DR SUBRATA CHATTERJEE

Uterine Tumors (Fibroids), Uterine Cancer, Gynecological Cancer & Cervical Cancer

 Uterine Tumors(Fibroids)

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage.

Many women have uterine fibroids sometime during their lives. But most women don’t know they have uterine fibroids because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

•  Fibroid locations



Many women who have fibroids don’t have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Sub mucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

 When to see a doctor

See your doctor if you have:

• Pelvic pain that doesn’t go away
• Overly heavy, prolonged or painful periods
• Spotting or bleeding between periods
• Difficulty emptying your bladder

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

Causes

Doctors don’t know the cause of uterine fibroids, but research and clinical experience point to these factors:

 Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.

 Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

 Other growth factors; Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue.The growth patterns of uterine fibroids vary they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

 Risk factors

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include:

Heredity. If your mother or sister had fibroids, you’re at increased risk of developing them.

Race. Black women are more likely to have fibroids than women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids.

Environmental factors. Onset of menstruation at an early age; use of birth control; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

Complications

Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss.

 Pregnancy and fibroids

Fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids; especiallysub mucosal fibroids could cause infertility or pregnancy loss. Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction and preterm delivery.

 Gynecological Cancer, Uterine Cancer (endometrial cancer)& Cervical Cancer

What is gynecologic cancer?

Cancer is a disease where cells grow and spread without control. Gynecologic cancers begin in the female reproductive organs. The most common gynecologic cancers are endometrial cancer, ovarian cancer and cervical cancer. Less common gynecologic cancers involve vulva, Fallopian tube, uterine wall (sarcoma), vagina, and placenta (pregnancy tissue: molar pregnancy).

If a woman has a gynecologic cancer, what should she do and where should she go?

Medical studies have shown that the quality of care and chances of survival are best when a cancer specialist provides care. Specialists in gynecologic cancer are GYNECOLOGIC. It is best to ask for referral to a gynecologic oncologist if cancer is diagnosed or suspected.

Uterine cancer symptoms

When present, common uterine cancer symptoms may include:

Vaginal bleeding or spotting: This includes vaginal bleeding between periods, prolonged periods, or bleeding after intercourse or after menopause.

Abnormal vaginal discharge: Some women experience a watery or bloody discharge as a symptom of their disease, though this is often a sign of infection or other non-cancerous conditions.

Pelvic pain or pressure: Pain during intercourse or at other times may be a uterine cancer symptom, or the sign of a less serious condition. Women who experience unexpected vaginal bleeding, spotting or unusual discharge should discuss these symptoms with their gynecologist.

The 5-year survival rate for women with uterine cancer is 82%. The 10-year survival rate is 79%. If the cancer is diagnosed and it is still only in the area it started, called local, the 5-year survival rate is about 95%. If the cancer has spread regionally, the 5-year survival rate is about 68%.

What causes endometrial cancer?

Endometrial cancer is the most common gynecologic cancer; one out of every 40 women will develop endometrial cancer. Too much estrogen, a hormone normally present in women, causes it. The most common cause of the excess estrogen is being overweight: fat cells actually produce estrogen. Another cause of excess estrogen is medication such as tamoxifen (often prescribed for breast cancer treatment) or some forms of prescribed estrogen hormone therapy (unopposed estrogen).

Is endometrial cancer treatable?

Yes! Most women with endometrial cancer will undergo surgery including hysterectomy (removal of the uterus) in addition to removal of ovaries and lymph nodes. In most cases, if biopsies taken at the time of surgery show that the cancer has not spread, no other treatment is needed. If cancer has spread to other areas, then additional treatment with radiation is usually needed. Most women with endometrial cancer will be cured if they receive appropriate treatment.

How is ovarian cancer different from endometrial cancer?

Ovarian cancer is less common than endometrial cancer, but it is a more deadly type of cancer. More women die from ovarian cancer than all other forms of gynecologic cancer combined. Unlike endometrial cancer, ovarian cancer is often not detected until it has already spread to other parts of the body.

Who gets ovarian cancer?

One out of every 60 women will develop ovarian cancer in her lifetime. There are 2 different groups of women who may be at risk for ovarian cancer. The majority of ovarian cancers develop in women who have many ovulations (egg release from the ovary) during their lifetime. Bearing children and use of birth control pills both reduce the likelihood of ovarian cancer because they reduce the number of lifetime ovulations. About 10% of women who develop ovarian cancer have inherited a gene from either parent that increases the risk. There are at least 6 genes that can cause inherited ovarian cancer, including BRCA-1, BRCA-2, MSH, MLH, PMS-1, and PMS-2. Warning signs that a gene abnormality may be present in a woman’s family include:

Multiple family members with breast cancer, ovarian cancer or colon cancer

Early age of cancer in affected relatives. A woman should inform her doctor if she is aware of a family history of cancer, Tests are available that can detect abnormal genes and if they are detected, prophylactic removal of the ovaries may greatly reduce the risk of ovarian cancer.

How is ovarian cancer detected?

Warning signs of ovarian cancer include abdominal discomfort, loss of appetite, nausea, bloating, gas, constipation, and frequent urination, among others. These signs usually do not occur until the ovarian cancer has already spread. Early ovarian cancer usually does not cause any symptoms, which is why this is often referred to as a “silent disease”. There are no reliable tests yet available to detect early ovarian cancer.

Tests that may be very useful in some, but not all, situations include ultrasound (sound waves that provide a visual image of the ovary) and tumor marker blood tests (CA-125, CA 19-9, CEA, AFP, and others). None of these tests are perfect, and inappropriate use of them can actually cause more harm than good. There are a number of new tests in development including a proteomics test (Ovacheck) and new markers (LPA). It is too soon to know whether these tests will improve our ability to detect early ovarian cancer.

How is ovarian cancer treated?

Surgery is almost always the first step for treatment. For most women, this will include a hysterectomy with removal of ovaries, lymph nodes and the omentum (a pad for other organs in the abdomen). In young women, some types of ovarian cancer can be treated with less aggressive surgery to preserve fertility.

Following surgery, the exact type of ovarian cancer and the extent of spread (stage), if any, are determined. Some early ovarian cancers require only surgery for treatment. The majority of women with ovarian cancer will need chemotherapy, which is medication designed to kill cancer cells in order to reduce the risk of the cancer recurring.

Is ovarian cancer curable?

With modern surgical techniques and chemotherapy, ovarian cancer without spread at the time of diagnosis can be “cured” in up to 95% of women. Unfortunately, at least 70% of ovarian cancers are detected after spread has occurred. For these women, treatment has an 80% chance of “remission”, meaning disappearance or shrinkage of disease. Disease of this advanced extent has a high likelihood of relapse, anywhere from months to years after treatment. We can often successfully treat relapses and attain another remission, but we are not able to permanently “cure” ovarian cancer that has relapsed.

What is being done to improve ovarian cancer treatment?

Immunotherapy (Ovarex, vaccines) Gene therapy; Biological therapy; New chemotherapy treatment. It takes a great deal of time to improve treatment of ovarian cancer, but progress is being made. Quality of life for women with ovarian cancer is improving. Chemotherapy no longer causes severe nausea, vomiting or exhaustion.

What is cervical cancer?

Cervical cancer involves the lowermost portion of the uterus where it enters the vagina. Cervical cancer was once the most common gynecologic cancer in the world. Use of the Pap test has greatly reduced cervical cancer by allowing detection of abnormalities that can be treated before the cancer develops.

What causes cervical cancer?

Cervical cancer is caused by the human papilloma virus(HPV); which is a sexually transmitted disease that also causes genital warts. Smoking is strongly associated with cervical cancer.

How often should Pap tests be done?

Pap tests should begin within 3 years of the time that a woman becomes sexually active or by 21 at the latest. The test should be done every year (conventional method) or two rears (liquid method: ThinPrep) until age 30. If all tests are normal by age 30, Pap tests can be every 2-3 years depending on which method your doctor uses.

What if a Pap test is abnormal?

If an abnormal Pap test occurs, additional testing with colposcopy (a microscope to view the cervix) is performed in the office. Removing the portion of diseased skin on the cervix can usually treat pre-cancer conditions.

Most cervical cancers are detected early as long as a woman has Pap tests regularly. Early cervical cancer is very treatable and the cure rate is high. New surgical techniques allow early cervical cancer to be treated with preservation of fertility. More advanced cases require radical surgery or radiation therapy.