Uterine cancer, also known as endometrial cancer or uterine carcinoma, is one of the most common types of cancer. One in four women affected by cancer suffers from this type of cancer. With early diagnosis and optimal treatment, the chances of curing uterine cancer are quite good. Here you will find further information and selected uterine cancer specialists and centers.
The womb (uterus) is a hollow organ and consists of the corpus and cervix. Uterine cancer develops in the upper part of the uterus, in the corpus.
The cervix is located at the end of the tubular extension of the corpus and forms the transition to the vagina. The so-called endometrium, the lining of the uterus, completely lines the inside of the uterus and renews itself with every menstrual period.
Unlike many other types of cancer, uterine cancer does not develop from the muscle tissue, but from the cells of the mucous membrane. Doctors therefore also refer to the disease as endometrial cancer. Other names for uterine cancer are cancer of the lining of the uterus, endometrial carcinoma or corpus carcinoma.
Anatomy of the uterus and surrounding structures © SHOTPRIME STUDIO | AdobeStock
Endometrial carcinoma is the fourth most common tumor disease in women after breast, colon and lung cancer . It is the most common malignant disease in the female genital area. According to statistics, around 11,000 patients are diagnosed every year.
The malignant tumor disease of theuterus occurs predominantly in women after the menopause. The disease peaks between the ages of 75 and 79. Uterine cancer is extremely rare before the age of 40.
Uterine cancer should not be confused with cervical cancer. Both types of cancer differ significantly in terms of early detection and treatment.
Various factors are involved in the development of the disease, which are not yet fully understood. What is clear is that the disease is primarily linked to the female sex hormone oestrogen and its influence on the lining of the uterus. The hormone is produced in the ovaries, but also in fatty tissue.
Both oestrogen and the corpus luteum hormone progesterone, which belongs to the progestogens, play a decisive role in the female cycle. Both hormones interact with each other:
Progesterone is responsible for shedding the upper layers of the mucous membrane during menstruation.
Oestrogen, on the other hand, ensures that the lining of the uterus rebuilds after menstruation.
Uterine cancer usually develops after the hormonal changes of the menopause © SHOTPRIME STUDIO | AdobeStock
With the onset of the menopause, fundamental hormonal changes occur in the female organism. The ovaries stop producing hormones - menstruation stops and the lining of the uterus no longer renews itself. As a result, the mucous membrane can thicken excessively and in some circumstances an oestrogen-dependent growing carcinoma (type I) can develop.
There are also estrogen-independent tumors (type II). The causes of this type of endometrial carcinoma are largely unknown.
As fatty tissue also produces oestrogen, overweight women after the menopause are particularly at risk. The continued presence of oestrogen exerts an additional growth stimulus on the lining of the uterus.
Due to the familial accumulation, scientists and doctors assume that predisposition also plays a role, i.e. a genetic component is present.
This is important, for example, in a genetic disease known as Lynch syndrome. Patients with this genetic change have an increased risk of developing endometrial and/or colon cancer.
Women whose bodies have produced oestrogen over a very long period of time are also at risk. This includes women with very early onset of menstruation and late onset of menopause.
Women who have taken the pill for a long time or who have become pregnant several times are less at risk.
Long-term use of the contraceptive pill reduces the risk of the disease © rosifan19 | AdobeStock
Summary: According to current research, several factors favor the development of the tumor - especially an estrogen-dependent carcinoma. These include
Factors that reduce the likelihood of developing uterine cancer are
There are no recognizable symptoms in the early stages . This is why uterine cancer often remains undetected in the early stages. The first signs that may indicate the presence of cancer only become apparent as the disease progresses.
The main symptom is unusual bleeding. This can be bleeding outside of menstruation or after the menopause. However, it is also important to be vigilant in the event of unusually long or heavy bleeding, spotting or purulent discharge.
Although cancer is not always the cause, it is advisable to have the symptoms checked by a gynecologist
If unusual bleeding occurs, this can be a sign of a uterine tumor © Мария Кокулина | AdobeStock
Pain in the lower abdomen or back as well as in the pelvic region is less common.
In advanced stages, the vagina, rectum or bladder are often also affected. This is where symptoms such as bleeding from the bowel or bladder appear and urinary tract infections occur more frequently.
Women with an increased risk of uterine cancer should have an ultrasound examination of the vagina once a year. This measures the thickness of the mucous membrane. If the double thickness of the mucous membrane is thinner than 4 mm after the menopause, endometrial cancer can be practically ruled out - provided there is no bleeding or any of the symptoms listed.
However, if cancer is suspected, the endometrium must be examined more closely. The most reliable way to do this is to perform a hysteroscopy of the uterus, during which tissue samples are taken from suspicious areas. The doctor then scrapes out the entire uterine lining (curettage or abrasion). By combining the two methods, malignant tumors can be diagnosed or ruled out with a high degree of certainty.
If the suspicion of uterine cancer isconfirmed, further examinations are required. These serve to assess the spread of the tumor within the uterine wall and the possible involvement of lymph nodes and adjacent organs. These include
Computer tomography(CT) and magnetic resonanceimaging (MRI) can also be used to better assess the situation.
Modern cancer medicine(oncology), in particular gynecological oncology, offers various therapeutic approaches for the treatment of uterine cancer. Their use depends on the stage of the disease.
Surgery as part of oncological surgery is currently the treatment method of choice, as it promises the best chances of recovery.
If the tumor is discovered at a very early stage, surgery is usually sufficient treatment. The pathologist then assesses the extent to which the uterine wall is affected by the tumor (deep infiltration) and whether lymph nodes are affected by the tumor. This assessment and the findings determine whether radiotherapy or chemotherapy (more rarely) is subsequently required.
In a so-called radical hysterectomy, the surgeon removes the uterus, ovaries and fallopian tubes.
Different forms of hysterectomy (removal of the uterus) © fancytapis | AdobeStock
If there is an increased risk of the tumor spreading or if it turns out that the tumor has grown beyond the boundaries of the uterus, lymph nodes are also removed from the area around the organ (the pelvis) and sometimes behind the abdomen.
If neighboring organs such as the bladder and rectum are also affected, it may be necessary to remove these organs partially or completely.
A side effect of the operation that affects younger patients is the acute onset of the menopause after removal of the ovaries. If the tumor was detected at an early stage, it is possible to take combined estrogen-progestin hormone preparations to alleviate the typical symptoms.
By Ed Uthman from Houston, TX, USA - Endometrial Carcinoma, CC BY 2.0, Link
Radiotherapy is primarily a post-operative measure, i.e. it is carried out after surgery has been completed. Although radiotherapy can promise success in the early stages, surgery offers a better prognosis. For this reason, radiotherapy is more likely to be used in conjunction with surgery - unless surgical treatment is not possible.
Radiotherapy is primarily aimed at preventing the formation of a new tumor. However, it is also used if the tumor could not be completely removed or the vaginal vault has already been affected. In this case, targeted, localized radiation improves the chances of recovery.
Two radiation techniques are commonly used for uterine cancer, which are often used in combination.
In so-called short-distance radiation (brachytherapy), a radiation source is inserted into the vaginal vault several times for a short period of time. There it emits high-energy radiation "on site". The aim is to prevent a recurrence in the vaginal area.
In contrast, with external radiation (external or percutaneous radiation), the entire pelvic area is irradiated. This is intended to prevent a relapse in this region.
Radiation is considered as the sole therapeutic measure if surgery is not possible. Reasons for this are, for example, concomitant illnesses or the patient's poor state of health.
Inflammation of the bladder and bowel can occur as a side effect of radiotherapy, which usually subsides after a few weeks. However, they can sometimes lead to chronic symptoms.
The vaginal tissue is also more sensitive and susceptible to infections after radiotherapy. However, these side effects can be alleviated with medication.
Therapeutic approaches with cell growth-inhibiting drugs (chemotherapy) and inhibitors of the female hormone oestrogen (anti-hormone therapy) are mainly used in advanced stages and for relapses that can no longer be treated in any other way.
Tumors that are classified as well differentiated (mature) by histological examination respond better to hormones. Poorly differentiated tumors are better treated with chemotherapy.
At an advanced stage, it can also be useful in combating metastases.
Chemotherapy is mainly used in advanced stages © Monkey Business | AdobeStock
Possible side effects of chemotherapy are
and an increased susceptibility to infections, some of which, e.g. vomiting, can be effectively alleviated by medication.
Although the administration of the female sex hormone gestagen can slow tumor growth somewhat, hormone therapy does not promise a cure. It can therefore only be used as a complementary measure to other forms of therapy.
In individual cases, hormone therapy is an option for younger women in the early stages who wish to have children. In most cases, the uterus is then removed after delivery.
Regular gynecological examinations are important after endometrial cancer treatment to detect possible local recurrences of the disease. This should take place every three to six months in the first three years after the operation, depending on the risk of recurrence. Most relapses and treatment-related complications occur during this period.
Local recurrences develop in around 11 percent of women with early-stage uterine cancer. If diagnosed early, surgery and thus a cure may be possible. The following therefore applies to all affected women: Any noticeable changes are a reason to see your doctor immediately and not wait until your next follow-up appointment.
Under certain circumstances, women with uterine cancer can fulfill their desire to have children. The prerequisite is a less aggressive uterine tumor at a very early stage.
Doctors then carry out temporary hormone therapy with artificial progestins. This does not usually inhibit the growth of the tumor permanently. Nevertheless, it is often possible to have children during this time. The prerequisite for this is another endoscopy of the uterine cavity (hysteroscopy) and a scraping as a therapy control after gestagen therapy (i.e. hormone therapy). The tumor should largely no longer be detected.
Under certain circumstances, those affected may still be able to fulfill their desire to have children © Dimid | AdobeStock
Following such fertility-preserving therapy, surgical treatment is required depending on the stage of the tumor.
Unfortunately, there is no preventive treatment that protects against uterine cancer. A preventive vaccination against human papillomavirus, which offers protection against cervical cancer, is ineffective against uterine cancer.
The most important measure against uterine cancer is early detection. That is why specialists recommend regular check-ups with a gynecologist.
If the disease is detected and treated early, the chances of recovery are very good. Statistics cover a period of five years and determine the so-called "five-year survival rate". The prognosis for uterine cancer is extremely positive. Around 80 percent of women affected have beaten the cancer after five years.
The prognosis worsens significantly if metastases have already formed. The metastases often settle in the lungs and liver - rarely in the bones - and can only be treated with medication.
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