Uterine cancer (uterine carcinoma, endometrial carcinoma)

The uterus is a hollow organ made up of muscle, similar in shape to an upside-down pear, with the pointed end facing the vagina. The inside is covered by a mucous membrane (called the endometrium), which is shed monthly during menstruation until menopause and is then regenerated. Malignant tissue changes of the endometrium usually only occur after menopause. 95% of cases of the disease affect women after the age of 40.

Cancer of the endometrium is called cancer of the body of the uterus, uterine cancer or, in technical terms, uterine carcinoma or endometrial carcinoma. The disease should not be confused with cervical cancer, which is about twice as common.

In Germany, about 11,000 women are diagnosed with endometrial carcinoma every year. The average age at diagnosis is 68 years. Since bleeding from the uterus is the main symptom of uterine cancer, bleeding that occurs after menopause should definitely be clarified by a medical examination.

The exact cause of endometrial cancer is not known. It is assumed that the sex hormone oestrogen plays a major role in the development of this cancer. Oestrogen is produced in the ovaries and in fatty tissue and, among other things, has a growth-promoting effect on the glandular cells of the lining of the uterus (endometrium). Women who are exposed to the higher oestrogen concentrations of the fertile phase of life for a long time (i.e. have their first period early or go through the menopause late) have a higher risk of developing uterine cancer. In addition, being overweight also increases the risk of developing the disease.

If women are treated with oestrogens during menopause to reduce menopausal symptoms, this also increases the risk of developing uterine cancer. Therefore, according to new treatment guidelines, oestrogens are only given in combination with progestogens, as these reduce the negative effects of oestrogens.

In addition, treatment with anti-estrogens used for breast cancer can also promote the development of endometrial cancer. In these cases, however, the benefits of anti-estrogen therapy on the development of breast cancer clearly outweigh the risk of endometrial cancer development.

The first symptoms of uterine cancer are usually bleeding from the uterus or vagina. These are similar to menstruation, but they are usually weaker and can also occur as intermittent bleeding.

In some cases there is spotting or bloody discharge. Contraction-like pain can also be a sign of endometrial carcinoma. After menopause, any bleeding from the uterus is generally suspicious and should definitely be clarified by a doctor.

In order to diagnose endometrial carcinoma, a vaginal sonography (ultrasound examination through the vagina) is usually performed. The diagnosis can also be confirmed with the help of a hysteroscopy or a scraping of the endometrium with subsequent microscopic examination (curettage).

A histological examination (examination of tissue under the microscope) of the endometrium can determine whether the growths are benign, preliminary stages or already cancerous. CT (computer tomography) or MRI (magnetic resonance imaging) can be used to determine how far the cancerous tissue has already spread.

If it is suspected that the cancer of the uterus has already spread to the rectum or bladder, a cytoscopy (cystoscopy of the bladder) and a rectoscopy (examination of the rectum) will also be performed.

The most important treatment for uterine cancer is the surgical removal of all tumour tissue. The standard procedure is complete removal of the uterus, ovaries and, if necessary, the vaginal cuff and adjacent lymph nodes, as uterine cancer often forms metastases (daughter tumours). This procedure offers the safest protection against progression and is performed primarily in post-menopausal women.

In younger women who wish to have children and have early uterine cancer, conventional therapy with uterine scraping and hormone treatment is usually used. In this case, the uterus is not removed and the possibility of conception is retained, but regular check-ups must be carried out for possible recurrence of the cancer.

If the cancer of the uterus is far advanced or inoperable, radiation therapy must usually also be performed. This involves short-distance radiation (brachytherapy), in which an encapsulated radiation source is inserted through the vagina into the uterus. Only in rare cases is uterine cancer also combated by hormone treatment or chemotherapy.

The prognosis of uterine cancer depends greatly on the time of diagnosis. Uterine cancer usually develops very slowly - the earlier it is detected and treated, the greater the chance of cure. The 5-year survival rate is quite good at about 80 percent.

With the appearance of metastases (daughter tumours) or severe changes in the cancer tissue, the prognosis deteriorates noticeably. Therefore, any bleeding outside the normal menstrual cycle or after menopause should definitely be clarified by a doctor in order to be able to detect the cancer at an early stage.

Uterine cancer cannot be prevented. However, regular examinations by the gynaecologist can diagnose and treat a possible cancerous tumour at an early stage, which can result in a fairly high probability of survival. Especially bleeding outside the normal menstrual cycle or after menopause should definitely be clarified by a doctor, as these are the most common symptom of uterine cancer.