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Source: Cancer Research/NHS
Completely different types of cancer affect different areas of the womb, or uterus.
The best known, perhaps as a result of a nationwide screening programme, is cervical cancer, which affects the cervix, or neck, of the womb.
Many women, thanks to early detection, find they have abnormal cell changes in their wombs which cannot be classed as fully cancerous.
These “pre-cancerous changes” are far easier to treat, and the number of women presenting with the symptoms of cervical cancer has fallen over recent years.
However, more common is uterine cancer, in its more usual form also called endometrial cancer – which affects the lining of the womb that grows, is shed, and regrows as part of a woman’s monthly cycle.
Professor Hilary Thomas, from the Royal Surrey County Hospital in Guildford, said that the key to successfully treating both cervical and uterine cancer was early detection.
Anybody who is sexually active should be having regular smears,
Professor Hilary Thomas, Royal Surrey County Hospital
She said: “Anybody who is sexually active should be having regular smears, and if they have a history of abnormal smears, they may need to go for more frequent smears.
“Cancer of the uterus, or the womb, is actually cancer of the body of the womb, which has a different kind of tissue in it from the neck of the womb.
“This is a disease which tends to affect elderly patients who have passed the menopause.
“Usually they will be advised to have a hysterectomy.”
Another, far less common cancer of the womb is uterine sarcoma, which affects the powerful muscles of the womb.
This is far more similar to other cancers which affect muscles than to either uterine or cervical cancer.
SYMPTOMS
Many cervical cancers are detected by the national screening programme.
Samples of cells from different areas around the womb neck are taken and looked at under a microscope for signs of abnormality.
If a smear is abnormal, the woman may be asked to take a repeat smear, or, particularly if there has been more than one abnormal smear, be sent to a specialist for further checks.
Once cancer is established however, the most common symptom is abnormal (ie non-menstrual) bleeding. This is a sign that the cancer has spread to surrounding tissue.
Menstrual bleeding may be heavier and last longer.
Abnormal bleeding, particularly after the menopause, can also be a sign of uterine cancer.
Women with certain symptoms should always consult a doctor. They are:
any sort of unusual vaginal discharge
pain in the pelvic area
painful or difficult urination
Once there is a suspicion of problems, there are various techniques used by doctors to try and locate the cause.
The first is a pelvic examination, which can be carried out by a family doctor, who will check the vagina, womb, ovaries, bladder and rectum for unusual lumps or changes.
Doctors may carry out another smear test, or Pap test, to gather cells to check for cervical cancer.
A technique called colposcopy, which uses a probe to look in more detail at the cervix, is sometimes used.
The extent of any cancer discovered may be confirmed by taking a deeper slice of tissue in a biopsy.
However, if uterine cancer is suspected, either a “pipelle biopsy”, in which a thin tube is used to take a small sample of tissue, or a dilation and curettage (D and C) may be undertaken. The latter, involves scraping tissue from the lining of the womb for examination.
CAUSES
Scientists have identified a virus which they believe may have some role in the development of cervical cancer.
The human papillomavirus (HPV), is found in most women who have developed cervical cancer.
However, most women who have the virus never go on to develop cervical cancer.
Smoking, as in so many other cancers, appears to increase the risk.
And women with HIV, the virus which causes Aids and weakens the immune system appear to be more prone.
The risk factors for uterine cancer are slightly more clearly understood.
In particular, those taking oestrogen-only hormone replacement therapies to alleviate menopausal symptoms are at higher risk. Most HRT formulations include other hormones such as progestin which appear to reduce that risk.
Overweight or obese women are thought to have more natural oestrogen in their bodies – another reason why they are more vulnerable.
Women who suffer from a condition known as benign endometrial hyperplasia, in which the lining of the womb is naturally thicker, also are more likely to develop endometrial cancer.
TREATMENTS
If caught at their earliest pre-cancerous stage, abnormal cervical cells can be dealt with simply, using either freezing or heat to scour the cells from the cervix.
The action of the deep biopsy, called a cone biopsy, can remove a cervical cancer if it has not spread.
Depending on the spread of the disease, and the age of the woman, a number of options are available, including surgery to remove abnormal tissue or the entire womb, including the cervix.
If there is evidence of spread, then the ovaries and nearby lymph nodes are sometimes removed as well.
If the cancer has spread beyond the wall of the womb, then radiotherapy and chemotherapy may be required to try to clear the disease.
In the case of uterine cancer, it is far more likely that a hysterectomy will have to be carried out, and the ovaries may also be taken out.
If it has not spread beyond the endometrium, then surgery will probably be enough, although other treatments may follow if there is evidence of spread.
It may be possible for the woman to take HRT following the operation, although this is only likely if the cancer has been caught early.
http://news.bbc.co.uk/2/hi/health/3244379.stm
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