Cancer of the uterus is one of the most common cancers of the female reproductive system, especially in postmenopausal women. The female hormone estrogen seems to play a significant role in development of uterine or endometrial cancer. The most common presenting symptom is abnormal vaginal bleeding. Postmenopausal bleeding is a particularly ominous sign. Almost all cancers of the uterus start in the endometrium, the inner lining of the uterus, hence uterine cancer and endometrial cancer are almost synonymous. Cancer starting in the supporting connective tissue (stroma) and muscle cells of the uterus, known as uterine sarcoma, is less common. Cancer of the cervix is very different from endometrial carcinoma.
The uterus is a hollow pear-shaped organ which lies within the pelvis between the bladder in front and the rectum behind it. The broad upper part is the body of the uterus, while the narrower lower portion is called the cervix, which leads into the vagina. The body of the uterus consists of 2 layers, the inner lining known as the endometrium and the outer muscular layer known as the myometrium. Cyclical changes occur in the endometrium every month due to varying hormonal levels. During a normal menstrual cycle the endometrium thickens and is then shed every month, which is known as menstruation.
Hormonal imbalances, such as unopposed estrogenic stimulation, can lead to endometrial thickening, known as endometrial hyperplasia. Although reversible in the initial stages, persistent stimulation may lead to atypical hyperplasia, which may be a precursor of endometrial cancer.
Based on their outlook and underlying cause, endometrial cancer may be of 2 types. Type 1 cancers are caused by excess estrogen. They are slow-growing, with better prognosis. Type 2 cancers are not estrogen dependent. They are more rapid-growing, with prognosis not as good as type 1 cancers.
Although the exact cause of uterine cancer is not known, contributing factors may be
Abnormal uterine bleeding is the commonest presentation of uterine cancer, of which postmenopausal bleeding is the most common symptom. There may be thin white or blood-tinged vaginal discharge in postmenopausal women. Bleeding in between periods (intermenstrual bleeding) and after or during intercourse (post-coital bleeding) is common. Prolonged, heavy periods may be present.
There may be lower abdominal or pelvic pain, painful urination, or pain during sexual intercourse. Other signs present may be unintentional weight loss and detecting a mass in the lower abdomen or pelvis.
Complications are more likely to occur if the cancer has been detected late. Urinary or bowel obstruction and bleeding from the vagina, rectum, or bladder may be due to spread of cancer to nearby structures. Spread to distant organs can cause breathing difficulty, persistent cough, and collection of fluid in the abdomen. There may be complications of treatment following surgery, radiotherapy, chemotherapy, and hormone therapy. Psychological complications such as depression are common.
Since uterine cancer is usually detected early, the outlook with proper treatment is very good. When diagnosed in the late stage, with spread to distant organs, the survival rate falls drastically.
