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  • GYNAECOLOGICAL CANCERS
    • UTERINE CANCER
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Dr. RAHUL REDDY LEVAKA

Dr. RAHUL REDDY LEVAKADr. RAHUL REDDY LEVAKADr. RAHUL REDDY LEVAKA

ENDOMETRIAL / UTERINE CANCER

RISK FACTORS FOR ENDOMETRIAL CANCER

Hormonal and Reproductive Factors

Hormonal and Reproductive Factors

Hormonal and Reproductive Factors

Estrogen Exposure: High levels of estrogen, especially unopposed by progesterone, can increase risk. This may be due to hormone replacement therapy, obesity, or certain conditions like polycystic ovary syndrome (PCOS).


Menstrual History: Early menarche (first menstruation before age 12) and late menopause (after age 55) extend the number of years of menstrual cycles, increasing exposure to estrogen.


Nulliparity: Women who have never given birth have a higher risk, possibly due to less protective progesterone exposure.

Genetic and Family History

Hormonal and Reproductive Factors

Hormonal and Reproductive Factors

Hereditary Syndromes: Conditions such as Lynch syndrome (hereditary nonpolyposis colorectal cancer) can significantly elevate risk.


Family History: A family history of endometrial cancer or related cancers (like ovarian or breast cancer) can increase risk due to shared genetic factors.

Lifestyle and Health Conditions

Hormonal and Reproductive Factors

Lifestyle and Health Conditions

Obesity: Excess body fat can lead to higher levels of estrogen, which is linked to increased risk of endometrial cancer.


Diabetes: Type 2 diabetes is associated with a higher risk, potentially due to related hormonal changes and metabolic syndrome.


Hypertension: High blood pressure and other related metabolic conditions may also contribute to increased risk.

SYMPTOMS OF ENDOMETRIAL CANCER

Abnormal Vaginal Bleeding

Postmenopausal Bleeding: Any bleeding after menopause is a significant symptom and should be evaluated by a healthcare provider.

Intermenstrual Bleeding: Bleeding between periods in premenopausal women can be a sign of endometrial cancer.

Heavy or Prolonged Menstrual Periods: Increased flow or duration of menstrual periods that is not typical for the individual can be concerning.

Pelvic Pain or Discomfort

Persistent Pelvic Pain: Pain or discomfort in the pelvic region that doesn’t go away or gets worse over time can be a symptom.


Pain During Intercourse: Experiencing pain during or after sexual activity may indicate a problem.

Unexplained Weight Loss: Significant, unexplained weight loss can be a symptom of various cancers, including endometrial cancer.


Difficulty Urinating or Bowel Changes: As the cancer grows, it may cause symptoms related to nearby organs, such as changes in urinary or bowel habits.

TESTS FOR DETECTING ENDOMETRIAL CANCER

Ultrasound

Transvaginal Ultrasound: A small probe inserted into the vagina provides images of the uterus and helps assess the thickness of the endometrial lining. Abnormal thickening can be a sign of endometrial cancer.


Endometrial Biopsy

A procedure where a small sample of the endometrial lining is removed and examined under a microscope to check for cancer cells. This can be done in a doctor's office or as a minor outpatient procedure.

1) D&C (Dilatation and Curettage)

A procedure in which the cervix is dilated, and the endometrial tissue is scraped or suctioned out for examination. This is often done if an endometrial biopsy results are inconclusive.

2) Hysteroscopy

A procedure where a thin, lighted tube (hysteroscope) is inserted through the vagina and cervix into the uterus. This allows the doctor to directly view the inside of the uterus and take biopsies if necessary.


Imaging Tests
1) CT Scan: Helps determine if the cancer has spread to other organs.

2) MRI: Provides detailed images of the uterus and surrounding tissues to assess the extent of the disease.

3) PET Scan: Occasionally used to identify cancer spread, though it is less commonly used than CT or MRI.


Blood Tests
While no blood test can definitively diagnose endometrial cancer, certain markers (like CA-125) might be measured to help assess the condition, particularly if cancer is suspected to have spread.

SURGERY FOR ENDOMETRIAL CANCER

Total Abdominal Hysterectomy (TAH) AND Bilateral Salpingo-Oophorectomy (BSO) AND Lymphadenectomy

Total Abdominal Hysterectomy (TAH) AND Bilateral Salpingo-Oophorectomy (BSO) AND Lymphadenectomy

Total Abdominal Hysterectomy (TAH) AND Bilateral Salpingo-Oophorectomy (BSO) AND Lymphadenectomy

In the surgical management of endometrial cancer, Total Abdominal Hysterectomy (TAH) and Bilateral Salpingo-Oophorectomy (BSO) are commonly performed together. TAH involves the removal of the uterus and cervix through an abdominal incision, aiming to eliminate cancerous tissue and reduce the risk of recurrence. Often, this procedure is combined with BSO, which involves the removal of both ovaries and fallopian tubes. BSO helps in staging the cancer by examining these tissues for any signs of spread. Additionally, Lymphadenectomy may be conducted to remove and analyze lymph nodes from the pelvic and sometimes para-aortic regions, providing crucial information on cancer spread and aiding in determining the appropriate treatment plan. This comprehensive surgical approach addresses both the primary cancer and potential metastases.

Minimally Invasive Surgery - Laparoscopic Surgery or Robotic-Assisted Surgery

Total Abdominal Hysterectomy (TAH) AND Bilateral Salpingo-Oophorectomy (BSO) AND Lymphadenectomy

Total Abdominal Hysterectomy (TAH) AND Bilateral Salpingo-Oophorectomy (BSO) AND Lymphadenectomy

Laparoscopic surgery involves using small incisions and a camera (laparoscope) to guide the surgeon in removing the uterus and other tissues, providing a less invasive alternative to traditional open surgery. This approach typically results in quicker recovery, less postoperative pain, and shorter hospital stays. However, it may not be suitable for all cases, depending on the cancer's extent and location. Robotic-assisted surgery, a specialized form of laparoscopic surgery, uses robotic technology to enhance precision and visualization in complex procedures. It offers potentially improved outcomes in terms of surgical accuracy and recovery but requires specialized equipment and extensive training for the surgical team.

ADDITIONAL TREATMENT FOR ENDOMETRIAL CANCER

Adjuvant Radiotherapy for Endometrial Cancer

Adjuvant radiotherapy is employed after surgery to target any remaining cancer cells and minimize the chance of recurrence. This can be particularly beneficial for patients with high-risk features such as deep myometrial invasion, lymphovascular space involvement, or positive surgical margins.

  1. External Beam Radiation Therapy (EBRT):
    • Procedure: Delivers high-energy radiation from outside the body to the pelvic region. The radiation targets the area where the cancer was removed, as well as surrounding tissues that may have microscopic cancer cells.
    • Purpose: Aims to eliminate residual cancer cells that were not removed during surgery and reduce the risk of local recurrence.
    • Considerations: Typically involves a series of treatments over several weeks. Side effects can include skin irritation, fatigue, and potential impacts on bowel and bladder function.

  1. Brachytherapy:
    • Procedure: Involves placing a radioactive source directly into or near the vaginal cavity or uterus. This method delivers radiation very precisely to the target area, minimizing exposure to surrounding healthy tissues.
    • Purpose: Used as a localized treatment to address any remaining cancerous cells in the vaginal cuff or pelvic area after surgery.
    • Considerations: Often used in conjunction with EBRT for patients with higher-risk features. Side effects may include vaginal dryness, discomfort, and potential changes in vaginal tissue.

Overall Strategy:

  • Selection Criteria: The decision to use adjuvant radiotherapy is based on factors such as the cancer's stage, grade, and the presence of high-risk features identified during surgery. The treatment plan is tailored to each patient’s specific needs and risk profile.

Chemoradiation

Chemoradiation combines chemotherapy and radiotherapy to enhance the effectiveness of treatment. This approach is used to target cancer cells more comprehensively, particularly in high-risk patients with high risk features after surgery.

Chemotherapy

Chemotherapy is used to target and destroy cancer cells that may have spread beyond the uterus. It is particularly beneficial for patients with advanced stages of endometrial cancer or those with high-risk features such as extensive lymph node involvement or distant metastases.

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