Understanding cancer of the uterus

Worldwide, the uterus has always been associated with fertility and continuation of the family line. Unfortunately, beyond its child-bearing function very little is known about the uterus.

Medical conditions that affect the uterus are often shrouded in secrecy and few women are willing to visit health facilities when things do not seem right with their womb.

Cancer awareness is growing in Kenya but there is a lot of focus on certain cancers while others are left in the dark. Among women, there is a heightened awareness about breast and cervical cancer with little emphasis on the rest of the reproductive system.

This lack of information has led to devastating effects in the care of women who develop these ‘neglected cancers’. Cancer of the uterus is one such ‘neglected case’.

Get to know your uterus

The uterus is an integral part of a woman’s reproductive system. It is a pear-shaped organ whose sole purpose is to carry a baby. For this reason, it is made up of an inner lining (endometrium) to which a fertilised egg attaches itself.

The rest of the uterus is made up of a special type of muscle which normally allows for it to enlarge as the baby becomes bigger. The opening of the uterus is known as the cervix. Menstruation occurs monthly as a result of the lining of the uterus shedding off due to lack of conception.

Which parts of the uterus can get cancer?

Cancer of the uterus can either affect the inner lining (this type of cancer is known as ‘Endometrial cancer’) or it can affect the muscles of the uterus (this type of cancer is known as ‘Uterine sarcoma’). Endometrial cancer is by far the common of the two and is the focus of our article. Cancer of the cervix is normally considered a separate entity from uterine cancer.

What should you look out for?

The most common features of uterine cancer are:

• Vaginal bleeding after menopause
• Bleeding between periods
• An abnormal, watery or blood-tinged discharge from your vagina
• Pelvic pain
• Pain during intercourse

What should you expect from your doctor during your visit?

If you have been experiencing any of the above symptoms you must visit your gynaecologist. During your visit, the doctor will get a detailed history of your menstrual pattern, hormonal therapy use, sexual and family history.

He/she will then do a thorough physical examination. This involves doing a pelvic exam (using his/her hands) and an ultrasound.

If any abnormality is seen in the uterus lining, he/she will then perform a biopsy (this involves getting a sample of the inner lining of the uterus). This sample will then be taken to the lab for further examination.

What treatment options are available?

Surgery: If discovered in the early stages, the removal of the uterus is usually curative. Usually, the tubes and the ovaries are taken out at the same stage.

Radiation: This involves using special rays to destroy cancer stages.

Chemotherapy: These are special drugs that destroy cancer cells. Usually they are given in either pill or intravenous (injecting directly into the blood stream).

Hormonal therapy: These are taken to alter the hormonal balance in your body (usually the aim is to reduce oestrogen – this is because oestrogen encourages the cancer cells to grow).

Are you at risk?

There are certain things that cause you to be at increased risk of getting endometrial cancer. These include:

• Women over the age of 50.
• Post-menopausal women who use hormone replacement therapy containing oestrogen only (without the use of progesterone). Oestrogen has been found to encourage endometrial cancer cells to grow (progesterone does not have this effect).
• Women who started menstruation at an early age (before 12)
• Women who start menopause after 50
• Women who have infrequent periods
• Breast cancer patients who have used the drug ‘Tamoxifen’
• Women who have never been pregnant
• Obese women (it is thought that excess fat alters the hormonal balance in the body)
• Women with Polycystic ovarian syndrome (PCOS)
• Diabetics

How can I prevent myself from getting uterine cancer?

There is no medication or vaccine that can be used to prevent this cancer. Our greatest tool in the fight against this cancer is regular screening.

All women over the age of 30 years should visit their gynaecologists annually. Usually, these visits are for screening purposes and allow for doctors to ‘catch’ disease processes such as uterine cancer in the early stages.

When cancers of the reproductive system are caught early, they tend to be curable. During your annual routine visits, your doctor must do a Pap smear and a transvaginal ultrasound.

You should also reduce your risk factors by keeping yourself at a healthy weight, controlling your diabetes and discussing any hormonal replacement therapy with your doctor.

Support for uterine cancer patients

Most women who undergo surgery to remove their uterus due to cancer feel as though they have lost an integral part of their womanhood. Those who have their ovaries removed during the same sitting find themselves going into menopause.

This poses immense challenges (both physical and emotional). The other treatment options tend to have side-effects like nausea, hair and appetite loss. In addition, the entire process is financially-draining.

To help a woman with uterine cancer cope, she needs a lot of support from those around her, especially her spouse and family to help her understand that her femininity, sexuality and role as a wife/mother are not defined by her disease.

What are the challenges doctors in Kenya experience?

Unfortunately, we tend to see women with reproductive cancers (ovary, uterus and cervix) when it is too late.

Most of them come to the hospital when the cancer is at advanced stage and nothing curative can be done for them. This means that we tend to lose the vast majority of our patients to these diseases.