Uterine Cancer Treatment in Delhi, India

Uterine cancer is a type of cancer that happens in the uterus. There are two main kinds:

• Uterine cancer starts in the endometrium, which is the inner lining of the uterus. It's one of the most common types of cancer in women's reproductive systems.
• Uterine sarcoma is a rare cancer that begins in the myometrium, the muscle layer of the uterus.

The staging is done using the FIGO system, which outlines the extent of cancer spread.

Stage I: Cancer is confined to the uterus or womb, without extending to other body parts.

• Stage IA: Cancer is present only in the endometrium or has infiltrated less than half of the myometrium.
• Stage IB: The cancer has invaded half or more of the myometrium.

Stage II: Cancer has extended from the uterus to the cervical stroma, the supportive tissue surrounding the cervix, but has not reached other body areas.

Stage III: Cancer has progressed beyond the uterus but remains within the pelvic region.

• Stage IIIA: Cancer has spread to the outer layer of the uterus, the serosa, and/or the tissues of the fallopian tubes and ovaries, but not to more distant locations.
• Stage IIIB: The tumour has advanced to the vagina or to the parametrium, which is the tissue adjacent to the uterus.
• Stage IIIC1: Cancer has reached the regional pelvic lymph nodes, which are small, bean-shaped structures that aid in infection control.
• Stage IIIC2: The cancer has affected the para-aortic lymph nodes, possibly along with the regional pelvic lymph nodes.

Stage IV: Cancer has metastasized, affecting the rectum, bladder, or distant organs.

• Stage IVA: The cancer has spread to the mucosal layer of the rectum or bladder.
• Stage IVB: The cancer has reached lymph nodes in the groyne area and/or distant organs like bones or lungs.

This type of cancer is also categorised by its grade (G), which is determined by how much the cancer cells resemble normal cells under microscopic examination.

When assessing the grade, doctors compare cancerous tissue with normal tissue. Normal tissue typically has a diverse mix of cell types arranged together. If the cancerous tissue resembles normal tissue with varied cell arrangements, it's termed "differentiated" or a "low-grade tumour." Conversely, if the cancerous tissue significantly differs from normal tissue, it's described as "poorly differentiated" or a "high-grade tumour." The grade of the cancer can indicate how rapidly the cancer might grow. Generally, slower-growing cancers have a more favourable prognosis.

Uterine cancer is graded using the letter "G":

• GX: The grade cannot be determined.
• G1: The cells show a high degree of differentiation.
• G2: The cells exhibit moderate differentiation.
• G3: The cells are poorly differentiated, showing significant deviation from normal cell structure.

The signs and symptoms of uterine cancer can vary, but here are some common ones:

• Vaginal bleeding or discharge: This is the most common sign. Abnormal bleeding, especially in postmenopausal women, is a key symptom. This can include bleeding between periods or after menopause.
• Pelvic pain: Pain or pressure in the pelvic area can be a symptom.
• Pain during intercourse: Experiencing pain during sex can be a sign of uterine cancer.
• Changes in menstruation: For those who are premenopausal, changes in the menstrual cycle, such as heavier or more prolonged periods, can be a symptom.
• Unexplained weight loss: Losing weight without trying can be a sign of many types of cancer, including uterine cancer.
• Difficulty urinating: Experiencing pain or difficulty when urinating can be a symptom.

The precise cause of uterine cancer remains unclear to researchers. It is believed that a series of changes occur in the uterus cells, leading these cells to mutate. These mutated cells then grow and multiply uncontrollably, potentially forming a mass known as a tumour.

There are specific risk factors that may elevate the likelihood of developing uterine cancer. If you are considered to be at a higher risk, it's important to discuss with your uterine cancer doctors in Delhi or elsewhere about measures you can take to safeguard your health.

Factors that increase the risk of uterine cancer include:

• Older age

• Hyperestrogenic states: A disease or condition that increases the amount of oestrogen, but not the level of progesterone, in the body, can increase the risk of uterine cancer symptoms. Examples include irregular ovulation patterns, such as those that can occur in women with polycystic ovary syndrome, obesity and diabetes. Taking hormones after menopause that contain oestrogen but not progesterone also increases the risk of uterine cancer.
• Early menstruation and late menopause: This increases the duration of exposure of endometrium to oestrogen, thereby increasing the chances of uterine cancer.
• Nulliparity: Women who have never been pregnant have a higher risk of uterine cancer than women who have had at least one pregnancy.
• Obesity: Being obese increases one’s risk of uterine cancer. This happens because of the peripheral conversion of hormones in the adipose tissue.
• Hormone therapy for breast cancer: Women with breast cancer who take the hormone therapy drug tamoxifen have an increased risk of developing uterine cancer.
• An inherited colon cancer syndrome: Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of colon cancer and other cancers, especially uterine cancer. HNPCC occurs because of a gene mutation passed from parents to children. The uterine cancer doctors in India may ask for cancer tests that include a pelvic exam, imaging tests, and a biopsy.

Diagnosing uterine cancer involves a series of tests:

Physical examination

A doctor might examine the abdomen for swelling. They may also perform an internal examination, either by placing two fingers inside the vagina while pressing on the abdomen or using a speculum to widen the vaginal walls, similar to a cervical screening test.

Pelvic ultrasound

This test uses sound waves to create images of the uterus and ovaries. The sound waves produce echoes when they encounter dense structures like tumours or organs, which a computer then converts into images. A pelvic ultrasound often includes both external and internal exams and typically lasts 15 to 30 minutes. If anything unusual is detected, a biopsy might be recommended.

Endometrial biopsy

Conducted in a specialist's office, this involves inserting a thin tube into the vagina to collect cells from the uterine lining. These cells are then examined microscopically. Patients may experience discomfort similar to menstrual cramps and might be advised to take anti-inflammatory medication beforehand.

Hysteroscopy and biopsy

A hysteroscope, a telescope-like device, is inserted through the vagina into the uterus, allowing a gynaecologist to view the inside of the uterus. Tissue can also be removed during this procedure for further testing.

Blood and urine tests

These tests help assess overall health and guide treatment planning.

Additional imaging tests 

If uterine cancer is confirmed, further scans like X-rays, CT, MRI, or PET scans (especially for types like sarcoma) may be conducted to check if the cancer has spread to other body parts.

Most people with uterine cancer need surgery. The particular treatment plan depends on the type of cancer and the patient’s overall health.

Surgery 

One of the most common treatments is a hysterectomy; it is a procedure wherein the uterus is removed if enquired the surgery also removes the ovaries and fallopian tubes and addresses the draining lymph nodes by either sentinel lymph node excision or complete lymphadenectomy depending on a case-to-case scenario.

Other Treatment Options

• Chemotherapy: This approach utilises potent medications to eliminate cancer cells.
• Radiation therapy: This method involves directing concentrated radiation at cancer cells to destroy them.
• Hormone therapy: This treatment either administers hormones or inhibits them to combat cancer.
• Immunotherapy: This strategy enhances the body's immune system to combat cancer.
• Targeted therapy: This involves using drugs designed to specifically target and halt the growth of cancer cells.

How can I know if I have uterine cancer?

Uterine cancer may cause abnormal vaginal discharge or bleeding, particularly after menopause or between periods. Other symptoms include pain or pressure in the pelvis. It's important to see a doctor if you experience any unusual bleeding, especially after menopause.

 Is uterine cancer curable? 

Uterine cancer, especially its most common form, uterine cancer, is often curable when caught early. Treatments include surgery, radiation therapy, chemotherapy, and other therapies. Uterine sarcomas are more aggressive and harder to treat, but they are rarer. 

How long can one live with untreated uterine cancer?

The survival rates for uterine cancer vary based on the stage of the cancer. The 5-year relative survival rates are 96% for localised, 72% for regional, and 20% for distant stages. It's important to note that these numbers are based on people diagnosed between 2012 and 2018 and only apply to the stage of the cancer when first diagnosed.

What is the difference between uterine fibroid and uterine cancer?

Uterine fibroids are noncancerous tumours that grow in the uterus, often during childbearing years. They are not the same as uterine cancer, which involves the uncontrolled growth of cancerous cells in the uterus. Uterine fibroids are generally benign, while uterine cancer requires medical intervention.

Are uterine cancer and uterine cancer the same? 

Uterine cancer is a type of uterine cancer that begins in the endometrium, the lining of the uterus. However, uterine cancer can also refer to other types, including uterine sarcoma, which starts in the muscles or other tissues of the uterus.

What’s the survival rate for people with uterine cancer?

As mentioned in response to question 3, the 5-year relative survival rates for uterine cancer are 96% for localised, 72% for regional, and 20% for distant stages.

 Can a Pap test diagnose uterine cancer? 

A Pap test, primarily used to detect cervical cancer, is not typically used to diagnose uterine cancer. It involves collecting cells from the cervix, not the uterus. For uterine cancer, other diagnostic methods like pelvic exams, ultrasounds, and biopsies of the uterine lining are more relevant. However, in some cases, a Pap test might incidentally reveal abnormal cells that could suggest further investigation is needed for potential uterine cancer.

Does uterine cancer spread quickly? 

The rate at which uterine cancer spreads can vary depending on the type and stage of the cancer. Uterine cancer, the most common type of uterine cancer, generally has a slower progression compared to more aggressive forms like uterine sarcoma. However, without treatment, any cancer has the potential to spread more rapidly. Early detection and treatment are crucial in managing the spread of uterine cancer effectively.

At what age is endometrial cancer most common?

Endometrial cancer is most commonly diagnosed in postmenopausal women, typically between the ages of 55 and 64. It's rare in women under 45. The risk increases with age, as most cases occur in women who have undergone menopause. Factors such as hormone changes, obesity, and genetics can influence the age of onset and risk of developing endometrial cancer.

Reviewed By Dr. Alka Dahiya - Consultant - Cancer Care / Oncology, Surgical Oncology, Gynecologic Oncology, Robotic Surgery, Breast Cancer on 30 Sept 2024.

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