Uterine cancer.pptx

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1. CANCER OF BODY OF UTERUS

2. Definition Cancer of the uterus occurs when abnormal cells develop in the uterus and begin growing out of control. Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ where fetal development occurs. Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer.

3. EPIDEMIOLOGY Epidemiology- The American Cancer Society estimates for cancer of the uterus in the United States for 2023 are: About 66,200 new cases of cancer of the body of the uterus (uterine body or corpus) will be diagnosed. About 13,030 women will die from cancers of the uterine body.

4. Risk factors There are several risk factors for endometrial cancer. Many of them relate to the balance between estrogen and progesterone. These risk factors include having obesity, a condition called polycystic ovarian syndrome (PCOS) or taking unopposed estrogen (taking estrogen without taking progesterone, too). A genetic disorder known as Lynch syndrome is another risk factor unrelated to hormones. Age, lifestyle and family history: Age as you get older, your likehood of developing uterine cancer increases. Most uterine cancers occur after age 50. Diet high in animal fat: A high-fat diet can increase risk of several cancers, including uterine cancer. Fatty foods are also high in calories, which can lead to obesity. Extra weight is a uterine cancer risk factor. Family history: Some parents pass on genetic mutations (changes) for hereditary non-polyposis colorectal cancer (HNPCC). This inherited condition raises the risk for a range of cancers, including endometrial cancer.

5. CAUSES Being postmenopausal, or reaching menopause (after age 55) . A thickened wall lining (endometrial hyperplasia) . Never having children Starting periods early (before age 12) Having high blood pressure or diabetes . Being overweight or obese . Family history of ovarian, uterine, or bowel cancer .

6. CAUSES Having a genetic condition such as Cowden syndrome or Lynch syndrome . Previous ovarian tumors , or polycystic ovary syndrome . Using estrogen only hormone replacement therapy or fertility treatment . Previous radiation therapy to the pelvis. Taking tamoxifen to treat breast cancer (the benefits of treating breast cancer usually outweigh the risk of uterine cancer - (talk to your doctor if you are concerned).

7. SIGNS AND SYMTOMS Unusual vaginal bleeding is the most common symptom of uterine cancer, particularly any bleeding after menopause. Other common symptoms may include: Heavier than usual periods or a change in your periods. Vaginal bleeding between periods Periods that continue without a break .

8. SIGNS AND SYMPTOMS Less common signs and symptoms include: A watery discharge, which may have an unpleasant smell. Unexplained weight loss. Difficulty urinating or a change in bowel habit. Abdominal pain below the belly.

9. TYPES There are two main types of uterine cancer. Endometrial cancers begin in the lining of the uterus (endometrium) and account for about 95% of all cases. Uterine sarcomas, which develop in the muscle tissue (myometrium), and is a rarer form of uterine cancer.

10. STAGES Stage I cancer hasn’t spread beyond the uterus. Stage II cancer has spread to cervix. Stage III cancer has spread to vagina, ovaries and/or lymph nodes. Stage IV cancer has spread to bladder or other organs far away from the uterus.

11. DIAGNOSIS Physical examination - The doctor may check patient abdomen for swelling. To check uterus, the doctor will place two fingers inside patient vagina while pressing on patient abdomen, or they may use an instrument (a speculum) that separates the walls of the vagina (similar to a cervical screening test). Pelvic ultrasound - A pelvic ultrasound will use sound waves to make a picture of patient uterus and ovaries. The sound waves echo when they meet something dense such as a tumor or organ. A computer then makes a picture from these echoes. A pelvic ultrasound can be done in two ways and patient often have both types at the same appointment. A pelvic ultrasound usually takes between 15 and 30 minutes. If anything appears unusual, the doctor may suggest a biopsy.

12. DIAGNOSIS Abdominal ultrasound - In order to get good pictures of the ovaries and uterus in an abdominal ultrasound patient need to have a full bladder so doctor will asked the patient to drink water before the appointment. A technician called a sonographer will move a small device called a transducer over your abdomen.  Transvaginal ultrasound - For a transvaginal ultrasound patient do not need a full bladder. The sonographer will insert a transducer wand into patient vagina. This ultrasound is uncomfortable, but it should not be painful. 

13. DIAGNOSIS Endometrial biopsy - An endometrial biopsy is done in the specialist’s office. A long, thin tube is inserted into patient vagina to gently suck cells from the uterine lining. The cells are sent to a pathologist who examines them under a microscope. There may be some discomfort similar to period cramps so doctor may suggest taking non-steroidal anti-inflammatory drugs such as ibuprofen, before the procedure. Hysteroscopy and biopsy- A hysteroscope is a telescope-like device which is inserted through patient vagina into uterus and allows a gynecologist or gynecological oncologist to see inside the uterus. During this procedure, tissue can also be removed (biopsy) and sent for further testing in a laboratory.

14. DIAGNOSIS Blood tests - CA-125 blood test. CA-125 is a substance released into the bloodstream by many, but not all, endometrial and ovarian cancers. If a woman has endometrial cancer, a very high blood CA-125 level suggests that the cancer has likely spread beyond the uterus. Some doctors check CA-125 levels before surgery or other treatment. Urine test - Pain or feeling of pressure in the pelvis, lower abdomen, back or legs. pain during urination, difficult urination or blood in the urine. Other tests - If cancer is detected in patient uterus, patient may have other scans to see if the cancer has spread to other parts of the body, such as an x-ray, CT scan or MRI scan. For particular types of uterine cancer, such as sarcoma, a PET scan may be used.

15. TREATMENT Surgery (hysterectomy and bilateral salpingo-oophorectomy) – The most common form of treatment for cancer of the uterus is surgically removing the uterus and cervix. This procedure is called a total hysterectomy. If the fallopian tubes and both ovaries are also removed, it is called a bilateral salpingo-oophorectomy.Ovaries are often removed to reduce the risk of the cancer coming back, as ovaries produce oestrogen, a hormone that may cause the cancer to grow. The surgery can be performed through a cut in the abdomen (laparotomy) or using keyhole surgery (laparoscopic surgery). Patient will be given a general anaesthetic.

16. TREATMENT Radiation therapy (radiotherapy) - Radiation therapy, the use of x-rays to kill or injure cancer cells, is commonly used as an additional treatment to reduce the chance of the cancer coming back.  It may be recommended as the main treatment if patient are not well enough for surgery. Hormone therapy - Hormone therapy is usually given if the cancer has spread or if the cancer has come back (recurred). It is also sometimes used if surgery is not an option. Progesterone is the main hormone treatment for women with uterine cancer, and it is available in tablet form or by injection by a GP or nurse. It helps shrink some cancers and to control symptoms.

17. TREATMENT Chemotherapy- Chemotherapy is used to treat certain types of uterine cancer, or when cancer comes back after surgery or radiotherapy, or if the cancer is not responding to hormone treatment. It can be used to control the cancer and to relieve symptoms. It is usually given as a drug that is injected into a vein (intravenously). The doctor will explain the chemotherapy treatment course and how long it will last. Drugs used are carboplatin ,cisplatin , paclitaxel (Taxol), doxetaxel (Taxotere). Their combinations also can be used. Palliative care - In some cases of uterine cancer, patient medical team may talk to patient about palliative care. Palliative care aims to improve patient quality of life by alleviating symptoms of cancer . As well as slowing the spread of uterine cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

18. TREATMENT Immunotherapy for endometrial cancer - Immunotherapy is a newer option for endometrial cancer. It is recommended to treat advanced endometrial cancer when other treatments haven't worked. Drugs used are livolumab , pembrolizumab etc. Immunotherapy medications can also cause side effects include: Skin rash or itching Muscle or joint pain Feeling tired Cough Shortness of breath Diarrhea Infusion reactions

19. PREVENTION :- There are no proven measures to prevent uterine cancer. However, you may be able to minimize your risk factors, such as maintaining a healthy weight, and being vigilant about any abnormal vaginal bleeding.

20. DIET

21. PROGNOSIS Prognosis of uterine cancer – It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, doctor may give a prognosis, the likely outcome of the disease, based on the type of uterine cancer patient have, the test results, the rate of tumor growth, as well as patient age, fitness and medical history. In most cases, early diagnosis of uterine cancer has a good prognosis.