Uterine tumor: signs, symptoms and treatment

Uterine tumor

One of the most common group of gynaecological malignancies are tumours of the uterine fundus, however the yearly incidence reports have remained stable at approximately 36,000 cases during the last decade. Number of deaths per year is in and around 6000 per year. The survivors from this cancers usually tell that the disease had a very early onset of the cancer with symptoms arising very early However not all women can survive the cancer; those with increased risk or those with advanced cancer have a very poor prognosis and succumb to the cancer. The most common tumor almost up to 90% arises from the epithelial lining and is categorized separately as the endometrial carcinomas. The most important risk factor in the development of endometrial carcinoma is related to chronic estrogen exposure. The main cause includes tumors secreting estrogen, oral intake of estrogen, late menopause and early menarche, low parity and also extended period of anovulation. The women having a greater risk for endometrial cancer are morbidly obese women; this is mainly due to excess adipocytes which have the ability to convert androstenedione into estrone a weak circulating estrogen. Women suffering from diabetes mellitus and increased blood pressure also have an increased risk of uterine tumor.
Diagnosis and signs; A diagnosis of endometrial carcinoma should be considered in postmenopausal women with any vaginal bleeding, perimenopausal women with heavy or prolonged bleeding, and premenopausal women with abnormal bleeding patterns who are obese or oligo-ovulatory. Asymptomatic women with endometrial cancer occasionally have abnormal glandular components detected by routine cervical cytology. A serum CA 125 assay may be predictive of occult extra uterine disease and may be useful as a tumor marker. More sophisticated imaging studies, such as ultrasound, computed tomography, intravenous pyelography, and magnetic resonance imaging, rarely provide information that is not determined after surgical exploration. These studies should be reserved for patients with advanced disease or prohibitive surgical risks.

Resection of the primary tumor by total abdominal hysterectomy and bilateral salpingo-oophorectomy is the mainstay of therapy for uterine cancers. Because endometrial cancer originates in the fundus, adequate surgical margins can usually be achieved by simple extrafascial hysterectomy. Salpingo-oophorectomy is recommended because the ovary is a relatively common site of occult metastasis and because most women are already postmenopausal and no longer has hormonal function from the organ. Removal of the uterus is curative treatment for most stage I cases. The more extensive radical hysterectomy has been recommended for selected patients with gross tumor involvement of the cervix. Once surgical therapy is complete, the patient’s individual risk profile can be identified and used to design an adjuvant therapy plan. Although acute toxicity is common in patients with endometrial cancer who are undergoing pelvic irradiation, it is generally mild and self-limited. Treatment failure in low-risk patients is exceedingly rare. Tumor recurrence is most common in women with advanced-stage disease or those with high-risk features in their primary tumor. Late recurrence is uncommon, and virtually all failures are clinically evident within 3 years of original diagnosis. One-half of patients whose tumors recur are symptomatic. A targeted examination and diagnostic evaluation should readily lead to the correct diagnosis.