Reproductive System Cancers
- Endometrial Cancer
- Ovarian Cancer
- Uterine Cancer
- Cervical Cancer
Endometrial Cancer
What is Endometrial Cancer
Endometrial Cancer also referred to as Cancer of the endometrium, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the lining of the uterus (endometrium). The uterus is the hollow, pear-shaped organ where a baby grows during a woman’s pregnancy.
Cancer of the endometrium is different from cancer of the muscle of the uterus (called sarcoma of the uterus).
Symptoms of Endometrial Cancer
You should see a doctor if you have any of the following problems:
- bleeding or discharge not related to menstruation,
- difficult or painful urination,
- pain during intercourse, or
- pain in the pelvic areas.
Risk factors for endometrial cancer
One risk factor for endometrial cancer is an increase in the number of normal cells lining the uterus (endometrial hyperplasia). Since the incidence of endometrial cancer may be related to hormonal changes, any condition which elevates hormone levels may put women at increased risk.
Estrogen replacement therapy, some ovarian tumours, obesity, having had few or no children, and late menopause are all associated with elevated hormone levels.
Diagnosis of Endometrial Cancer
Your doctor may use several tests to see if you have cancer, usually beginning with an internal (pelvic) examination.
During the examination, your doctor will feel for any lumps or changes in the shape of the uterus.
Your doctor will then do a Pap test, using a piece of cotton, a brush, or a small wooden stick to gently scrape the outside of the cervix (opening of the uterus) and vagina to pick up cells for microscopic study.
Because cancer of the endometrium begins inside the uterus, it does not usually show up on a Pap test. For this reason, your doctor may also do a test to remove pieces of the lining of the uterus. This tissue is then checked for cancer cells.
Treatment for Endometrial Cancer?
Surgery is the most common treatment for cancer of the endometrium. Your doctor may take out cancer using one of the following operations:
- Hysterectomy, removal of the uterus but not the ovaries
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy, both of which involve removing the uterus, fallopian tubes and ovaries through a cut in the abdomen. Lymph nodes in the pelvis may also be removed (lymph node dissection). The lymph nodes are small, bean-shaped structures found throughout the body that produce and store infection-fighting cells, but may also contain cancer cells
- Radical hysterectomy involves removing the cervix, uterus, fallopian tubes, ovaries, and part of the vaginal Lymph nodes in the area may also be taken out
Ovarian Cancer
What is Ovarian Cancer?
Ovarian Cancer or Cancer of the Ovaries is the most ovarian cancers (eighty-five to ninety per cent) develop from the cells that cover the outer surface of the ovary, called the epithelial cells.
The cells that make up epithelial ovarian cancers have several histologic patterns, which are recognized under the microscope.
They are referred to as serous, mucinous, endometrioid or clear cell types. Some lack distinctive features and may be considered “undifferentiated” epithelial tumours.
Ten to fifteen per cent of ovarian cancers develop in the germ cells or sex cord-stromal cells of the ovary. Ovarian germ cell tumours developed from the cells that produce the ova or eggs. Germ cell tumours may occur in teenagers and in women in their twenties. However, overall, these are rare tumours and have a good prognosis.
Ovarian stromal tumours develop from connective tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone. These tumours are generally much less aggressive than the other tumours. These are also rare tumours.
What are the symptoms of ovarian cancer?
There are usually no obvious symptoms of ovarian cancer.
Women complain about vague symptoms including
● abdominal swelling or bloating,
● generalized abdominal discomfort,
● early satiety,
● lack of appetite,
● dyspepsia,
● malaise,
● urinary frequency or weight change (either gain or loss).
Women may develop unexplained ascites (fluid in the abdominal cavity) which contributes to abdominal discomfort. Because the symptoms are not unique to ovarian cancer, the disease can be difficult to identify and diagnose.
Ovarian Cancer Diagnosis
A definitive diagnosis of ovarian cancer requires surgery. The initial surgery has two aims. First, to remove any cancer that exists (or as much as possible), including removing the ovaries, the uterus and the omentum. The best results for survival are in those women in whom all cancer can be removed. Second, to sample tissues and surrounding nodes to determine where the tumour has spread (to determine the stage of the disease).
In pre-menopausal women, a more limited surgery may be appropriate depending upon the cell type of the tumour.
Treatment Options for Ovarian Cancer?
After the initial diagnosis has been established at surgery, additional therapy will depend on several factors, including the histologic cell type, the stage, the extent of spread of cancer; and the residual tumour remaining at the end of the initial surgery. Treatment includes chemotherapy (usually a combination of drugs), or radiation. Other treatment options may include immunotherapy, or in the future, gene therapy.
What are the risk factors for ovarian cancer?
The causes of ovarian cancer are unknown. The disease tends to be more common in women from western industrialized countries, especially white women, who have had no full-term pregnancies. There also have been noted associations with exposure to talc or asbestos. In addition, there is an association with infertility.
It appears that factors that decrease ovulation have been associated with a lower risk of ovarian cancer in the general population. Women who have had multiple pregnancies or who have breastfed have fewer ovulations and have been noted to have a decrease in the occurrence of ovarian cancer. The use of oral contraceptives has also been associated with a decrease in the development of ovarian cancer.
The protection provided by oral contraceptives appears to be real and increases as the duration of the pill use increases. A risk reduction of up to 60% may occur when oral contraceptives are used for longer than five years.
Recent studies have noted that there is a decreased incidence of ovarian cancer in women with a history of tubal ligation. The mechanism of this is unclear. The use of powders containing talc should be avoided on the external female genitals.
Is ovarian cancer hereditary?
Most ovarian cancers are sporadic and not inherited. However, five to ten per cent of individuals who develop ovarian cancer have an inherited genetic susceptibility to the disease.
Generally, the risk of developing ovarian cancer increases as the number of family members affected by ovarian cancer increases. Having a first-degree relative affected by ovarian cancer (for example, a mother or a sister) increases a woman’s lifetime risk from 1.4% to 3.1%.
Those at the greatest risk for inherited genetic susceptibility have a personal or family history of ovarian and/or breast cancer. Histories that include cancers with early age of onset, multiple primary (new) cancers and Jewish ancestry reflect greater risk.
There are three different syndromes that fall under the heading of familial ovarian cancer. The first is a site-specific, hereditary ovarian cancer syndrome in which only ovarian cancer is manifested.
More commonly, however, there is hereditary breast-ovarian cancer syndrome in which both ovarian cancer and breast cancer may occur in the same family. And finally, there is the Lynch II syndrome in which breast, ovarian, colon, endometrial and other cancers occur throughout the family. The cases of familial ovarian cancer, however, account again for only five to ten per cent of ovarian cancers.
Those people who are interested in learning more about their hereditary risks should speak to their physicians about the option of genetic counselling and testing.
What can I do to prevent ovarian cancer?
There are no known methods to guarantee the prevention of ovarian cancer. Women who are diagnosed in an early stage, however, have a higher survival rate. Unfortunately, ovarian cancer is usually not diagnosed at an early stage.
There are no effective methods currently for diagnosing ovarian cancer early in all women and thus intervening at an early stage. Currently, there are many programs attempting to develop strategies for diagnosing ovarian cancer early.
Can I get ovarian cancer if I have my ovaries removed?
Women at a very high risk of developing ovarian cancer can consider removal of the ovaries. Such a “prophylactic” removal of the ovaries appears to lower the risk of developing ovarian cancer but does not eliminate the risk. Women with one first-degree relative with ovarian cancer have a risk of developing the disease, which is approximately 3.1%.
A prophylactic oophorectomy (removal of the ovaries) as an independent operation is not recommended, in general, for these women. With two first-degree relatives, the risk of developing ovarian cancer is approximately seven per cent and prophylactic removal of the ovaries may be considered.
In general, women found to be carriers or who have a family history highly suggestive of a syndrome may be appropriate candidates for prophylactic removal of the ovaries.
Removal of the ovaries results in lost hormone production, which can have side effects. A woman considering prophylactic removal of the ovaries should discuss possible side effects with her doctor.
Uterine Cancer
What is Uterine Cancer
Uterine Cancer or Cancer of the Uterus is also called sarcoma of the uterus — is a very rare kind of cancer in women. It is a disease in which cancer (malignant) cells start growing in the muscles or other supporting tissues of the uterus.
Cancer of the uterus is different from cancer of the endometrium, a disease in which cancer cells start growing in the lining of the uterus.
Symptoms of Uterine Cancer
You should see your doctor if you have
- bleeding after menopause (the time when you no longer have menstrual periods) or
- bleeding that is not part of your menstrual cycle.
Cancer of the uterus usually occurs after menopause.
What Factors Put Me At Risk For Uterine Cancer?
Currently, there has been little insight into the exact causes for uterine cancer. However, 10-25 per cent of malignancies occur in women who received pelvic radiation five to 25 years earlier for benign bleeding.
As in other cancers of its type, risk factors for uterine cancer include diabetes, hypertension, obesity, and improper estrogen levels.
What Is The Most Common Treatment For Uterine Cancer?
Surgery is the most common treatment for cancer of the uterus.
Your doctor may take out cancer in an operation to remove the uterus, fallopian tubes and the ovaries, along with some lymph nodes in the pelvis and around the aorta (the main vessel in which blood passes away from the heart).
The operation is called a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy.
The lymph nodes are small bean-shaped structures that are found throughout the body that produce and store infection-fighting cells but may contain cancer cells.
Cervical Cancer
What is Cervical Cancer?
Cancer of the cervix, a very common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the cervix.
The cervix is the opening of the uterus (womb). It connects the uterus to the vagina (the birth canal). Cancer of the cervix usually grows slowly over a period of time.
Before cancer cells are found on the cervix, the tissues of the cervix go through changes in which abnormal cells begin to appear (a condition called dysplasia). Later, cancer starts to grow and spread more deeply into the cervix and to surrounding areas.
Risk Factors for Cervical Cancer
It appears that the main causal factor in cervical cancer is the genital human papillomavirus (HPV) or the genital wart virus.
The presence of genital HPV has been found in almost all cases of cervical cancer. However, because the vast majority of women with genital HPV do not develop cervical cancer it is thought that other cofactors, such as smoking, also need to be present.
Genital HPV is primarily transmitted through sexual contact and, therefore, the risk factors for cervical cancer are related to sexual behaviour.
Risk factors include:
- Sexual activity: women who have never had sexual intercourse do not tend to develop cervical cancer
- Early sexual intercourse: evidence from many studies suggests that adolescent sexual intercourse increases the risk of developing cervical cancer
- Sexual activity with a number of different partners: multiple partners increase a woman’s chance of contracting a sexually transmitted infection, as does sexual intercourse with a person who has had multiple partners
- Smoking: although it is not known how the mechanism works, the association between smoking and cervical cancer is well-recognized
Symptoms Of Cervical Cancer
There are no real symptoms of the early stages of cervical cancer. That is why it is so important that your doctor does a series of tests regularly to look for it.
The first of these is a Pap smear, which is done by using a piece of cotton, a brush, or a small wooden stick to gently scrape the outside of the cervix to pick up some cells that can be examined under a microscope.
You may feel some pressure, but you usually do not feel pain. Most cervical cancers can be caught early with regular screening.
Treatments for Cervical Cancer?
Treatments for cancer of the cervix depend on the stage of disease, the size of the tumour, and a woman’s age, overall physical condition, and desire to have children.
Treatment for cervical cancer during pregnancy may be delayed, depending on the stage of cancer and how many months of pregnancy remain. There are three kinds of treatment for women with cancer of the cervix:
- Surgery – removing cancer in an operation;
- Radiation therapy – using high-dose x-rays or other high-energy rays to kill cancer cells;
- Chemotherapy – using drugs to kill cancer cells;
The National Cancer Institute recommends that doctors should strongly consider giving chemotherapy at the same time as radiation therapy for women with invasive cervical cancer.
Up to now, surgery or radiation alone has been considered standard treatment for this form of cancer.
