Uterine cancers are among the most common cancers in women who develop from the cells of the uterus. Endometrium cancers are sometimes referred to as uterine cancer. However, there are other cells such as muscles or myometrial cells that can develop cancer in the uterus. These are much less common and are called sarcomas.
Uterine cancers can usually be detected at an early stage. If endometrial cancer is detected early, surgical removal of the uterus will treat the cancer. Uterine cancers are the most common gynecological cancers in developed countries. The incidence is 12.9 / 100.000 and the mortality rate is 1.7-2.4 / 100.000. Each year, 290,000 women are diagnosed with uterine cancer worldwide.
Most of the uterine (endometrium) cancers occur in postmenopausal women at the time of menstruation.
• Bleeding in postmenopausal period
• Excessive menstrual bleeding and long duration
• Pelvic pain
• Pain during intercourse
• Abnormal bloody discharge
• Weight loss
Healthy cells grow, divide and die in a certain order for the body to function normally. However, sometimes cells may undergo changes and growth may be out of control. These cells continue to divide even if no new cells are required. This abnormal division invades and destroys neighboring tissues and can even travel to other parts of the body and continue to grow. In uterine (endometrium) cancers, cancer cells develop in the layer laying inside the uterus. It is not known exactly why cancer cells develop. However, estrogen hormone is thought to play a role in the development of endometrial cancer. In addition, researches are continuing on gene changes that develop cancer in endometrium cells.
Two main hormones are secreted from ovaries: estrogen and progesterone. The balance between these two hormones varies during the menstrual cycle. Endometrium thickens from the early period of the cycle, if the pregnancy does not occur thicken endometrium is poured. If the balance between these two hormones turns favorable to the estrogen that stimulates the growth of the endometrium, the risk of developing endometrial cancer in women increases.
• Factors that increase the level of estrogen:
Longer menstruation: If menstruation begins at an early age (before the age of 12) or if menopause is late, the risk of endometrial cancer increases. The more periods, the more endometrium is exposed to estrogen.
Nulliparity: It is estimated that pregnancy reduces the risk of endometrial cancer. More estrogen is released during pregnancy; but more progesterone is secreted. Increased progesterone production can reduce the effect of increased estrogen.
Ovulation irregularity: Ovulation means the removal of the ovary from the ovary and regulated by estrogen. Irregular ovulation or no ovulation increases exposure to estrogen. The causes of ovulation disorders include obesity and polycystic ovary syndrome. Treatment of obesity and polycystic ovary syndrome (PCOS) leads to the restoration of monthly ovulation and menstruation, thus reducing the risk of endometrial cancer
Obesity: The source of estrogen is not only the ovaries. Fat tissue also secretes estrogen. In obesity, the level of estrogen in the body increases and puts you in a risky group for endometrial cancer. The risk of endometrial cancer in obese women has increased by 3 times. But weak women can also have cancer.
Fatty Diet: This type of dietary habit may lead to an increased risk of endometrial cancer as it causes obesity, or fatty foods can directly affect the estrogen metabolism and increase the risk of endometrial cancer.
Diabetes: Endometrial cancer is more common in women with diabetes. Because obesity and diabetes often go together. However, the risk of cancer is high in those who are not overweight.
Estrogen replacement therapy: Estrogen stimulates the growth of endometrium and only post-menopausal estrogen therapy increases the risk of cancer. Combination of estrogen with progesterone hormone leads to thinning and spillage of the endometrium and a reduction in the risk of endometrial cancer.
Ovarian Tumors: Some tumors of the ovary are the source of estrogen and increase the estrogen level.
Older age: A large proportion of endometrial cancers occur after 55 years of age
Having a story of breast or ovarian cancer:
Use of tamoxifen: One in every 500 women receiving breast cancer and tamoxifen treatment is diagnosed with endometrial cancer. Tamoxifen has an estrogen-like effect on the endometrium and leads to thickening of the endometrium. Therefore, an annual periodic pelvic examination should be performed for all who use tamoxifen as it increases the risk of endometrial cancer.
Hereditary Nonpolyposis colorectal cancer (HNPCC): This inherited disease is a major DNA repair gene disorder. The risk of colon cancer and endometrial cancer is high in patients with this hereditary disease.
Having these risk factors does not mean endometrial cancer. However, it means that it is at risk and needs to be sensitive to possible signs and symptoms.
• The patient’s history is taken and physical / pelvic examination is performed.
• Transvaginal Ultrasonography: Endometrial thickness and structure are evaluated.
• Biopsy: The exact diagnosis is made by biopsy. This endometrial biopsy can be performed under office conditions without anesthesia. If adequate tissue cannot be taken, dilatation and curettage should be performed. Operating room conditions may be required. It is scraped from all endometrial layers and sent to pathological examination. The definitive diagnosis is made after examination of these tissues under a microscope. If endometrial cancer is diagnosed, the patient is referred to a gynecological oncologist.
• Tomography, MRI or PET: If necessary, further examinations can be performed to evaluate the spread of the disease. The next stage is the staging of the disease and is done with the surgical treatment of the disease.
Surgery: It is the most commonly used treatment method. In surgical treatment (hysterectomy), uterus, ovaries and tubes are removed. Furthermore, regional lymph nodes should be removed and tissue samples should be collected from surrounding tissues. The operations are usually performed by laparoscopic and robotic methods with closed method. Considering that most of the patients are obese, the operation of the patients with closed methods without open surgery will result in much less complications in patients and their recovery in a short time. The first surgery of the patient is the most important treatment and must be done by a gynecologist oncologist. An inadequate surgery prevents patients from getting cancer completely. However, depending on the prevalence of the disease, surgical treatment may sometimes not be sufficient, and additional treatments (radiotherapy and / or chemotherapy) may be needed.
Radiotherapy: Radiation therapy is given after surgery (hysterectomy) if the findings after surgery show the risk of cancer recurrence.
Hormone therapy: Progesterone can be given to stop the growth of the tumor if the cancer is spread to other parts of the body.
Chemotherapy: Chemotherapy is the drug used to kill cancer cells. Usually these drugs are used in combinations. If cancer has reached advanced stages and spread to other organs, chemotherapy is given by the blood to reach and kill the cancer cells in these regions.
After the treatment, the patients are monitored at regular intervals and during this follow-up, physical examination, pelvic examination, X-ray and laboratory tests are performed. Endometrial cancer is a disease that can be completely cured when diagnosed early. In the early stages, patients have a 5-year survival chance of approximately 95%.