子宫癌.docx
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子宫癌.docx
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子宫癌
子宫癌-CanceroftheUterus
Whatistheuterus?
Theuterus(womb)isinthelowerabdomenbehindthebladder.Theinsideoftheuterusiswhere ababygrowsifyoubecomepregnant.Theinsideliningoftheuterusiscalledtheendometrium.Thisbuildsupandisthenisshedeachmonthasa'period'inwomenwhohavenotyetgonethroughthemenopause.Thethickbodyoftheuterusiscalledthemyometriumandismadeofspecialisedmuscletissue.
Thelowestpartoftheuterusiscalledthecervixwhichpushesjustintothetoppartofthevagina.Atthetopoftheuterusaretherightandleftfallopiantubeswhichcarrytheeggsreleasedfrom theovariestotheinsideoftheuterus.
Whatiscancer?
Cancerisadiseaseofthecellsinthebody.Thebodyismadeupfrom millionsoftinycells.Therearemanydifferenttypesofcellinthebody,andtherearemanydifferenttypesofcancerwhicharisefrom differenttypesofcell.Whatalltypesofcancerhaveincommonisthatthecancercellsareabnormalandmultiply'outofcontrol'.
Amalignanttumourisa'lump'or 'growth'oftissuemadeupfrom cancercellswhichcontinuetomultiply.Malignanttumoursinvadeintonearbytissuesandorganswhichcancausedamage.
Malignanttumoursmayalsospreadtootherpartsofthebody.Thishappensifsomecellsbreakofffrom thefirst(primary)tumourandarecarriedinthebloodstreamor lymphchannelstootherpartsofthebody.Thesesmallgroupsofcellsmaythenmultiplytoform'secondary'tumours(metastases)inoneor morepartsofthebody.Thesesecondarytumoursmaythengrow,invadeanddamagenearbytissues,andspreadagain.
Somecancersaremoreseriousthanothers,somearemoreeasilytreatedthanothers(particularlyifdiagnosedatanearlystage),somehaveabetteroutlook(prognosis)thanothers.
So,cancerisnotjustonecondition.Ineachcaseitisimportanttoknowexactlywhattypeofcancerhasdeveloped,howlargeithasbecome,andwhetherithasspread.Thiswillenableyoutogetreliableinformationontreatmentoptionsandoutlook.Seeseparateleafletcalled'WhatareCancerandTumours'for furtherdetailsaboutcanceringeneral.
Whatiscanceroftheuterus?
Mostcancersoftheuterusdevelopfrom cellsintheendometrium(endometrialcancer).Cancerdevelopingfrom musclecellsinthemyometrium(uterinesarcomas)arerareandarenotdealtwithfurtherinthisleaflet.Cancerofthecervixisquitedifferenttouterinecancerandisdealtwithinaseparateleaflet.
Therestofthisleafletdealsonlywithendometrialcanceroftheuterus.
Endometrialcancer
About5000womenintheUKdevelopendometrialcancereachyear.Mostcasesdevelopinwomenintheir50sand60s.Itrarelydevelopsinwomenundertheageof50.
Typeandgradeofendometrialcancer
Mostcasesofendometrialcancerarecalled'endometrioidadenocarcinomas'.Thesearisefrom cellswhichformtheglandulartissueintheliningoftheendometrium.Asampleofcancertissuecanbelookedatunderthemicroscope.Bylookingatcertainfeaturesofthecellsthecancercanbe'graded'.
∙Grade1(lowgrade)-thecellslookreasonablysimilartonormalendometrialcells.Thecancercellsaresaidtobe'welldifferentiated'.Thecancercellstendtogrowandmultiplyquiteslowlyandarenotso'aggressive'.
∙Grade2-isamiddlegrade.
∙Grade3-thecellslookveryabnormalandaresaidtobe'poorlydifferentiated'.Thecancercellstendtogrowandmultiplyquitequicklyandaremore'aggressive'.
Therearealsosomerarertypesofendometrialcancer.
Whatcausesendometrialcancer?
Acanceroustumourstartsfrom oneabnormalcell.Theexactreasonwhyacellbecomescancerousisunclear.Itisthoughtthatsomethingdamagesor alterscertaingenesinthecell.Thismakesthecellabnormalandmultiply'outofcontrol'.(Seeseparateleafletcalled'WhatCausesCancer'for moredetails.)
Thereare'riskfactors'whichareknowntoincreasetheriskofendometrialcancerdeveloping.Theseincludethefollowing.
∙Increasedexposuretooestrogen.Oestrogenisthemainfemalehormone.Beforethemenopausethechanginglevelofoestrogentogetherwithanotherhormone,progesterone,causetheendometriumtobuildupeachmonthandthenbeshedasaperiod.Itisthoughtthatfactorswhichleadtoprolongedhigherthanusuallevelsofoestrogen,or increasedlevelsofoestrogennotbeing'balanced'byprogesterone,maysomehowincreasetheriskofendometrialcellsbecomingcancerous.Theseinclude:
oIfyouhaveneverhadababy(youruterushasneverhada'rest'from thecyclicalriseofoestrogeneverymonth).医学.全.在线.网.站.提供
oIfyouareoverweightor obese(fatcellsmakeacertainamountofoestrogen).
oIfyoutakeoestrogen-onlyHRT(hormonereplacementtherapy).Mostwomentake'combinedHRT'whichincludesprogestogentobalancetheeffectofoestrogenandcausesmuchlessofariskofendometrialcancerthanoestrogen-onlyHRT.
oIfyouhavecertainrareoestrogenproducingtumours.
oIfyouhavealatemenopause(aftertheageof52)or startedperiodsatayoungage.
∙Endometrialhyperplasia.Thisisabenign(noncancerous)conditionwhere theendometriumbuildsupmorethanusual.Itcancauseheavyperiods,or irregularbleedingafterthemenopause.Mostwomenwiththisconditiondonotdevelopcancer,buttheriskisslightlyincreased.
∙Tamoxifen.Thisisadrugwhichisusedinthetreatmentofbreastcancer.Althoughtakingtamoxifenincreasestheriskofdevelopingendometrialcancer,thebenefitsoftakingitusuallyoutweightherisks.
∙Diabetesandhighbloodpressure.Thesmallincreasedriskwiththesetwoconditionsmayberelatedtothefactthatmanypeoplewiththeseconditionsareoverweight,andasmentioned,thisincreasestherisk.
∙Polycysticovarysyndrome.Possiblyincreasestherisk.Again,thesmallincreasedriskmayberelatedtothefactthatmanypeoplewiththisconditionareoverweight.
∙Diet.Therearemuchfewercasesofendometrialcancerincertaineasterncountriesanddietaryfactorsmaybethereason.Awesterndiethighinfatmaybeacontributingfactor.
∙Geneticfactors.Mostcasesarenotduetogeneticor hereditaryfactors.Inasmallnumberofcases,a'faulty'genewhichcanbeinheritedmaytriggerthedisease.
Whatarethesymptomsofendometrialcancer?
Inmostcasesthefirstsymptomtodevelopisabnormalvaginalbleedingsuchas:
∙Vaginalbleedinginwomenpastthemenopause.Thiscanrangefrom 'spotting'tomoreheavybleeds.
∙Bleedingafterhavingsex(postcoitalbleeding).
∙Bleedingbetweennormalperiods(intermenstrualbleeding)inwomenwhohavenotgonethroughthemenopause.
Anearlysymptominsomecasesispainduringor afterhavingsex,vaginaldischarge,andpaininthelowerabdomen.
Alloftheabovesymptomscanbecausedbyvariousothercommonconditions.Butifyoudevelopanyofthesesymptoms,youshouldhaveitcheckedoutbyadoctor.
Intime,ifthecancerspreadstootherpartsofthebody,variousothersymptomscandevelop.
Howisendometrialcancerdiagnosedandassessed?
Toconfirmthediagnosis
Adoctor willusuallydoavaginalexaminationifyouhavesymptomswhichmaypossiblybeduetoendometrialcancer.Heor shemayfeelanenlargeduterus.However,eveniftheexaminationisnormal,ifendometrialcancerissuspectedyouwillusuallyneedtohaveafurthertesttoconfirmthediagnosis,usuallyoneofthefollowing:
∙Endometrialsampling.Thisiswhere athintubeispassedintotheuterus.Byusinggentlesuction,smallsamplesoftheendometriumcanoftenbeobtained.Thiscanbedonewithoutananaesthetic.Thesample(biopsy)islookedatunderthemicroscopetocheckfor abnormalcancerouscells.
∙Hysteroscopy.Thisiswhere adoctor usesahysteroscopewhichisathintelescopethatispushedthroughthecervixintotheuterus.Thedoctor canseetheliningoftheuterusandtakesamples(biopsies)ofabnormallookingareas.Thiscanbedonewithoutananaesthetic.
∙DandC(dilationandcurettage).Thistestisdonelesscommonlythesedays.Itinvolvesthecervixbeingdilated(widened),andthenaninstrumentcalledacuretteisinsertedintotheuterustoscrapesamplesoftissuefrom theendometriumtobelookedatunderthemicroscope.Youneedageneralanaestheticfor aDandC.
Youmayalsohaveanultrasoundscanoftheuterus.Anultrasoundscanisasafeandpainlesstestwhichusessoundwavestocreateimagesoforgansandstructuresinsideyourbody.Theprobeofthescannermaybeplacedonyourabdomentoscantheuterus.Asmallprobeisalsocommonlyplacedinsidethevaginatoscantheuterusfrom thisangle.
Assessingtheextentandspread
Ifendometrialcancerisconfirmedthenfurthertestsmaybeadvisedtoassessifthecancerhasspread.For example,aCTscan,anMRIscan,achestx-ray,bloodtests,anexaminationunderanaestheticoftheuterus,bladderor rectum,or othertests.(Thereareseparateleafletswhichdescribemostofthesetestsinmoredetail.)Thisassessmentiscalled'staging'ofthecancer.Theaimofstagingistofindout:
∙Howmuchthetumourhasgrown,andwhetherithasgrowntoothernearbystructuressuchasthecervix,bladderor rectum.
∙Whetherthecancerhasspreadtolocallymphglands(nodes).
∙Whetherthecancerhasspreadtootherareasofthebody(metastasised).
Findingoutthestageofthecancerhelpsdoctorstoadviseonthebesttreatmentoptions.Italsogivesareasonableindicationofoutlook(prognosis).Seeseparateleafletcalled'CancerStagingandGrading'for details.
Whatarethetreatmentoptionsforendometrialcancer?
Surgeryand/orradiotherapyarethemaintreatmentsusedforendometrialcancer.Hormonetreatm
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