Uterine cancer is the fourth common cancer that affects South African women. It affects mainly women over 50 but can occur in younger women. The majority of women who get this cancer are post-menopausal.
The risk factors are being overweight, diabetic, and hypertensive, or in a tiny number of patients who are on tamoxifen for breast cancer. It’s caused by having too much oestrogen with not enough progesterone. Oestrogen can be made in fat cells that’s why being overweight is a risk factor. A hereditary form of endometrial cancer (a type of uterine cancer) called Lynch syndrome can occur in younger women who carry this gene and have a strong family history of uterine cancer.
Most women present with abnormal uterine bleeding after menopause. Any woman who bleeds after stopping her period should be investigated. The required investigations are a transvaginal sonar and some form of uterine lining (endometrial) sampling. The sample can be taken with a tiny suction in the rooms or ultimately with a camera into the uterus called a hysteroscope. This is done with a biopsy of the lining. It can be done as an outpatient procedure or in theatre.
Once the diagnosis is made, a chest, abdomen, and pelvis CT scan will be needed. This helps to plan treatment.
Once the diagnosis is made, the ultimate treatment is a total laparoscopic hysterectomy (ovaries and uterus) with a sentinel lymph node (first lymph node the cancer cells go to) removal. This is a type of keyhole surgery. The recovery time is good and usually requires a short stay in hospital.
A complete open hysterectomy with lymph nodes must be done if a laparoscopic hysterectomy is unavailable or the uterus is too large.
All uterine cancers are surgically staged. Namely, once the uterus is out, the pathologist examines the specimen and tells us the type of cancer and where the tumour has spread.
If the cancer is advanced, there will be the need for radiation and possibly chemotherapy. This depends on the stage and grade of cancer and other factors seen on the histology. The chemotherapy is usually platinum-based so there may be some hair loss.
The outcome for this cancer is generally very good.
If young women are diagnosed with uterine cancer, a conversation about reproduction needs to be discussed. A referral to a reproductive medicine specialist can be made after treatment. Routine follow-up consists of an examination and a smear.
Uterine cancer can be cured and has excellent survival rates if caught early. If radiation is given, it’s essential to have sexual intercourse or use a vaginal dilator.
You will need regular checks with your gynaecologist after treatment, including looking into the vagina and assessing the top of the vagina.
Prevention is always first prize which consists of a healthy lifestyle, not being overweight, and if you carry the gene to have a hysterectomy when your family is complete.
Dr Trudy Smith is a gynaecology oncologist at Wits Donald Gordon Medical Centre and a senior lecturer at the University of Witwatersrand. She has a keen interest in teaching postgraduates and undergraduates.
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