Uterine Cancer
As A Source Of Abdominal Pain
Introduction:
Uterine cancer (="uterus cancer" or "endometrial cancer") is a very common cancer in women, it ranks 4th after cancer of the breasts, colorectal cancer and cancer of the lung. Among gynecological cancers uterine cancer is the most common cancer. As it arises out of the lining of the uterus (medically termed "endometrium") the medical term used by physicians is mostly"endometrial cancer". The majority of cases are among postmenopausal women in the age group between 50 and 60.
Symptoms of Uterine Cancer:
Almost all women with uterine cancer (=endometrial cancer) have irregular or abnormal periods. Warning signs are, if a woman before menopause develops very heavy bleeding around the regular period time or a woman who has been in the menopause is starting to have menstrual bleeding again.
A significant percentage of women with postmenopausal bleeding will have endometrial cancer, which will require surgery. A vaginal discharge in a postmenopausal woman is another danger signal, as this may be the first sign of a lesion inside the uterus, which is leaking serum or blood. The family physician or the gynecologist will likely do an endometrial biopsy, which can be done right in the office. It has a diagnostic accuracy rate of more than 90%. Another technique, which the gynecologist is using in case of doubt, is a fractional dilatation and curettage (=fractional D&C).
With this method the patient needs to be put under a general anesthetic in a hospital operating room and a scraping is made separately from the lining of the cervical canal and from the lining of the uterus (two fractions, hence the name "fractional D&C"). Usually the gynecologist will also perform a hysteroscopy, where an endoscope (=fiberoptic instrument) is used to visualize the inside of the uterine cavity. With this combination of techniques the gynecologist should be able to diagnose 100% of all the uterine cancers. The gynecologist may want to include some other tests such as a pelvic CT scan, blood tests, chest X-ray, ECG and others to help in the staging of the disease and in preparation for surgery.
Treatment:
Treatment for uterine cancer is most successful, if the diagnosis can be made early on in the disease. If the cancer is confined to the uterus, the 5-year survival rate after abdominal hysterectomy is 65% to 95% (stage I achieving the higher rates).
If the cancer has invaded the neighboring structures such as the cervix, the vagina, the bladder, the rectum or the pelvic lymph glands (stage III and IV), the 5-year survival rate goes down to 10% to 55%.For stage I uterine cancer with local disease a total hysterectomy with removal of both ovaries (=bilateral "salpingo-oophorectomy") is done. In high risk situations (late stage II cases and higher) where invasion may be more than perhaps originally anticipated, the surgeon will do a radical hysterectomy with a wide abdominal incision so that adequate exploration of the abdominal organs can be done. The surgeon will remove the uterus, both ovaries, all lymph glands in the pelvis, the lymph gland chain along the aorta and sample lymph glands in other areas of the abdominal cavity.
Later, when the patient is recovering from the surgery, the pathology report will come back and the surgeon can explain to the patient what stage the cancer was found to be in at the time of surgery. In case there was no further metastasis found on further pathological analysis, no further action would be required following the radical surgery. If there are positive lymph nodes (meaning that they contained cancer cells), then the appropriate further therapy such as radiotherapy or chemotherapy can be done. There are several cytotoxic drugs that are effective against uterine cancer: doxorubicin, cisplatin and paclitaxel. For more deatail on uterine cancer, click on this link.
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