As we look into the advances and recent discussions in medicine and the treatment of uterine cancer, which is also known as endometrial cancer, there have been advances and successes that are worth sharing. Although some diagnosed with cancer might not have positive outcomes, it is important to make sure that we move boldly and with hope every day. Cancer is a major public health concern and is the second leading cause of death in the United States. Research and study of cancers is a priority within the medical communities and some cancers have been decreased in incidence. Cancer is something that we may never know fully about but, with all the advances in medical industry and with technology in the world today, I am hopeful there will be a time when we can say we do. There are many good sites and sources to look at and the support from community and others will be key to the success of treatment and care of patients that are diagnosed with Uterine Cancer.
First, it is important to understand what uterine cancer is. Uterine cancer generally begins in the uterus, which is an organ that is pear-shaped and in a woman’s pelvis and plays an important part for any woman as it is where a baby grows during a pregnancy. There are two types of uterine cancer, the first is endometrial and is the most common type diagnosed. This type of uterine cancer begins in the layer of cells that form in the lining known as the endometrium of the uterus (Mayo Clinic Staff). It is often found in early stages as it usually has bleeding associated with it. The second type of uterine cancer is uterine sarcoma, this is when the cells malignant (cancer) cells form in the muscles of the uterus or other tissues that support the uterus, this which is not as common. For this research, we will focus on the most common form, endometrial cancer.
Uterine Cancer is within the top 5 of most common cancer in women globally, and the doctors don’t know what cause it. They do have enough information and have found in numerous studies that there is some sort of mutation within healthy cells that turn them into abnormal cells. In studies, most commonly found, is that the abnormal cells grow and multiply out of control and they do not die. Because these cells do not die they accumulate and form a mass which can be cancerous. (Mayo Clinic Staff) It is important to know that uterine cancer can metastasize and spread to other parts of the body if not treated appropriately.
It is important that by the time a person develops symptoms of uterine cancer; their disease is usually advanced and harder to treat. The most common symptom is vaginal bleeding after menopause, menopause is a natural occurrence in women and it is when the woman stops having a menstrual cycle. Unfortunately, there are many other symptoms with uterine cancer that can be associated with other diseases such as unusual discharge from the vagina including watery or blood-tinged, difficult urination, pain in the pelvic area and lower abdomen, also pain during sexual intercourse (National Cancer Institute). No matter what the symptom the earlier the detection the better the outcome. So it is important for patients to visit with the provider if any of the above symptoms from bleeding to pain occur to ensure diagnosis as early as possible.
Studies have looked at the above symptoms to help understand and within one meta-analysis, which is a statistical analysis that combines the results of many studies. This study looked at and utilized 129 studies to determine if there is a connection between bleeding and diagnosis (National Cancer Institute). This published study included over 40,000 women between the years 1977 and 2017 looked at this relationship and found that yes there is a connection and that the stats were consistent with other studies (National Cancer Institute). The published study showed that bleeding after menopause is a possible sign and that women should always consult with their providers to be checked and tested to rule out a cancer (National Cancer Institute).
The main path of diagnosis for the endometrial type of cancer will include a transvaginal ultrasound, biopsy, or both to determine if an endometrial tumor is a cause. A transvaginal ultrasound is a safe and easy procedure and when they use ultrasonography to visualize the organs within the vaginal and pelvic area. This type of ultrasound uses high-frequency sound waves to get detailed images of these female organs (Cancer Center Victoria). Ultrasounds do not use radiation is important and that the transvaginal ultrasound is an insertion of the transducer in the vagina to produce the images needed (Cancer Center Victoria). When examining the internal organs to rule out uterine cancer they look at the vagina, cervix, uterus, fallopian tubes, ovaries, and bladder. The transvaginal ultrasounds have no real side effects or risks associated with the test. If there is something shown on the ultrasound a biopsy will be taken, which is taking a piece of tissue to examine under a microscope for an exam of cells, this will help to see if there are cancer cells or not (Cancer Center Victoria). It is important to the patient and providers to make sure they are looking at all lab, X Rays, ultrasounds, and biopsies to determine the treatment plan and the timing of plan.
Uterine cancer is treated by one or a combination of treatments, these include surgery, radiation therapy, chemotherapy, or hormone therapy. Combinations are usually recommended, but the doctors look at several factors, including the stage of cancer, side effects, overall health, age, and whether the treatment will affect the woman’s ability to have children (American Cancer Society). Surgery is the complete removal of the tumor and surrounding healthy tissue. This is typically the first treatment used for uterine cancer. It can be a hysterectomy or a lymphadenectomy (American Cancer Society). A hysterectomy is the removal of the uterus and cervix and a lymphadenectomy is when the surgeon may remove the uterus, cervix and the lymph nodes near the tumor if cancer spread farther than the uterus (American Cancer Society). The side effects after surgery include short term and long term effects. Short-term effects include pain, tiredness, nausea, vomiting, difficulty having bowel movements and the patient’s diet might be constricted to liquids with a gradual return to solid foods (American Cancer Society). The hospital stay after this surgery is 1 or 2 days most women will have complete recovery between 2 and 3 weeks. Long-term effects would be early menopause, reduction of sex hormones, hot flashes and vaginal dryness, and the patient can no longer become pregnant (American Cancer Society). A hysterectomy typically costs $10,000-$20,000 or more but can reach more than $40,000, depending on the extent of the surgery (Costhelper).
Radiation therapy is the use of high energy x rays or other particles to destroy cancer cells. Radiation is usually done after surgery to destroy any remaining cancer cells. Radiation can sometimes be given before surgery to shrink the tumor. For endometrial cancer, the radiation therapy is directed toward the whole pelvis or vaginal cavity (American Cancer Society). A typical course of radiation for uterine cancer would entail daily radiation treatments, Monday through Friday, for 3 to 5 weeks (American Cancer Society). The actual treatment with radiation generally lasts no more than a few minutes, during which time the patient is unlikely to feel any discomfort. Side effects depend on the extent of radiation therapy and they include fatigue, skin reactions, upset stomach, loose bowel movements (American Cancer Society). They soon go away after the treatments are finished, but long-term side effects could have bowel or vaginal symptoms (American Cancer Society).
Women who are diagnosed with uterine cancer will need to understand what the outcome of this diagnosis and there are many variables the providers will look at to help her with this information. With stage I uterine cancer women who receive treatment with surgery and radiation therapy have a 5-year survival of 80-90% and a local cancer recurrence rate of only 4-8% (Texas Oncology). Treatment of stage II uterine cancer with surgery followed by radiation therapy has been reported to cure 60-80% of patients (Texas Oncology). Despite radiation therapy, 20-40% of patients will experience a cancer recurrence (Texas Oncology). Recurrences occur outside the pelvis in approximately 25% of women, primarily those with cancer deep in the uterus(Texas Oncology). Treatment of stage III uterine cancer with surgery followed by radiation therapy has been reported to cure approximately 50% of patients (Texas Oncology). Many patients can and will experience a cancer recurrence. Further treatment with chemotherapy, instead of or in addition to radiation therapy, may be required to further decrease the risk of cancer recurrence in patients with stage III cancer (Texas Oncology).
Treatments also include Chemotherapy which is the use of drugs to destroy cancer cells. Chemotherapy is usually considered if the endometrial returns after the initial treatment (American Cancer Society). The goal of chemotherapy is to destroy any remaining cancer cells after surgery or to slowly shrink the tumor (National Cancer Institute). Common ways to administer chemotherapy is through an intravenous (IV) tube or in a pill that is administered orally (American Cancer Society). These treatments can consist of multiple in number and over a period of time, in cycles that include rest periods and the chemo drugs may be given on one or more days (National Cancer Institute). Side effects of chemo depend on the dose used or the type of drugs used. Usually, the most common can include fatigue, a risk of infection, nausea, vomiting, hair loss, loss of appetite, and diarrhea (American Cancer Society). Most chemo side effects go away after the treatments are finished. Long-term effects are an inability to become pregnant, early menopause, hearing loss and kidney damage (National Cancer Institute). Chemo can be an effective treatment when cancer spreads outside the uterus and in stage three of uterine cancer (American Cancer Society).
Another type of commonly used treatment is Hormone therapy. Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them (American Cancer Institute). Often involves a high dose of the sex hormone progesterone given in a pill form. Hormone therapy may be used for women who are not eligible to have surgery or radiation therapy or it can be used in combination with other types of treatment. Side effects of hormone therapy may include fluid retention, increase in appetite, insomnia, muscle aches, and weight gain and most side effects are manageable (ASCO). The cost of hormone therapy depends on the types of hormones you receive, how long or often you are receiving them and what part of the country you live in.
As we look at cutting-edge treatments, timing, effectiveness side effects and economic costs associated with these types of treatments we can see that there are many new clinical trials and current research. In one such study, the National Cancer Institute has looked at the postmenopausal bleeding and endometrial cancer in greater detail. The study published on August 29, 2018, was one of the largest studies to date that looked at the extent to which vaginal bleeding is associated with endometrial cancer in women who have already gone through menopause, and it found that 90% of women diagnosed with uterine cancer reported bleeding prior to diagnosis and it found that 9% of postmenopausal women who saw a doctor for bleeding were diagnosed with endometrial cancer (National Cancer Institute).
There have been additional information published in the New England Journal of Medicine that looked at the impact to uterine fibroids and their prevalence of undiagnosed uterine cancers among women with fibroids. The study found that although there is some chance of these turning cancerous genetic mutation play a role as well as the other risks such as increasing age up to menopause, black race and obesity play a role (Stewart). It showed that uterine cancer is seven times as high in black women as among white women (Stewart). Reproductive and environmental factors influence the risks as well as early period and early use of contraceptives and dietary factors (Stewart). If the women had a long-term healthy diet they did see a decrease in risk (Stewart).
Within a current article published in the New England Journal of Medicine in May of 2017, it analyzed infiltrating endometriotic lesions from 27 patients by means of exome-wide sequencing which is a genomic technique to sort all of the protein-coding genes in a genome for the lesions (Anglesio). In the study, the results showed somatic mutations in 19 of the 24 patients which are 79% (Anglesio) Within the study 5 patients had the known cancer mutations, this was validated by sequencing and immune analysis (Anglesio). The conclusion of the study was that there is no risk of malignant transformation, driving mutations. Ten of the 39 deep lesions did carrier driver mutations and all were confined (Anglesio). By understanding the impact to cancer-driving genes on uterine endometrial lining will help to continue to work towards a cure of this type of cancer. Unfortunately, not all studies have a clear-cut result and we should continue to research approaches to this form of cancer.
Also, discussed on the American Cancer Society site, there is molecular pathology research and they have information that shows that the mutation of the damaged DNA can change genes that inhibit cell growth that can result in cancer. They have found that because of this that some cancers can run in families and have inherited this defect. Continued long-term studies on genes and the DNA abnormalities will help advance treatments and therapies and impact future cancer diagnosis(American Cancer Society).
All the above studies have costs associated with them and the continued studies will be needed. We know that any time there is a cancer diagnosis that there is a socioeconomic cost for that research. In the United States alone, endometrial cancer alone has costs of more than $12,000 per hospital stay and more than $54 billion per year in total (Rose). According to the summary no matter the cost it is known that cancer-associated mutations are found in endometriotic lesions, therefore we should invest in additional research in the study of cancer.
When looking at the morbidity and mortality rates and stats of Uterine cancer it has been noted that if uterine cancer is found early it has a 95% chance of survival rate for 5 years (National Cancer Institute). By contrast, if women are not diagnosed early their cancer can spread outside the uterus, and the chance for survival rate at 5 years drops to 16-45% (National Cancer Institute). Most recent data posted on cancer surveillance from 2017 shows overall that there are 1,600,000 new cancer cases and 600,000 deaths from cancer projected (Siegel). In this data, it was broken down by type of cancer and showed for uterine related cancers that there were almost 74,000 new cases in 2017 and approximately 15,000 deaths. It looked at even by state and in Iowa, there were 700 and Nebraska had 380 new cases (Siegel). With this data, epidemiologists can identify trends and use the data for additional input on treatments. When you can see the specific data every year on new cancer cases and deaths associated with cancer and specific to the types of cancers this information is interesting. Data shows what occurs in the US and shows that overall Cancer death rate has gone down over the last 2 decades and whether you are man or women does play a role, but, not for uterine cancer for obvious reasons.
Understanding, that anytime you are given a cancer diagnosis the main question arises and that is what is my survival rate and if I treat what life years will I gain. As shown above, the survival rate drops if not diagnosed early. It will be important to understand the different stages of uterine cancer. There are 5 different stages of uterine cancer, zero being the least likely to cost you your life, and five being the most life-threatening. All of the numbers I found are based on the 5-year survival rate which starting at stage 0 endometrial cancer has a 90% survival rate and the percent of survival rate progressively gets worse (Cancer Treatment Centers of America). Stage 0 is when the cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below and the cancer has not spread to nearby lymph nodes or distant sites (Cancer Treatment Centers of America).
Most of the life-years gained in the treatment of early endometrial cancer are attributable to hysterectomy, with a very low associated cost. For the “average” woman with endometrial cancer, about 10 life-years are gained from a hysterectomy at a cost of $1000 per life-year gained, whereas adjuvant radiation yields on average 1 year of life gained at $4000 per life-year gained (Ashih). Both life-years gained and cost are dramatically affected by age at diagnosis and to a lesser extent by histologic grade and comorbid medical conditions (Ashih)
It is common for women who are diagnosed with uterine cancer to want to understand what their quality of life is going to be if they are diagnosed with uterine cancer. In a study that was published in Acta Oncologica indicated that patients who are disease-free following treatment for uterine cancer experience physical, psychological and social sequelae related both to the disease itself and the radiation (McAlpine) Radiotherapy for uterine cancer exposes the patient to 5–6 weeks of daily treatments and thereafter to 1–3 months of adverse physical symptoms that impact on their daily lives (Marianne Klee) A few of the patients develop chronic symptoms that persist for at least 24 months and patients with endometrial cancer receiving radiotherapy should be informed of the expected changes, thereby giving them a chance to cope more effectively with these changes should they occur (Marianne Klee).. Uterine cancer has many associated health factors that can influence the quality of life such as obesity, advanced age, and other types of medical diseases (McAlpine).
Finally, the best news is if you are given the diagnosis of Uterine Cancer, your prognosis is good. And we understand what that means to a person given this news and the many concerns and questions that come with such a diagnosis. With any cancer diagnosis and the many issues that occur when you are diagnosed is and can understandably be a huge challenge. The statement “life can change in an instant” certainly is true. The unknown and not knowing what to expect will consume you. But, understanding the current treatments, the success of advancing treatments and the outcomes will only help you be as prepared as you can. Early detection of any cancer is of utmost importance and make sure to contact your medical health care team, family and friends.