Endometrium tissue is the membrane surrounding the uterus. We expel the endometrium tissue, which thickens within the physiological limits every month from the first menstrual period, together with the menstrual cycle. The area where the gestational sac is healthy is the endometrial tissue.
The definition of “Uterine Cancer” frequently refers to cancers of the endometrium tissue and since this area is a gland tissue, it carries the pathology of “adenocarcinoma”. The most common uterine cancers are endometrium cancers. It is known that 2-3% of women will have uterine cancer during their life. Uterine sarcomas arise from the mesodermal structure of the uterus. 3% of uterine cancers are sarcomas. Although endometrium cancers are common and better progressing cancers, sarcomas are much less rare but aggressive cancers.
Endometrium cancers are mostly estrogen-related cancers. Women who are exposed to estrogen for a long time and at high rates are considered to be at risk.
Having menstruation early
Enter late menopause
Polycystic ovary syndrome
Have never had labour
Receiving long-term infertility treatment
Endometrial cancer and hereditary nonpoliposis colorectal cancer syndrome in the family
Estrogen-secreting tumours (such as the granulosa cell tumour and the ovary tumour)
Atypical complex endometrial hyperplasia
Simple endometrial hyperplasia with atypia
Using unmet estrogen for hormone replacement in menopause
Having had colon cancer before
Presence of familial non polyposis colorectal cancer
Drugs such as tamoxifen used in breast cancer treatment and protection are risk factors of endometrium cancers.
At this point, it would be appropriate to explain about obesity. Hormones secreted from the adrenal gland in fat women turn into estrogen in adipose tissue, and increased estrogen levels also increase the likelihood of thickening and cancer in the intrauterine tissue, while the same issue is raised for breast cancer. Lifestyle changes are very important here. Nutrition should be regulated correctly and movement should be increased in order to decrease weight to age and paint.
Meanwhile, long-term use of birth control pills for 5 years reduces uterine cancer by 5 times, as it reduces the effects of estrogen.
Estrogen has no role in the formation of sarcomas, and cancers that develop from the mesodermal layer of the uterus. These are rare but very aggressive tumours.
25% of endometrial cancers occur before menopause and in the period when menopause is entered (premenapose and perimenapose) and 75% is seen after menopause. The most common symptoms are bleeding and vaginal discharge. Endometrial sampling should be performed in women who are still menstruating, if there are menstrual periods of less than 21 days, if they have intermediate bleeding or excessive menstrual bleeding. If there is bleeding after menopause, endometrial sampling should be done regardless of ultrasonographic findings.
Bleeding is an important and early sign and if evaluated correctly, the probability of early diagnosis is quite high. 75-80% of endometrium cancers are caught early and can be treated.
Although the smear test has no anatomical relation with the diagnosis of endometrial cancer, if a woman who is not in the menopause has atypical endometrial cells as a result of smear, or if endometrial cells are seen as a result of smear after menopause, endometrial sampling should be performed.
Endometrial cancers can be suspected without any signs of bleeding, by means of ultrasonography performed during routine control, due to the increase in the thickness of the endometrial tissue or irregularity, and again, endometrial sampling should be performed.
Again, if the patient feels abdominal swelling, or if there is a mass in the uterus and a mass in ultrasonography, further examination should be performed.
Uterine sarcomas can originate from myomas or other cells of the mesoderm independently. If it is anatomically close to the tissue of the endometrium, an abortion can be diagnosed, but this is not always possible. Basically, the diagnosis will be made by examining the surgically removed mass by the pathologist. This means diagnosis by surgery.
There are three types: leiomyosarcoma, endometrial stromal sarcoma and mixed mesodermal tumour. Spread via blood and distant metastases are quite common.
How is endometrial sampling done?
Three ways can be proposed for endometrial sampling;
The first is a mini vacuum extraction that can be easily applied in the polyclinic environment without any anesthesia, which is called aspiration by pipette. Often enough samples can be taken and an idea can be obtained. However, it is not possible to sample all endometrial tissue in this way. However, this method, which does not require anesthesia, is cheap, easy and mostly effective, can be easily applied in selected cases.
The second method is dilatation and abortion, which are performed to sample as much of the intrauterine tissue as possible. It can also be performed under local anesthesia, but if the patient and hospital conditions are suitable, it can be easily performed under anesthesia. For abortion, the cervix is sampled first, then the cervix is expanded a little and the intrauterine tissue is sampled by scraping with the appropriate sized curettes.
The third method is to take samples from the intrauterine tissue by hysteroscopy. Here, under anesthesia, special fluids are first introduced into the intrauterine tissue under anesthesia and a field of view is created where the tissue can be examined telescopically. Irregular structures in the area, mass or polyp looking lesions are determined and the necessary biopsy or mass excision is applied. Although it is a very effective and reliable procedure, it often requires anesthesia or an increase in cost.
After diagnosis, before surgical treatment, examinations regarding distant metastases should be performed when necessary and the general condition of the patient should be analyzed very well.
Endometrial cancer treatment
The first treatment in endometrial cancer is surgery, removal of the uterus, cervix, ovaries and tubes, that is, hysterectomy and salpingooferectomy. While this may be enough for treatment at a very early stage, it may be necessary to remove the lymph in the pelvic area and / or paraaortic area to assess the possibility of continuing treatment with chemotherapy or radiotherapy. Meanwhile, removal of omentum tissue is also required for staging. In advanced cancer, if a suspicious mass is detected in other foci in the abdomen, they are also removed.
The main thing here is not the removal of the uterus and ovaries, but the correct surgical staging. For this reason, uterine cancers should be operated by physicians trained in gynecological oncology and trained with this experience. Correct surgical treatment until early diagnosis and correct application of chemotherapy and radiotherapy will be life-saving. The life expectancy with correct treatment is quite long in uterine cancers with high probability of early diagnosis.
In the follow-up follow-up, it is followed up every 3-6 months for the first 3 years and then annually. Most recurrence occurs in the first 3 years. During follow-up, gynecological examination, bimanual examination, pap smear and vaginal ultrasonography are performed. If necessary, chest radiography, whole abdominal ultrasonography, computed tomography, magnetic resonance examination or PET can be performed. After 3 years of disease free follow-up, the follow-up intervals range from 6 months to 1 year.
Diagnosis in uterine sarcomas is already made by surgery. Staging is done like endometrial cancers. Surgery and subsequent radiotherapy, chemotherapy requirement is done by surgical staging of the patient. Although it can be completely recovered when detected at an early stage, relapse is very common and treatment results are less satisfactory than endometrial cancer. Recurrence, including distant metastasis, is common during diagnosis and after surgery. Much more research, knowledge and experience are needed for sarcomas.