Uterine Cancer
The most common gynecologic cancer, uterine cancer (cancer of the endometrium) typically afflicts postmenopausal females between ages 50 and 60. It’s uncommon between ages 30 and 40 and rare before age 30. Most premenopausal females who develop uterine cancer have a history of anovulatory menstrual cycles or other hormonal imbalance. About 33,000 new cases of uterine cancer are reported annually; of these, approximately 5,500 are eventually fatal.
Causes
Uterine cancer appears linked to several predisposing factors:
low fertility index and anovulation
history of infertility or failure of ovulation
abnormal uterine bleeding
obesity, hypertension, diabetes, or nulliparity
familial tendency
history of uterine polyps or endometrial hyperplasia
prolonged estrogen therapy without use of progesterone.
In most patients, uterine cancer is an adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, by way of the blood or the lymphatic system. Lymph node involvement can also occur. Less common uterine tumors include adenoacanthoma, endometrial stromal sarcoma, lymphosarcoma, mixed mesodermal tumors (including carcinosarcoma), and leiomyosarcoma.
Complications
Intestinal obstruction, ascites, increasing pain, and hemorrhage can result from disease progression.
Assessment
The patient history may reflect one or more predisposing factors. In the younger patient, it may also reveal spotting and protracted, heavy menstrual periods. The postmenopausal female may report that bleeding began 12 or more months after menses had stopped. In either case, the patient may describe the discharge as watery at first, then blood-streaked, and gradually becoming bloodier.
In more advanced stages, palpation may disclose an enlarged uterus.
Diagnostic tests
Endometrial, cervical, or endocervical biopsy confirms cancer cells.
Fractional dilatation and curettage identifies the problem when the disease is suspected but the endometrial biopsy is negative.
Positive diagnosis requires the following tests to provide baseline data and permit staging:
multiple cervical biopsies and endocervical curettage to pinpoint cervical involvement
Schiller’s test, the staining of the cervix and vagina with an iodine solution that turns healthy tissues brown (cancerous tissues resist the stain)
computed tomography scan or magnetic resonance imaging to detect metastasis to the myometrium, cervix, lymph nodes, and other organs
excretory urography and, possibly, cystoscopy to evaluate the urinary system
proctoscopy or barium enema studies, which may be performed if bowel and rectal involvement are suspected
blood studies, urinalysis, and cytologic examination of the urine
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