Uterine Cancer

Faraza Javed

Ph.D Pharmacology

Uterine Cancer

The terms uterine cancer may refer to any of

several different types of cancer which occur in

the uterus, namely:

Endometrial cancer: originate from cells in the

glands of the endometrium (uterine lining).

Cervical cancer: arises from the transformation

zone of the cervix, the lower portion of the

uterus.

Pathophysiology

Endometrial cancer forms when there are errors

in normal endometrial cell growth. Usually,

when cells grow old or get damaged, they die,

and new cells take their place. Cancer starts

when new cells form unneeded and old or

damaged cells do not die as they should.

These abnormal cancer cells have many genetic

abnormalities that cause them to grow

excessively. Mutations are found in a tumor

suppressor gene, commonly p53 or over

expression of PI3k/Akt kinase pathway, which

promote cell growth in endometrial cancer.

Risk Factors

Increased estrogen

Hormone therapy

Obesity

Estrogen secreting tumors

Older age

Infertility

Genetics

Lynch syndrome (Hereditary colorectal cancer

(HNPCC) is a syndrome results due to gene

mutation that increases the risk of colon cancer

and other cancers, including endometrial

cancer).

Endometrial Hyperplasia (The endometrium has

an average thickness of 6.7 mm).

Viral Infection (Human Papilloma Virus)

Some evidence shows that Tobacco Smoking

reduces the rate of progression of tumor.

Smokers have lower levels of estrogen and lower

rate of obesity.

Symptoms

Bleeding or watery discharge from vagina

Difficult or painful urination

Back Pain

Swelling in Legs

In later stages of the disease, women may feel

pelvic pain and experience unexplained weight

loss.

Diagnostic Parameters

Transvaginal Ultrasound:

An ultrasound uses sound waves to create a

picture of internal organs. If the endometrium

looks too thick, the doctor may decide to

perform a biopsy.

Hysteroscopy:

Hysteroscope allows doctors to do a visual

examination of the endometrium.

Biopsy:

Testing for endometrial cancer or endometrial

hyperplasia.

CT Scan and MRI:

Both are used to measure the tumor’s size.

CA 125 Blood Test:

CA 125 is a substance released into the

bloodstream. The normal value is less than 35

U/mL. A level above 35 U/mL is considered

abnormal. In someone with endometrial cancer,

a very high blood CA 125 level suggests that the

cancer has probably spread beyond the uterus.

Treatment

Once cancer has been diagnosed, treatment

strategy depends on the extent (stage) of your

cancer. Stages of endometrial cancer include:

Stage I cancer is found only in uterus.

Stage II cancer is present in both the uterus and

cervix.

Stage III cancer has spread beyond the uterus,

but hasn't reached the rectum and bladder. The

pelvic area lymph nodes may be involved.

Stage IV cancer has spread past the pelvic

region and can affect the bladder, rectum and

more-distant parts of your body.

Combinations of treatments are often

recommended.

Surgery:

Hysterectomy: Removal of uterus

Lymph node dissection: Removal of lymph

nodes near the tumor if the cancer has spread

beyond the uterus.

Radiation Therapy:

The radiation therapy is most often given after

surgery to destroy any cancer cells remaining in

the area but rarely given before surgery to shrink

the tumor. Radiation therapy options for

endometrial cancer may include radiation

directed towards the whole pelvis externally or

tiny radioactive seeds are placed in the body

close to tumor which is termed as

Brachytherapy.

Chemotherapy:

Hormone Therapy: Hormone therapy for

uterine cancer often involves the hormone

progesterone, given in a pill form. Other

hormone therapies include the Aromatase

inhibitors (AIs) often used for the treatment of

women with breast cancer, such as Anastrozole

and Letrozole. An AI is a drug that reduces the

amount of the hormone estrogen in a woman's

body by stopping tissues and organs other than

the ovaries from producing it with other types

of treatment.

Hormone therapy may also be used for women

who cannot have surgery or radiation therapy or

in combination.

The chemo often includes the combination of

Doxorubicin+ Cisplatin+ Paclitaxel.

Bevacizumab (Avastin) blocks angiogenesis

(the formation of new blood vessels) and is

under evaluation in clinical trials.

Pazopanib blocks angiogenesis and stop the

growth of cancer cell.

Vaccination: The World Health Organization

(WHO), as well as public health officials in

Australia, Canada, Europe, and the United States

recommend this vaccination against HPV. Two

vaccines have market approval in manycountries

as of 2014 (called Gardasil and Cervarix in the

US). Both vaccines protect against the two HPV

types (HPV-16 and HPV-18) that cause 70% of

cervical cancers. Both Gardasil andCervarix have

been shown to prevent cervical hyperplasia due

to viral infection.

Both vaccines are given as a series of three

injections over a six-month period. The second

dose is given one to two months after the first

dose, and the third dose is given six months

after the first dose.

THANKYOU