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|  | More info on Endometrial Cancer....
« Thread Started on Apr 8, 2005, 7:09am » | ![[Quote]](http://i3.photobucket.com/albums/y73/cancertalk/quotep.gif) |
Overview
Endometrial cancer originates in the endometrial lining of the uterus. It is the most common gynecologic malignancy (cancer originating in female reproductive organs). It is estimated that there are about 35,000 cases diagnosed each year in the United States, resulting in 4000 - 5000 deaths per year. The disease normally occurs in postmenopausal women; the average age at diagnosis is about 60 years.
Endometrial cancer is considered an estrogen-dependent disease. Estrogen is a hormone that is secreted by the ovaries. It plays an important role in the development of the female reproductive system and is largely responsible for the physiologic changes that occur during menstruation, puberty, and pregnancy. Progesterone is another hormone secreted by the ovaries that plays an important role. Normally, both estrogen and progesterone are secreted in certain proportions. Chronic exposure to estrogen, without the accompanying balancing effects of progesterone, is considered the major risk factor for endometrial cancer and may play a causal role in the development of the disease.
Benign uterine tumors, known as fibroids, usually are asymptomatic and do not require treatment. If fibroids cause bleeding or pain, they may be surgically removed. Cancerous (malignant) uterine tumors spread to other tissues and organs if left untreated. Endometrial cancer refers specifically to tumors that originate in the endometrial lining of the uterus. If the tumor originates in the deeper, muscular walls of the uterus, it is called uterine sarcoma. About 90% of all uterine cancers are endometrial.
A precancerous condition called endometrial hyperplasia, or adenomatous hyperplasiam, may cause irregular uterine bleeding. This condition can be mild, moderate, or severe. Severe hyperplasia is considered carcinoma in situ, the earliest detectable stage of endometrial cancer.
Incidence and Prevalence
Endometrial cancer is the most common gynecologic cancer and the fourth most common cancer in women in the United States. Worldwide, it is the fifth most common cancer in women. It is estimated that there are approximately 35,000 new cases of endometrial cancer reported annually in the United States, and nearly 5000 deaths. The death rate fell more than 50% from 1950-1970 and has continued to decline, due in large part to earlier diagnosis and more effective treatment. Though the incidence of endometrial cancer rose rapidly for a while in the 1970s, presumably due to an increased use of menopausal estrogen therapy (which has been linked to the disease), it has since stabilized. Its incidence is increasing, however, in many economically underdeveloped countries.
In the United States, the incidence rates of endometrial cancer are much higher for Caucasian women than for African American women, although the incidence rate in Caucasian women has been declining over the past thirty years. It has remained steady for African American women. Importantly, however, the incidence-to-mortality ratio (the number of women who have endometrial cancer and die from the disease) is much lower, 2:1, for African American women and 7:1 for Caucasian women. Thus even though a greater percentage of Caucasian women are diagnosed with endometrial cancer, a smaller percentage of them die from the disease. The ratio of incidence to mortality for Hawaiian women is 3:1. The smaller incidence-to-mortality ratios among African American and Hawaiian women suggest that access to health care may be an issue. It is likely that endometrial cancer in Caucasian women is diagnosed at an earlier stage and thus easier to be treat.
Anatomy of the uterus and endometrium
The uterus (womb) is a muscular, upside-down, pear-shaped organ that is located in a woman's pelvis behind the bladder and in front of the rectum. The top, wider part of the uterus is called the fundus (body), and the bottom, narrow part is the cervix. The fundus has very thick, muscular walls that are lined with a mucuous surface called the endometrium.
Two uterine tubes, the fallopian tubes or oviducts, lead from either side of the upper part of the uterus to the ovaries. The ovaries are paired organs, one on each side of the pelvis. Ova (eggs) are transported from the ovaries to the uterus via the fallopian tubes.
All of the parts of the female genital tract, from the ovaries to the girl thingy, are held together by various types of connective tissue. For example, there is a thin, delicate sheet of lining called the peritoneum that covers the uterus and extends over the bladder and rectum, keeping the uterus snug between the latter two organs. But, despite all the well-connected organs, the female genital tract is more mobile and plastic than any other part of a woman's body. The ovaries rupture monthly, the uterus sheds countless cells during menstruation, and the changes that a woman's uterus undergo during pregnancy are the most dramatic changes that any human organ experiences without suffering damage. A woman's reproductive system is incredibly responsive to hormonal changes in its environment. The endometrium is no exception. It is very sensitive to hormonal changes, and it is believed that endometrial cancer may be caused by an imbalance in its hormonal environment.
The endometrium contains several layers of cells that vary in appearance and amount as a woman's menstrual cycle changes. It is full of glandular cells and blood vessels. Nearly all of the cells are responsive to the hormonal changes that the uterus regularly experiences. Certain cells undergo what is called hyperplasia, increased cell division, in response to estrogen. It is this cell-growing response to estrogen that leads many researchers to believe that estrogen likely plays a causal role in the development of endometrial cancer.
The uterus has a flat, inner surface and is covered with tall, columnar epithelial cells. There are pits in the surface that lead down into uterine glands. The columnar cells, the pits, and the connective tissue and blood vessels that surround the glands are all part of the endometrium. The endometrium undergoes dramatic changes during a woman's menstrual cycle. During the luteal phase, for example, the two-week period just before a woman bleeds, the endometrium is thick, its epithelial cells are enlarged, the glands bulging, and the arteries swollen. At menstruation, the arteries break, the epithelial cells die, and the endometrium, in effect, sheds. Following menstruation, during the follicular phase, the endometrium regenerates. The changing thickness of the endometrium is highly dependent on the secretion of estrogen and progesterone. Estrogen causes cellular growth and is an important component of the rebuilding, follicular phase of the menstrual cycle. Progesterone is secreted during the later, thick-walled luteal phase, and it balances out the effects of the estrogen. Abnormal growth of endometrial cells (whether cancerous or not) and endometrial cancer are believed to be due to chronic exposure to too much estrogen without the balancing effect of progesterone.
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| | Re: More info on Endometrial Cancer....
« Reply #1 on Apr 8, 2005, 7:09am » | |
Types
There are two types of uterine tumors: benign and cancerous. Benign tumors, known as fibroids, do not spread and are usually asymptomatic. They usually do not require treatment. Though if they do cause any bleeding or pain, they can be surgically removed. Cancerous tumors of the uterus, as with most cancers, spread to other tissues and organs if left untreated. Endometrial cancer refers specifically to tumors that originate in the endometrial lining of the uterus. If the tumor originates in the deeper, muscular walls of the uterus, it is called uterine sarcoma. About 90% of all uterine cancers are endometrial.
There is a precancerous condition called endometrial hyperplasia, or adenomatous hyperplasia. It is similar to cervical intraepithelial neoplasia (CIN), the precancerous condition that occurs in the cervix. Endometrial hyperplasia can be mild, moderate, or severe. The usual symptom is irregular uterine bleeding. Severe hyperplasia is considered carcinoma in situ of the endometrium, the earliest detectable stage of endometrial cancer.
Endometrial adenocarcinoma
About 90% of all endometrial cancers are typical endometrial adenocarcinomas. Adenocarcinomas are cancers that arise in the epithelium (the surface layer of cells). Endometrial adenocarcinomas are cancers that originate in the epithelium of the uterine lining. There are three types of adenocarcinomas based on the percentage of tumor growth: grade 1, grade 2, and grade 3. Grade 1 tumors are the least solid. They have at least 95% normal endometrial tissue, and the glands that are so prominent in the endometrium are distinct from the cancer cells. Grade 3 tumors are characterized by solid tumor growth, and the endometrial glands are not well differentiated.
Rare cell types
The other 10% of endometrial cancers are caused by rare cell types (papillary serous carcinoma, clear cell carcinoma, papillary endometrial carcinoma, mucinous carcinoma). In general, these rarer cancers are associated with later age, greater risk for metastases outside the uterus, and a poorer prognosis.
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| | Re: More info on Endometrial Cancer....
« Reply #2 on Apr 8, 2005, 7:11am » | |
Causes
As with most cancers, what exactly what causes endometrial cancer is not known. However, several risk factors have been identified. A risk factor is something that causes an increased frequency of occurrence in people who have been exposed to it or who have the characteristic of the factor. A woman who is "at risk" has a higher than average chance of developing endometrial cancer. For example, estrogen exposure is considered the major risk factor for cervical cancer. Women who have experienced chronic estrogen exposure have a greater chance of developing cervical cancer. A risk factor, however, is not something that necessarily causes cancer. Researchers often do not know what makes a risk factor a risk. Finding the actual cause of endometrial cancer is an important area of cancer research.
Risk Factors
Chronic Estrogen Exposure
The best recognized risk factor is chronic estrogen exposure either through oral contraceptives (without progestins), estrogen-secreting tumors, early onset of first menstruation, late menopause, low number of pregnancies, or prolonged periods of anovulation (failure to ovulate). Additional factors include morbid obesity, hypertension and diabetes, and the long-term use of tamoxifen (an adjuvant therapy, i.e., the addition of drugs in addition to chemotherapy and/or radiation, used for women with breast cancer).
Obesity
Studies have estimated that women with excess body weight have a 2-5x greater risk of developing endometrial cancer than women with no excess body weight. This correlation is likely due to the face that fat cells (adipocytes) produce estrogen.
Diabetes Mellitus and Hypertension
The relationship between these risk factors and endometrial cancer is unclear, although obesity may play a role. Women with a history of diabetes mellitus are 2x more likely to develop endometrial cancer.
Few or No Children
Pregnancy is a period of intense progesterone stimulation by the placenta. Because progesterone counterbalances the growth-stimulating effects of estrogen, women who have experienced pregnancy are at a lower risk for developing endometrial cancer.
Early Menarche and Late Menopause
Late menopause (and possibly early age at menarche) are both associated with more estrogen exposure. Women who started menstruating at an early age or stopped at a late age might have a higher risk for developing endometrial cancer.
Estrogen Replacement Therapy
Estrogen replacement therapy that is used to relieve the symptoms of menopause puts women at high risk for endometrial cancer. It is believed that the increase in endometrial cancer that occured in the U.S. in the 1970s was due to the introduction and widespread use of postmenopausal estrogen therapy. The risk is reduced when the estrogen is combined with progesterone.
Tamoxifen
Tamoxifen is an anti-estrogenic drug and is the most widely prescribed hormonal treatment for women with breast cancer. One of the side effects of tamoxifen is that it induces growth of noncancerous uterine tumors, some of which develop into endometrial cancer. There may be an association between the long-term use of tamoxifen and the development of endometrial cancer. There may also be an association between the usual dose of tamoxifen and the development of endometrial cancer. Although researchers caution that the risk of developing endometrial cancer is much smaller than the risk of recurrent breast cancer. Only 1 in 500 women who are taking tamoxifen develop endometrial cancer, and the small risk is more than justified by the enormous benefits that tamoxifen can have for women with breast cancer.
Genetic Predisposition
Some women appear to have a genetic predisposition to endometrial cancer. The risk may approach 50% in some families. But these account for few cases of endometrial cancer overall.
Previous Cancer
Women who have had cancer of the breast, colon, or ovary are at an increased risk for developing endometrial cancer. The time interval between diagnosis of the two different cancers can be as long as ten years.
Diet
The association between diet and endometrial cancer is unclear. There is some evidence to suggest that a diet rich in animal fat and protein puts a woman at a greater risk, whereas a diet rich in vegetable, fruits, and whole-grain food reduces the risk. The most important dietary factor, however, seems to be excess food energy.
Oral Contraceptives: Reduced Risk
Use of combined oral contraceptives is correlated with a 50% reduced rate of cancer, but the actual reduction in number of cancer cases is small because endometrial cancer is uncommon in women of child-bearing age. Longer use of combined oral contraceptives affords better protection from endometrial cancer. The reduced risk is presumably due to the progesterone effects of the contraceptives, which act to counterbalance estrogen's effect on endometrial cells.
Tobacco Smoking
There is some evidence that tobacco smoking actually reduces the rate of endometrial cancer. This is likely not due to the actual effect of smoking but rather to the fact that smokers tend to have lower levels of estrogen and a lower rate of obesity.
Prevention
Early detection is the best prevention from developing invasive endometrial cancer. As the disease progresses, the chances of survival decrease markedly. Average 5-year survival rates for endometrial cancer are 90% for Stage I, 60% for Stage II, 40% for Stage III, and 5% for Stage IV. Treating precancerous hyperplasia with hormones (progestins), a hysterectomy, or a D & C can prevent abnormal, precancer cells from developing into cancer. About 10%-30% of all hyperplasia cases eventually develop into cancer, if left untreated.
Any woman with abnormal girl thingyl bleeding should visit her physician immediately. The American Cancer Society recommends that all women at high risk for endometrial cancer (e.g., women with a history of infertility or obesity) should undergo an endometrial biopsy at menopause.
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| | Re: More info on Endometrial Cancer....
« Reply #3 on Apr 8, 2005, 7:11am » | |
Diagnosis
The Pap smear plays a very important role in diagnosing and preventing cervical cancer, but it is not an accurate test for either hyperplasia (precancerous condition that leads to endometrial cancer) or endometrial cancer. Fewer than 50% of women with endometrial cancer have an abnormal pap smear.
Abnormal girl thingyl bleeding
The most important symptom used to diagnose endometrial cancer is abnormal girl thingyl bleeding. Postmenopausal bleeding is the classic symptom for 90% of all endometrial cancer cases. All women at high risk should have an endometrial biopsy at menopause.
For premenopausal women, abnormal bloody discharge does not always mean cancer, but it does indicate the need for more tests, especially if a woman is obese or has, for whatever reason, not ovulated much.
Sampling the endometrial tissue: biopsy and D&C
Standard diagnostic techniques include a biopsy or D & C (dilation and curettage). The D & C has been the standard in the past, but as long as the biopsy is done correctly, it can provide the same diagnostic accuracy as the D & C and is a much shorter and easier procedure. A biopsy is the removal of a very small amount of endometrial tissue by suctioning. A very narrow tube is inserted into the uterus through the girl thingy, and the whole procedure takes only minutes. In order to provide the same diagnostic accuracy as a D & C, tissue should be sampled from several different places on the uterine wall. In a D&C, the cervix is dilated so that a special instrument (a curette) can be inserted into the uterus through the girl thingy. The curette is used to scrape the uterine wall and collect tissue. Both procedures are done on an out-patient basis, though the D&C is more involved (it takes longer, about an hour, and it requires anesthesia). If either a biopsy or D & C reveals hyperplasia or endometrial cancer, the extent of the disease needs to be determined with other tests.
The tissue that is sampled from either procedure is sent to a laboratory, where the cells can be examined under a microscope and evaluated for any abnormalities. If cancerous cells are found, the type of cancer and the tumor grade (how thick it is) are evaluated.
Pretreatment medical evaluation
If a woman is diagnosed with endometrial cancer, the extent of the disease and an optimal treatment plan need to be determined. Because the treatment of endometrial cancer requires surgery, unless for some reason a woman cannot or chooses not to have surgery, the pretreatment evaluation usually focuses on determining whether the disease has spread to other parts of the body and is inoperable. Tests might include various laboratory studies, such as a CA-125 blood test, and a chest radiograph (to check for lung mestastasis).
However, metastasis to other parts of the body (beyond the cervix) are uncommon for endometrial cancer. Tumors in the lung, for example, occur in only 2%-3% of all endometrial cancer patients.
CA-125 assay
CA-125 is a substance that some endometrial cancer cells secrete into the bloodstream. If a woman's cancer appears to have cells that secrete CA-125, a CA-125 assay can provide some measure of whether the cancer has spread to other parts of the body.
Cystoscopy and proctoscopy
The uterus is sandwiched between the bladder in front and the rectum behind. If endometrial cancer spreads outside of the uterus, it spreads first to these organs. A cystoscopy is an examination that involves inserting a tube into the bladder through the urethra that enables the physician to check for tumors and sample tissue for microscopic examination. A proctoscopy involves using a tube to check the inside of the rectum for tumors.
Imaging studies
Sophisticated imaging studies can be done to get a look at the inside of the body, although if a woman is going to have surgery, these procedures usually do not provide any additional information. A CT (computed tomography) is a test that involves taking x-ray pictures of the body from various angles. An IVP (intravenous pyelogram) involves taking x-ray pictures of the urinary system in particular.
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| | Re: More info on Endometrial Cancer....
« Reply #4 on Apr 8, 2005, 7:12am » | |
Diagnosis
The Pap smear plays a very important role in diagnosing and preventing cervical cancer, but it is not an accurate test for either hyperplasia (precancerous condition that leads to endometrial cancer) or endometrial cancer. Fewer than 50% of women with endometrial cancer have an abnormal pap smear.
Abnormal girl thingyl bleeding
The most important symptom used to diagnose endometrial cancer is abnormal girl thingyl bleeding. Postmenopausal bleeding is the classic symptom for 90% of all endometrial cancer cases. All women at high risk should have an endometrial biopsy at menopause.
For premenopausal women, abnormal bloody discharge does not always mean cancer, but it does indicate the need for more tests, especially if a woman is obese or has, for whatever reason, not ovulated much.
Sampling the endometrial tissue: biopsy and D&C
Standard diagnostic techniques include a biopsy or D & C (dilation and curettage). The D & C has been the standard in the past, but as long as the biopsy is done correctly, it can provide the same diagnostic accuracy as the D & C and is a much shorter and easier procedure. A biopsy is the removal of a very small amount of endometrial tissue by suctioning. A very narrow tube is inserted into the uterus through the girl thingy, and the whole procedure takes only minutes. In order to provide the same diagnostic accuracy as a D & C, tissue should be sampled from several different places on the uterine wall. In a D&C, the cervix is dilated so that a special instrument (a curette) can be inserted into the uterus through the girl thingy. The curette is used to scrape the uterine wall and collect tissue. Both procedures are done on an out-patient basis, though the D&C is more involved (it takes longer, about an hour, and it requires anesthesia). If either a biopsy or D & C reveals hyperplasia or endometrial cancer, the extent of the disease needs to be determined with other tests.
The tissue that is sampled from either procedure is sent to a laboratory, where the cells can be examined under a microscope and evaluated for any abnormalities. If cancerous cells are found, the type of cancer and the tumor grade (how thick it is) are evaluated.
Pretreatment medical evaluation
If a woman is diagnosed with endometrial cancer, the extent of the disease and an optimal treatment plan need to be determined. Because the treatment of endometrial cancer requires surgery, unless for some reason a woman cannot or chooses not to have surgery, the pretreatment evaluation usually focuses on determining whether the disease has spread to other parts of the body and is inoperable. Tests might include various laboratory studies, such as a CA-125 blood test, and a chest radiograph (to check for lung mestastasis).
However, metastasis to other parts of the body (beyond the cervix) are uncommon for endometrial cancer. Tumors in the lung, for example, occur in only 2%-3% of all endometrial cancer patients.
CA-125 assay
CA-125 is a substance that some endometrial cancer cells secrete into the bloodstream. If a woman's cancer appears to have cells that secrete CA-125, a CA-125 assay can provide some measure of whether the cancer has spread to other parts of the body.
Cystoscopy and proctoscopy
The uterus is sandwiched between the bladder in front and the rectum behind. If endometrial cancer spreads outside of the uterus, it spreads first to these organs. A cystoscopy is an examination that involves inserting a tube into the bladder through the urethra that enables the physician to check for tumors and sample tissue for microscopic examination. A proctoscopy involves using a tube to check the inside of the rectum for tumors.
Imaging studies
Sophisticated imaging studies can be done to get a look at the inside of the body, although if a woman is going to have surgery, these procedures usually do not provide any additional information. A CT (computed tomography) is a test that involves taking x-ray pictures of the body from various angles. An IVP (intravenous pyelogram) involves taking x-ray pictures of the urinary system in particular.
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| | Re: More info on Endometrial Cancer....
« Reply #5 on Apr 8, 2005, 7:12am » | |
Diagnosis
The Pap smear plays a very important role in diagnosing and preventing cervical cancer, but it is not an accurate test for either hyperplasia (precancerous condition that leads to endometrial cancer) or endometrial cancer. Fewer than 50% of women with endometrial cancer have an abnormal pap smear.
Abnormal girl thingyl bleeding
The most important symptom used to diagnose endometrial cancer is abnormal girl thingyl bleeding. Postmenopausal bleeding is the classic symptom for 90% of all endometrial cancer cases. All women at high risk should have an endometrial biopsy at menopause.
For premenopausal women, abnormal bloody discharge does not always mean cancer, but it does indicate the need for more tests, especially if a woman is obese or has, for whatever reason, not ovulated much.
Sampling the endometrial tissue: biopsy and D&C
Standard diagnostic techniques include a biopsy or D & C (dilation and curettage). The D & C has been the standard in the past, but as long as the biopsy is done correctly, it can provide the same diagnostic accuracy as the D & C and is a much shorter and easier procedure. A biopsy is the removal of a very small amount of endometrial tissue by suctioning. A very narrow tube is inserted into the uterus through the girl thingy, and the whole procedure takes only minutes. In order to provide the same diagnostic accuracy as a D & C, tissue should be sampled from several different places on the uterine wall. In a D&C, the cervix is dilated so that a special instrument (a curette) can be inserted into the uterus through the girl thingy. The curette is used to scrape the uterine wall and collect tissue. Both procedures are done on an out-patient basis, though the D&C is more involved (it takes longer, about an hour, and it requires anesthesia). If either a biopsy or D & C reveals hyperplasia or endometrial cancer, the extent of the disease needs to be determined with other tests.
The tissue that is sampled from either procedure is sent to a laboratory, where the cells can be examined under a microscope and evaluated for any abnormalities. If cancerous cells are found, the type of cancer and the tumor grade (how thick it is) are evaluated.
Pretreatment medical evaluation
If a woman is diagnosed with endometrial cancer, the extent of the disease and an optimal treatment plan need to be determined. Because the treatment of endometrial cancer requires surgery, unless for some reason a woman cannot or chooses not to have surgery, the pretreatment evaluation usually focuses on determining whether the disease has spread to other parts of the body and is inoperable. Tests might include various laboratory studies, such as a CA-125 blood test, and a chest radiograph (to check for lung mestastasis).
However, metastasis to other parts of the body (beyond the cervix) are uncommon for endometrial cancer. Tumors in the lung, for example, occur in only 2%-3% of all endometrial cancer patients.
CA-125 assay
CA-125 is a substance that some endometrial cancer cells secrete into the bloodstream. If a woman's cancer appears to have cells that secrete CA-125, a CA-125 assay can provide some measure of whether the cancer has spread to other parts of the body.
Cystoscopy and proctoscopy
The uterus is sandwiched between the bladder in front and the rectum behind. If endometrial cancer spreads outside of the uterus, it spreads first to these organs. A cystoscopy is an examination that involves inserting a tube into the bladder through the urethra that enables the physician to check for tumors and sample tissue for microscopic examination. A proctoscopy involves using a tube to check the inside of the rectum for tumors.
Imaging studies
Sophisticated imaging studies can be done to get a look at the inside of the body, although if a woman is going to have surgery, these procedures usually do not provide any additional information. A CT (computed tomography) is a test that involves taking x-ray pictures of the body from various angles. An IVP (intravenous pyelogram) involves taking x-ray pictures of the urinary system in particular.
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| | Re: More info on Endometrial Cancer....
« Reply #6 on Apr 8, 2005, 7:14am » | |
Staging
The main goal of staging a cancer is to determine the extent of the disease before treatment begins and to evaluate an appropriate treatment protocol. Endometrial tumors are also graded to aid in the evaluation.
Most endometrial cancers are staged according to the surgical system approved in 1988 by the International Federation of Gynecology and Obstetrics. Factors used to stage the disease include the depth of the tumor, whether the tumor has spread to the cervix and other nearby organs, the cytology of the cancer (the cellular make-up and activity), whether it has metastasized to the lymph nodes, and the extent to which it has spread to other parts of the body. If a patient does not undergo surgical evaluation, because of their age or other conditions that make surgery prohibitive, then the older, clinical staging system is used.
FIGO Surgical Stages For Endometrial Cancer
Stage I The tumor is confined to the uterine fundus (the body of the uterus).
Stage IA The tumor is limited to the endometrium (the lining of the uterus).
Stage IB The tumor invades less than one-half of the myometrial thickness (the myometrium is the muscular tissue that is found just beneath the endometrium).
Stage IC The tumor invades more than one-half of the myometrial thickness.
Stage II The tumor extends to the cervix (the lower part of the uterus).
Stage IIA Cervical extension is limited to the endocervical glands (glands in the inner lining of the uterus, where the cervix meets the uterus).
Stage IIB Tumor invades the cervical stroma (the supporting connective tissue of the cervix).
Stage III There is regional tumor spread.
Stage IIIA The tumor invades the uterine serosa (the layer of tissue that surrounds the outside of the uterus), or adnexa (tissues on either side of the uterus), or cells in the peritoneum (the member surrounding the abdominal cavity) show signs of cancer.
Stage IIIB girl thingyl metastases are present.
Stage IIIC The tumor has spread to lymph nodes near the uterus.
Stage IV There is bulky pelvic disease or distant spread.
Stage IVA Tumor has spread to the bladder or rectum.
Stage IVB Distant metastases are present.
FIGO Clinical Staging System
Stage 1 The tumor is limited to the uterine body.
Stage 1A Uterine cavity measures 8 cm or less.
Stage 1B Uterine cavity measures greater than 8 cm.
Stage 2 Tumor extends to the uterine cervix.
Stage 3 Tumor has spread to the adjacent pelvic structures.
Stage 4 Bulky pelvic disease or distant spread.
Stage 4A The tumor invades the mucosa of the bladder or rectum.
Stage 4B Distant metastasis is present.
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| | Re: More info on Endometrial Cancer....
« Reply #7 on Apr 8, 2005, 7:14am » | |
Treatment
The treatment of endometrial cancer depends on many factors, including a patient's general health, age, and stage of the disease.
In the early stages, endometrial cancer is usually treated with surgery and/or radiation. In the later stages, it is usually treated with hormone therapy. There are numerous treatment options for patients.
Surgery
The typical surgery is bilateral salpingo-oophorectomy, the removal of the ovaries and fallopian tubes, as well as a complete, radical hysterectomy. A radical hysterectomy involves removing the uterus, the tissues surrounding the uterus, and the upper third of the girl thingy. A hysterectomy can be either abdominal or girl thingyl. In an abdominal hysterectomy, the surgeon makes an incision in the front of the abdomen and removes the uterus. In a girl thingyl hysterectomy, the uterus is removed through the girl thingy. Because endometrial cancer originates in the uterine body, a hysterectomy should be sufficient, but the ovaries are removed as well because they are the most common sites of undetected metastasis. Also, most women who undergo the surgery are postmenopausal, and their ovaries are no longer providing the hormonal function that is so important before menopause. During an abdominal hysterectomy, the lymph nodes are also almost always sampled (a pelvic lymph node dissection) to detect any spread of cancer to the lymph nodes.
Until recently, if a girl thingyl hysterectomy was used to remove the uterus, there was no way to get a sample of lymph node tissue. Now, however, there is a new surgical technique called laparascopic lymph node sampling that many surgeons are beginning to use that allows for sampling the lymph nodes even when the abdomen is not cut open for an abdominal hysterectomy. Thus women can opt for a girl thingyl hysterectomy and still have their lymph nodes examined. The new method involves inserting a tube through a very small opening in the abdomen. The girl thingyl hysterectomy combined with the laparascopy are much less invasive and require less recovery time than an abdominal hysterectomy.
Although the primary treatment for any stage endometrial cancer involves a radical hysterectomy, according to the National Cancer Institute, early stage I cancers may not require a radical hysterectomy. A simple hysterectomy,which involves removal of the uterus but not the surrounding tissues or upper third of the girl thingy, may be sufficient. It is important that you discuss with your surgeon the different options and why she or he thinks one procedure is more appropriate than another.
Radiation
There are two types of radiotherapy commonly used to treat various stages and grades of endometrial cancer: external-beam pelvic radiation and intracavitary irradiation.
External beam pelvic radiation
Radiotherapy was first used to treat uterine cancer around the turn of the century, very shortly after Marie Curie's discovery of radium. For many decades, radiation therapy was used as a standard presurgical treatment, but it is no longer done preoperatively because it prevents accurate surgical staging. It is standard to reserve the use of radiotherapy until an initial hysterectomy, at least, has been performed. Even following a hysterectomy and bilateral salpingo-oophorectomy, however, the effectiveness of adjuvant radiation therapy (therapy used in addition to surgery) is controversial. Although regional pelvic radiation has proven to decrease pelvic recurrences, it does not necessarily improve the survival rate. It is likely most beneficial for patients with tumors that are confined to the pelvis and that have features that increase the likelihood of recurrence (stages IC to IIIC). The potential benefits of radiation should be weighed against the risks, such as a history of pelvic infections or severe diabetes mellitus.
Postoperative girl thingyl irradiation (brachytherapy)
In addition to pelvic radiation, postoperative girl thingyl irradiation is often used to prevent girl thingyl cuff recurrences (the girl thingyl cuff is the upper third of the girl thingy). girl thingyl cuff recurrences are common for certain types of tumors. This type of therapy involves inserting small metal cylinders, or some other type of applicator, through the girl thingy, where it releases a radioactive substance over the course of two or three days.
Hormonal therapy
Hormones, particularly progesterone, can be used to treat metastatic endometrial cancer, but their effectivness is not very great. Studies indicate that less than 20% of patients who are treated with hormones respond to the treatment.
Chemotherapy
Studies have not yet produced clear results on the effectiveness of chemotherapy to treat endometrial cancer. Chemotherapy is potentially most useful for cancers that have spread to distant parts of the body.
Treatment by stage
* Stages I and II
Hysterectomy and bilateral salpingo-oophorectomy plus radiation, depending on the grade of the tumor and whether it has invaded the myometrium.
* Stage IA, grade 1 or 2 tumor
Usually there is a low risk of disease recurrence, therefore radiation therapy is not used. Treatment is surgery only.
* Stage IA, grade 3 tumor; all stage II tumors
There is an intermediate risk for disease recurrence in these patients, although it is not clear that postoperative radiation therapy improves survival. It does, however, decrease the risk of local relapse. Following surgery, it is important that patients be given the opportunity to participate in clinical, postoperative radiation therapy trials. Either girl thingyl cuff radiation (internal radiation of the upper third of the girl thingy) or pelvic radiation should be considered.
* Stages III and IVA (all grade tumors)
Following surgery, girl thingyl cuff radiotherapy with or without pelvic or whole abdominal radiation may increase a woman's chances of survival. Progesterone is used for metastatic endometrial cancer.
* Stage IVB
This group of women have distant spread of the disease at the time of diagnosis. The chance of cure in this group is, unfortunately, low. If possible, patients can participate in a clinical trial. If not possible, or if they choose not to participate, palliative (pain-relieving) therapy should be considered. Palliation of symptoms can include hormones, chemotherapy, or radiation.
Recurrent disease
Recurrence is more likely in women with advanced disease and in those whose tumor had certain high-risk features. Usually recurrence happens within three years of the original diagnosis. Hormone therapy can be used to treat recurrent disease, although its effectiveness does not appear to be that great. The use of various combinations of hormones are currently being evaluated. The use of chemotherapy to treat recurrent disease is also currently being evaluated. If a woman was originally treated only with surgery and no radiation, if the cancer recurs, either external-beam pelvic or intracavitary radiation can be used as therapy. In the case of radiation, the prognosis depends on many features such as the size and extent of the tumor and the time to recurrence.
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Administrator
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Posts: 127
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| | Re: More info on Endometrial Cancer....
« Reply #8 on Apr 8, 2005, 7:15am » | |
Follow-Up
Know when to visit your physician or surgeon for follow-up tests
Follow-up care depends in large part on the stage of the cancer. No matter how it was treated, regular follow-up care is an important part of cancer therapy. Make sure you talk with your team of physicians and surgeons about their follow-up recommendations, so that you know when to schedule visits for routine tests and other procedures. These tests could range from x-rays to biopsies.
Healthy lifestyle
Just as a healthy lifestyle is important for the prevention of cancer, it is equally, if not more, important for surviving cancer and preventing recurrence.
Getting adequate rest, eating healthfully, limiting alcohol consumption, and stopping tobacco smoking are all ways that you can treat your body well and improve its chances for recovery.
Support
Building a social support system is an important part of taking care of yourself. Join a cancer support group and/or seek out a psychotherapist or other trained professional to help you cope with the stress and emotional difficulties of living with cancer.
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