Uterine Cancer

• Happens in post-menopausal age
• Young women
• Good prognosis

Risk Factors

• Estrogen
• Progesterone
• Obesity
  • 2x-50lb overweight - 3x incidence
  • >50lb weight – 10x incidence
• Nulliparity  - incidence increased 2x
• Late Menopause – incidence increased 2.5x
• Hypertension and Hypothyroidism are associated.

Symptoms

• Bleeding
  • 15% of the patients with postmenopausal bleeding will have endometrial cancer.
  • Intermenstrual bleeding/spotting.
• Other signs & symptoms
  • Vaginal Discharge (80-90%)
  • Pelvic Pain, Pressure.

What to do if someone has symptoms

• Please do not panic, majority of cases it's not cancer.
• Consult your doctor for routine checkups.

Tests

• Ultrasound of the abdomen
• Endometrial Biopsy – if anything suspicious.
• Hysteroscopy guided biopsy – dilation and curettage.
• CT Scan/ MRI as necessary.

If Diagnosed with uterine cancer, then

• Meet your one surgeon to plan next.
• Imaging to stage the disease.
• Surgery is the mainstay of treatment followed by adjuvant therapy based on staging.
• Surgery in cancer is different from what surgery is done in benign conditions.
• Surgery includes:- 
  • Removal of the uterus with ovaries.
  • Removal of draining lymph nodes.
  • Omental Biopsy
  • Visual evaluation and if suspicious – excision of peritoneal lesions.
  • In Stage 2 – a radical hysterectomy has to be done.
• Incomplete surgery increases the chances of recurrence.
• Patients with incomplete surgical staging may require
  • Revision surgery
  • Addition of chemotherapy/radiation.

What After surgery

• Adjuvant treatment based on the pathology report.
• Regular Follow-up:-
  • First 2 years – Every month.
  • Every 6 months until 5 years.

A patient with uterine cancer wants to have a child

• Only in selected patients with early disease.
• Grade 1 disease limited to endometrium on MRI
• Require proper counseling and frequent follow-up.
• In consultation with the oncology team

Summary

• Uterine cancer is curable if detected early.
• Surgery is the mainstay of treatment and differs from those done for non-cancer conditions.
• Complete treatment and regular follow-up have high chances of cure.