure for endometrial cancer is surgery. Chemotherapy and radiation therapy are used elsewhere.
In any case, the recommended treatment depends on certain factors, such as the stage of the disease (size and spread of the tumor) and the general condition of the patient.
One should talk to a specialist who is familiar with the situation.
The doctor will provide information about the pros and cons of the individual forms of treatment, the chances of success, possible side effects and other aspects with regard to the treatment options.
Treatment goals should also be discussed.
In some cases, treatment is aimed at curing the tumor. In most cases, endometrial cancer is diagnosed at an early stage, when it has good prospects of healing or regression.
Doctors prefer to use the term regression.
Regression means that there are no traces of the tumor after treatment.
In some cases, however, the tumor comes back after months or years. That’s why doctors are sometimes wary of the word “cure.”
In other cases, treatment is used only to control the tumor.
If the therapy cannot cure the tumor, growth and spread can often be restricted.
In this way, the symptoms are stopped for a while.
In still other cases, treatment is designed to relieve symptoms. If the tumor has progressed, painkillers or other measures, for example, can be used to relieve pain and symptoms.
Some therapies help to reduce the size of the tumor, in this way symptoms and pain can be alleviated.
Surgery for uterine cancer
Surgical removal of the ovaries and uterus is a common treatment measure. As a rule, fallopian tubes and both ovaries are also removed.
Many procedures nowadays are performed laperoscopically.
If the tumor is in initial development and has not spread, surgical treatment may be sufficient.
If the tumor has spread to other areas of the body, surgery may also be useful here, but it is usually supplemented by other therapies.
Even if the tumor is advanced and cannot be cured, some surgical measures may be helpful in relieving the symptoms, such as occlusion of the intestine or urinary tract caused by the spread of the tumor.
Radiotherapy for uterine cancer
Radiotherapy uses high-energy beams of radiation that are concentrated on the tumor tissue.
In this way, the cancer cells are killed or their multiplication is prevented.
Radiotherapy alone can lead to a cure for early-stage endometrial cancer and be an alternative to surgery.
In some cases, radiation therapy is used in addition to surgery.
Even if the tumor progresses and regression is impossible, radiation therapy can be used to relieve symptoms.
For example, it can reduce secondary tumors that have formed in other parts of the body and cause pain.
One of the side effects of radiation therapy is the formation of fibrosis with an excess of X-rays.
Chemotherapy for uterine cancer
Chemotherapy is based on treatment with anticancer drugs.
These medicines destroy cancer cells or hinder their division.
Chemotherapy is not part of the standard treatment for endometrial cancer, but it can be used in certain situations (usually in addition to radiation therapy or surgery).
Side effects of chemotherapy include:
- Vomiting, nausea and diarrhoea;
- Shortness of breath;
- bleeding (hemorrhages);
- Mouth ulcers.
For some types of endometrial cancer, progesterone treatment is performed.
This usually does not happen in the early stages, but is considered when the tumor spreads or when it recurs after treatment.
Because uterine cancer progresses slowly and women immediately sit up and take notice of unusual vaginal bleeding, the majority of tumors are detected and treated in the early stages.
An endometrial carcinoma is curable in the early stages, the prognosis for a metastatic, relapsed carcinoma is much worse.
For early-stage cancer, surgery alone may be enough to cure 80% of cases.
In 20-30% of tumors, relapse occurs within 5 years.
Patients in the 1st to 3rd stages of the disease are usually treated surgically and with radiotherapy.
For the past twenty years, chemotherapy has been used in addition to or instead of radiotherapy.