The organ that bears life can often have a hidden side to it and harbor fatal disease. Uterine cancer is the most common cancer that OB-GYNs diagnose in post-menopausal women.
Causes and Types:
There are a multitude of factors that can increase your risk of uterine cancer. One of the hormonal changes that can lead to cancer, specifically Type 1 endometrial carcinoma, is an excess of estrogen. Type 1 endometrial carcinoma is usually diagnosed in women in their 60s. A normal amount of estrogen is naturally present in women( it's even found in men) and helps in the development of reproductive organs, breasts and appropriate fat distribution. When does the female body produce too much estrogen? You have probably heard of these conditions below.
Diabetes mellitus type 2, metabolic syndrome and obesity are associated with abnormally high estrogen levels. Early puberty, late menopause, polycystic ovaries, infertility, nulliparity( no history of childbirth) and hormone replacement therapy in menopausal women are some of the life events that also elevate estrogen due to more menstrual cycles throughout lifetime and endometrial buildup. Interestingly enough, Tamoxifen, which is a drug given to breast cancer patients also increases the risk of uterine cancer. Cancer often has a genetic component to it as well and Type 1 endometrial carcinoma involves PTEN, k-ras, and microsallite instability inception. When we look at Type 1 cancer under the microscope, it looks like endometrial glands merging together without any supportive tissue between them.
Type 2 endometrial carcinoma is sporadic and seen primarily in women in their 70s. It is not caused by excess of estrogen and the mutations associated with it are p53 and HER2/neu. This type has more unique histological characteristics. It appears serous and has papillae( nipple shaped projections). Psammoma bodies which are collections of calcium salts with a layered onion like appearance can also be seen.
Symptoms:
If a woman has not yet reached menopause, bleeding between periods and irregular menstrual cycles may be a symptom. But the most important symptom and red flag for uterine cancer is postmenopausal bleeding. So if an elderly woman comes to the doctor complaining of her "period" restarting after having been dormant for years, be alert. There may be development of anemia due to prolonged blood loss from uterus. As the tumor grows bigger, there may be pressure on the surrounding pelvic organs leading to urinary difficulties and constipation. With time, weight loss and loss of appetite occur. The most common sites where this cancer metastasizes are the lungs, lymph nodes and liver.
Diagnostic Tests:
In post-menopausal women we will first do a transvaginal ultrasound. If we find that the endometrial lining is more than 4 mm, we will proceed to endometrial biopsy. If the woman is younger and has not yet reached menopause we will skip the ultrasound due to it being of little value due to normal changes in the endometrial lining during various stages of the menstrual cycle and jump straight to endometrial biopsy.
Treatment:
Removal of the cancerous tumor is done in most cases and surgeons will perform hysterectomy with bilateral salpingo-oophorectomy( removal of uterus and both fallopian tubes with ovaries). This may be performed in combination with radiotherapy and chemotherapy. There are also hormonal therapies that can be given such as progestins.
In conclusion, understanding and confronting uterine cancer is essential for both patients and healthcare professionals. Recognizing the symptoms, especially postmenopausal bleeding, can lead to early diagnosis and improved outcomes.
Sources:
First Aid for the USMLE 2023
Fundamentals of Pathology by Husain A. Sattar
Assessed and Endorsed by the MedReport Medical Review Board
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