The female
reproductive system is composed of the uterus (womb), fallopian tubes, ovaries, cervix (opening of the
uterus), vagina, and vulva. Cancer
of the lining of the uterus (endometrium) is most common, with an estimated
37,000 new cases expected in 1999. Invasive cervical cancer is next with 12,800 new cases expected.
Factors that put women at high risk for
cervical cancer are sexually transmitted diseases like the human papilloma
virus (HPV), multiple sexual partners, and first intercourse at an early age.
This is unlike endometrial cancer, where increased risk is associated with early
menarche (onset of period), late menopause, exposure to female hormones or
estrogens, infertility, or nulliparity (never having been pregnant). Other risk factors are obesity,
hypertension, diabetes, and gallbladder disease.
In-depth
Information
Abnormal vaginal
bleeding or spotting may be one of
the signs of cervical or endometrial carcinoma, but this may be a late sign.
Cervical cancer is detected much earlier if a Pap smear is done. This involves examination of cells scraped
from the surface of the cervix with a special brush. A Pap smear usually is
not helpful in diagnosing endometrial cancer, but it may be followed by a biopsy (sampling) from the cervix or
endometrium. Sometimes this biopsy may require
a brief hospitalization with an examination under anesthesia. A complete history and physical examination
also is performed. Blood work such as complete blood counts and kidney and liver
function tests are obtained. Radiographic studies include a chest x-ray and
CT/MRI of the abdomen and
pelvis, depending on the stage of disease at diagnosis.
The cancer
"stage" describes how advanced the disease is at the time of diagnosis.
Staging is different for the various gynecologic sites, but in general it ranges from stage I (confined to the
cervix or endometrium) to stage IV (cancer has spread to other organs beyond the
pelvis). Stages II and III
involve more bulky disease with possible extension to nearby surrounding
structures or lymph nodes.
There are many treatments for cervical or endometrial cancer, and the treatments depend on the stage of the disease and the patient’s age and general medical condition. With early invasive cervical cancer, a conization may be performed. This is the removal of a cone-shaped piece of tissue from the abnormal area in the cervix. Alternatively, if the cancer is more advanced, the patient may be a candidate for a hysterectomy (removal of the uterus and cervix). Stages II-IV and large stage I cervical cancers are treated with radiation (x-ray) therapy, usually in combination with chemotherapy. The radiation may be given as external beam therapy (using a linear accelerator to deliver high-energy x-rays from outside the patient's body) or brachytherapy (temporarily placing radioactive sources within the patient's body at the site of the disease) or a combination of both techniques.
Endometrial cancers are most times treated first with a hysterectomy, possibly followed by radiation therapy depending on the intraoperative findings. As with cervical cancer, the radiation therapy may be external beam, brachytherapy, or both, depending on the specific details of the individual patient's case.
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