CANCER OF THE UTERUS: DIAGNOSIS AND TREATMENT
Diagnosis. A woman should have her history taken and an examination performed by a doctor. There may be nothing much to find, because usually the action is happening in the lining of the uterus.
Specific testing of the endometrium needs to be performed. This is usually a microscopic examination of samples collected from the endometrium. Sampling can be done using either dilatation and curettage (D and C), or using an endometrial sampling device or hysteroscopy.
If abnormal cells are found, further examination and investigation will be done to assess the type and extent of the disease. The stage of the disease is determined at an operation. The extent of the spread and the type of cancer are determined, and a plan of management can be formulated.
Treatment. Depending on the type and spread, and the age, well-being and wishes of the
woman, the options include:
• Surgery—hysterectomy. The ovaries are also removed, as they can be another potential site of cancer. More extensive surgery may be considered if there is local spread into the muscle of the uterus, or into the cervix, tubes or ovaries. Under these circumstances, the lymph glands in the area would also be removed.
• Radiotherapy—this may be given after surgery.
• Chemotherapy—standard anti-cancer drugs are effective in the treatment of this cancer. About 40 per cent of tumours respond, but this response may only last for a few months.
• Hormonal therapy—progesterone-type medications, and anti-oestrogen drugs are often used in treating advanced adenocarcinomas. Treatment, not surprisingly, is more successful when the disease is caught early, and has not spread far. The five-year survival rate for stage 1 adenocarcinoma is about 85 per cent. Fortunately, because this disease has a tendency to cause irregular bleeding fairly early, it is often investigated and treated before there is significant spread.
The outlook for sarcoma is less bright, because it is usually a more aggressive cancer, but fortunately sarcomas make up a very small proportion of all uterine cancers. The symptoms, investigation and treatment options are similar to those outlined for adenocarcinoma.
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