Female genital system constitutes the uterus, cervix, vagina, fallopian tubes and ovaries. Cancer developing in the uterus is called Uterine cancer or Endometrial cancer.

Uterine cancer occurs most often in postmenopausal women and also reported in premenopausal women. In the present scenario and recent past, the incidence of this cancer is increasing in India. Why this change?

Lifestyle shift , more of modernisation like intake of junk food, high calorie food, sedentary lifestyle, sleep deprivation, stress. This led to a significant rise in the incidence in India.At the same time cancer of cervix incidence has gone down. This may be related to better hygiene and awareness.

What causes uterine cancer?

•  Obesity 
  
• Diabetes 
• Thyroid disorders
• Genetic disorders
• Early start of menstrual cycles
• Late menopause
• Nulliparous women
• Increased life expectancy

What symptoms should the patient know?

Bleeding per vagina especially postmenopausal, advaced disease may present with fluid in the abdomen and multiple swellings. Most of the uterine cancers present with early disease with postmenopausal spotting.

How to evaluate a uterine cancer patient?

When you present these complaints, the clinician will do a biopsy which can be done in the outpatient department or in the operation theatre. It is called endometrial biopsy done in three ways.

• Office endometrial biopsy (outpatient department)
• Dilatation and currettage
• Hysteroscopic biopsy

Biopsy will be reported in 2-3 days. After seeing the report, the doctor will suggest imaging for staging the disease. Imaging will be MRI Pelvis for low grade and early disease and whole body PETCT for high grade disease and aggressive histologies. 

Based on this evaluation , the doctor will decide the line of management and also the course of treatment. He/she can explain the prognosis to a certain extent.

What treatments are available?

• Surgery
  
• Radiation
• Chemotherapy 

Stage I, II  and some stage III patients are suitable for surgery. The surgery includes peritoneal wash followed by hysterectomy with pelvic lymph nodal dissection and removal of omentum if needed. This can be done in open, laparoscopic and robotic methods.

Open method recovery takes a few weeks. Laparoscopy  helps in quicker recovery and less blood loss with minimal scars on the abdomen. Robotic procedure is advantageous in morbidly obese patient ,the conversion to open surgery is less and also in clearing the lymph nodes over the aorta.

Sentinel lymph node biopsy - it is performed to avoid lymph nodal dissection.

You should collect the histopathology report which will show the grade of the disease and the extent of the disease. Based on this whether you will need follow up or any additional treatment will be decided. It can be either radiation or chemotherapy.

Advanced stage III patients and stage IV (metastatic) patients are given chemotherapy.

 What is the prognosis?

Stage I patients have very good prognosis. Some of them may need radiation, but all of them will perform well.

Stage II patients will definitely need radiation and have good prognosis

 Stage III and IV prognosis is poor.

Conclusion - 

Any postmenopausal women with bleeding should present early to the clinician to have good prognosis. In certain patients cure is possible.

by

Dr. Madhu Devarasetty

Consultant Surgical Oncology

KIMS Hospitals, Secunderabad.