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Cancer of Uterine Cavity

Incidence
  • It is commonest genital tract malignancy among women of in western countries. In United States about 41,200 new cases registered every year.
  • Its incidence in India the is on the rise mainly because of the changes in the lifestyle & obesity.
  • In population based cancer registry of Delhi, the incidence of endometrial cancer is 4.3/ 100,000 women per year (ICMR).
  • >70% of cases, are confined to uterus at time of diagnosis

Predisposing high risk Factors
  • Most uterine cancers develop at age >50years , but 10% of them are in <40 yrs of age.
  • Exposure to unopposed estrogen; ERT, anovulatory cycles/infertility, obesity, estrogen secreting tumors.
  • Tamoxifen exposure increases risk to 2-3 folds.
  • Family history of uterine, breast, ovarian or colorectal cancers.
  • Occasionally may develop post radiation for cancer cervix.

Presenting Features
  • Abnormal vaginal bleeding in 90% cases, especially if in postmenopausal women
  • Abnormal inter-menstrual or heavy prolonged peri-menopausal bleeding
  • Some may present with purulent vaginal discharge
  • High index of suspicion is necessary to diagnose it in young women, who has history of PCOD/ anovulatory cycles
  • Abnormality in pap smear

Staging of Uterine Cancers
  • Stage I: In this stage the cancer is limited to the uterus
  • Stage II: In this stage the cancer spread to the cervix area of the uterus
  • Stage III: In this stage, cancer reached an advanced phase but it is still located only in the pelvis
  • Stage IV: In this stage, the cancer spreads massively to the entire pelvic cavity or affected distant organs and areas

Diagnosis
  • Pelvic sonography
  • Endometrial sampling by EB or D&C

Treatment
  • Surgery: Staging laparotomy:- Total hysterectomy with BSO with lymph node dissection upto para-aortic lymph nodes, followed by adjuvant tailored radiotherapy. Sometimes hormonal therapy or chemotherapy may also be required.

Prognosis
  • 5 year survival rate varies with histo-pathological type of tumor
  • Endometriod type variety of uterus is highly treatable cancer in early stages and fortunately most cases(>70% ) are diagnosed, when confined is still to uterus( Stage I ).
  • Survival rates are lower in other varieties like uterine papillary serous or sarcomatous or mixed mullerian types

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