Cancer of the Uterus

The womb, also called the uterus, is pear-shaped. The upper, broader part is called the body and the lower end, which opens in the vagina, is the cervix. Both parts can be affected by cancer and in each case the symptoms, the treatment and the prognosis are similar.

The body of the uterus is frequently the site of benign tumours, often called fibroids. They do not invade surrounding tissues or spread to other organs, but when they press against normal tissues they can cause pain or bleeding and for this reason may require surgical removal. After the normal menopause, uterine fibroids sometimes become smaller and may even disappear. This is not so with cancer arising either in the body of the uterus or in the cervix.

Symptoms Of Cervical Cancer

The most common symptom of cervical cancer is bleeding between periods or bleeding on intercourse. Sometimes there is only an increased vaginal discharge.

Diagnosis

All these symptoms are warning signals which require vaginal examination by a doctor. Such examination involves examination by hand and the insertion of a small duck-bill instrument called a speculum, which allows inspection of the cervix and of the upper vagina. This enables the doctor to take a cervical smear with a wooden spatula, a test that is painless and very quick. The sample of cells collected from the cervix can then be checked. If there are any abnormalities, bigger samples of tissue are removed from suspect areas of the cervix at another examination.

The presence of atypical cells (also called dysplasia) is a pre-cancerous condition. When left untreated it may advance to carcinoma in situ, a cancer inside the layer of cells where it began. This is the earliest stage of malignancy that can be detected.

Treatment

There are two main forms of treatment for cervical cancer depending in particular on the stage of advancement of the disease but also on the patient’s age and general condition. Surgery is recommended only for the early stages and involves the partial removal of the cervix for carcinoma in situ and hysterectomy (womb removal) for the more advanced yet still localised growth.

Radiotherapy is the alternative. It usually consists of insertion of caesium into the vaginal vault and inside the uterine canal. This is given in three treatments, each lasting for 24 hours and given at weekly intervals. The treatment is combined with external ray treatment to the pelvic side-walls, in order to treat the regional lymph nodes, to which the disease frequently spreads at an early date. Such treatment is usually given on an outpatient basis over several weeks.

Neither treatment causes any actual pain but unpleasant side-effects such as diarrhoea, frequent urination and discomfort, though temporary, are common. They usually disappear within a few weeks after completion of treatment. Chemotherapy so far has little to offer in the treatment of cervical cancer.

Symptoms Of Cancer of the Body of the Uterus

The first symptom of cancer of the body of the uterus is abnormal bleeding from the uterus. It usually occurs after the menopause and is the most common symptom of endometrial cancer (the lining of the uterine body is called endometrium and this is where the cancer arises).

Diagnosis

Menstrual bleeding after regular menstruation has stopped should not be considered to be part of the change of life. It should always be reported to a doctor and investigated, often by dilatation and curettage (commonly called a D and C). This is usually carried out under anaesthesia and involves expanding the cervix enough (dilatation) to permit insertion of a small instrument which removes material from the uterine lining (curettage) The procedure does not take more than ten minutes and examination of the removed specimen will establish the presence or absence of malignancy beyond doubt.

Treatment

The standard treatment for endometrial cancer consists of a preliminary insertion of a radiation source (radium or caesium) into the cavity of the uterine body for 24 48 hours and surgical removal of the entire womb, called total hysterectomy. Post-operative radiation is usually not given but may become necessary in the case of extensive spread of the disease.

Uterine cancer has been found to be sensitive to the female hormone progesterone and hormone treatment is employed in cases where the disease has recurred after surgery or radiation therapy.