What is uterine cancer?
Cancer is the uncontrolled growth of cells within the body. Usually, all of our cells have a specific lifespan of days to years that is genetically programmed in our DNA. When our DNA becomes damaged, either through the aging process, exposure to toxins such as radiation or chemicals or through inherited genes, some cells do not die a natural death but continue to grow. As they do, they form new cells with the same genetic misinformation. These extra cells may form masses or tumours that can be either malignant or benign. A benign tumour is a tumour that does not invade the surrounding tissue or spread around the body and stays in one place. A malignant tumour can invade the surrounding tissue or spread via the blood or lymph networks and affects other cells and organs.
Uterine cancer, womb cancer or sometimes endometrial cancer is a common type of cancer that only occurs in women. The majority of uterine cancers occur in the endometrium – the mucous membrane that lines the inner wall of the womb. It is the endometrium that thickens during the menstrual cycle to prepare for pregnancy.
While vulvar, cervical and ovarian cancers are not a subgroup of uterine cancer, we have included their diagnosis and treatment in this article.
Uterine cancer can be curable but usually involves a hysterectomy or surgical removal of the womb. Later stage uterine cancer is most likely to metastasize to the colon, rectum and lungs.Cancer of the cervix or ovaries may also requires the removal of extensive areas of reproductive tissue, sometimes including the uterus. Cancer of the vulva is also surgically treated. Most oncologists recommend additional radiotherapy before (neoadjunct) or after (adjunct) surgery. Chemotherapy and more recent targeted and immunological therapies also have their role to play. Gynaecologic cure rates, including those of breast cancer, are consistently increasing due to advances in treatment, screening and more awareness of symptoms in the general population.
Whether you have been diagnosed with uterine, ovarian, cervical or vulvar cancer or are in a high-risk group, Remedazo can put you in touch with expert gynaecologists, reproductive endocrinologists and oncologists for up to three free online consultations to discuss every possible treatment option.
Are there different types of uterine cancer?
The uterus is an upside-down pear shape with three layers of tissue. The inner layer, the endometrium, provides a blood vessel-filled bed that allows foetal nutrition during pregnancy. The middle layer – the myometrium – is composed of a thick layer of smooth muscle. The outer layer or perimetrium covers the outside of the uterus. At the bottom of the womb, the narrow cervix leads into the vagina. Finally, the folds of the vulva surround the openings of the vagina and urethra.
Cervical and vulvar cancers are not the same as uterine cancer. Ovarian cancer, often linked to more aggressive cancer types, is also a separate entity. However, many women believe a papanicolaou (PAP) smear test will detect most cancers of the reproductive system. This is not correct. For peace of mind and early detection, screening for a broad range of cancers on an annual basis is advised. Remedazo arranges complete diagnostic health checks using radiation-free MRI and ultrasound imaging in all medical specialties.
For an overview of the most common types of ovarian, uterine, cervical and vulvar cancers, please read on.
Endometrial hyperplasia
Endometrial hyperplasia or excess thickening of the endometrium is not cancer but can lead to uterine cancer in those who have been diagnosed. In the presence of high levels of oestrogen in the absence of progesterone, the lining of the uterus remains in place if fertilisation of the egg or ovulation does not occur. This means irregular periods with little bleeding as the endometrium becomes thicker and thicker.
If you have been diagnosed with atypical endometrial hyperplasia, you will need to undergo treatment to remove abnormal cells before they have the opportunity become cancerous. Endometrial hyperplasia is more common after the menopause but increasing numbers of young, obese women are experiencing endometrial hyperplasia.
Vulvar intraepithelial neoplasia
Vulvar intraepithelial neoplasia or VIN is another benign diagnosis that may increase your risk of developing vulvar cancer. Younger women usually present with this disease after becoming infected with the human papilloma virus; older women have a slightly different type that is not associated with a sexually transmitted infection. This precancerous condition can be treated as a minimally-invasive outpatient procedure.
Adenocarcinoma and squamous cell carcinoma
The most common uterine cancer is endometrial adenocarcinoma. It is also one of the least likely uterine cancer types to metastasize and produces symptoms at an early stage. Endometrial cancer is quite slow to develop and most common in post-menopausal women; however, obese women, women with type II diabetes or those who have had hormone therapy for breast cancer are all high risk. In fact, up to 40% of endometrial adenocarcinoma cases occur in women who are obese. Very few cases are hereditary. When uterine endometrial cancers begin in mucous-producing cells of the womb they are referred to as adenosquamous carcinomas.
Cervical adenocarcinoma is another form of gynaecologic cancer but is less associated with post-menopausal women. Cervical cancers are often the result of sexual activity with a person infected with human papilloma virus (HPV). Where the mucus-producing glands produce mutated cells, the diagnosis will be squamous cell carcinoma of the cervix. This type of cancer can also be found in the vulva but only very rarely in the ovaries. A verrucous carcinoma of the vulva is a wart-like, slow-growing cancer that responds well to treatment at early to mid stages.
Vulvar melanoma
Melanoma is usually the result of sun damage and growths are located on exposed areas of skin. This is not the case with vulvar melanoma. Women with melanoma on other areas of the body are more likely to develop vulvar melanoma.
Papillary serous carcinoma
Papillary serous carcinoma is a rare cancer type that begins in either the womb or the cervix. It is aggressive and often only detected in later stages. Treatment is therefore always a combination of surgery, chemotherapy and radiotherapy.
Uterine sarcoma
Uterine sarcomas are very rare and begin in the connective tissue of the uterus, usually in the thick muscle layer. They can develop on their own (de-novo) or after radiation treatment (RT sarcoma). As with all types of uterine cancer, first-line treatment is surgery and radiation therapy; your oncologist may additionally prescribe chemotherapy, targeted therapy, immunotherapy or a combination of these. Cervical sarcoma is similarly rare, as is ovarian sarcoma.
Ovarian epithelial cancer
Most ovarian tumours of the outer ovarian surface (the epithelium) are benign but have the potential to become cancerous and should therefore be closely followed up if not removed. Where ovarian epithelial tumours are malignant, lack of symptoms can mean the disease is already advanced. If your medical report mentions low malignant potential or LMP tumours, these do not yet appear to be cancerous.
Ovarian germ cell tumours
The cells that produce human eggs can overgrow but are rarely malignant. Cancerous cases are usually found in young women and teenagers. If your daughter has been diagnosed with a germ cell tumour of the ovary, you can be sure Remedazo will provide a sensitive team of support staff, and empathic, expert physicians and nursing staff for all of our patient partners. We also cater for all accompanying family members.
Nearly all cases of ovarian germ cell cancers are curable and future fertility is left unaffected after treatment.
Ovarian stromal cell tumours
Hormone-producing cells can, on rare occasions, produce stromal tumours that grow extremely slowly and are usually detected at an early stage. This means their treatment is nearly always curative.
Oestrogen-positive cancer
Some types of mutated cells that cause uterine, ovarian or cervical cancer have receptors on their outer surfaces that female sex hormones (oestrogen and progesterone) can attach to. When these hormones attach they encourage cancer cells to multiply at a faster rate. New scientific discoveries allow oncologists to block the receptors and so slow down cancer growth.
Oestrogen-positive cancers grow more quickly in the presence of oestrogen. Progesterone-positive cancers use progesterone to increase in size. Women taking hormone replacement therapy during or after the menopause sometimes have a higher risk of developing uterine cancers.
HER2-positive cancer
Some types of mutated cells that cause ovarian, uterine, cervical or vulvar cancer have receptors on their outer surfaces that substances such as proteins can attach to. When these proteins attach, they encourage the cancer cells to multiply at a faster rate. New scientific discoveries allow oncologists to block these receptors and slow down cancer growth.
One protein that encourages gynaecological cancer growth is called HER2. If you are prescribed trastuzumab, your uterine or ovarian cancer is HER2-positive. Remedazo can arrange free Second Opinions with oncologists up to date with the most recent therapies to ensure you have access to the latest approved treatments.
Triple negative cancer
When cancer cells do not have receptors for oestrogen, progesterone or the HER2 protein, they are known as triple-negative cancers. This term is most commonly used to describe breast cancer types but it is now known that this genetic pattern also exists in ovarian, cervical and endometrial cancers and possibly in vulvar cancer. Where a biopsy shows that hormonal or HER2 inhibitory treatment will not work, other treatments are used.
Uterine cancer stages
Your medical notes may have listed a number of codes concerning your diagnosis. Or perhaps you are waiting for further testing and prefer to be well-informed before receiving your results.
The majority of oncologists adhere to the universal TNM staging system. In short, this system uses a scoring system for tumour, (lymph) nodes and metastasis according to biopsy and imaging results.
T stands for tumour. T plus a letter or number describes the size (in centimetres) and location of a tumour. T letter and number systems for uterine, cervical, ovarian, and vulvar tumours vary but all can be described as a group - albeit in slightly less detail - to cover the most important data:
TX: It is not possible to evaluate the tumour due to a lack of data
T0: No evidence of a primary tumour
Tis: Carcinoma ‘in situ’ – in one location and has not spread
T1: The tumour is in situ and small
T2: The tumour is in situ and slightly larger
T3: The tumour is in situ and generally large
T4: The tumour has spread to areas beyond its immediate location and into surrounding tissues
N stands for nodes or lymph nodes and the following codes apply:
NX: Regional (nearby) lymph nodes cannot be evaluated due to lack of data
N0: No spread to regional lymph nodes
N1: Tumour has spread to the closest (sentinel) lymph nodes
N2: Tumour has spread to nearby lymph nodes
N3: Tumour has spread to non-regional lymph nodes
Finally, M stands for metastasis. The following codes apply:
M0: There is no spread to distant lymph nodes or other organs
M1: Cancer is present in distant lymph nodes and/or other organs.
Uterine cancer metastasis is most likely to affect the lungs. Ovarian cancer metastasis is most often found in the liver or intestines.
Most cancer is then further grouped according to the TNM results in up to 5 stages. Stage 0 is a carcinoma in situ and at a very early stage. Stage I is early non-metastasized cancer with no lymph node spread and a small tumour. Stage II indicates a larger tumour with minimal regional lymph node spread. Stage III describes non-regional but close-lying lymph node involvement and a large tumour. Stage IV indicates metastasis.
Additionally, you may have been diagnosed with recurrent cancer after being in remission for a time. Local recurrence refers to cancer reappearing in the same area as the previous cancer, regional recurrence to an area close to the previous cancer, and distant recurrence refers to metastatic cancer.
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