In 2000, an estimated 36,100 new cases of uterine cancel were diagnosed in the United States. Most uterine cancers develop in the body of the uterus, usually in the endometrium (lining). The rest develop in the cervix, located at the base of the uterus. The overall incidence of early-stage uterine cancer – that is, cervical cancer – has increased slightly in recent years in women under the age of 50. In contrast, invasive, later-stage forms of the disease appear to be decreasing. Much of this apparent trend may be due to more effective regular screenings of younger women using the Pap test, a procedure in which cells taken from the cervical region are examined for abnormal cellular activity. Although these tests are very effective for detecting early-stage cervical cancer, they are less effective for detecting cancers of the uterine lining and are not effective at all for detecting cancers of the fallopian tubes or ovaries.Risk factors for cervical cancer include early age of first intercourse, multiple sex partners, cigarette smoking, and certain sexually transmitted diseases, such as the herpes virus and the human papillomavirus. For endometrial cancer, a history of infertility, failure to ovulate, obesity, and treatment with tamoxifen or unopposed estrogen therapy appear to be major risk factors.Early warning signs of uterine cancer include bleeding outside the normal menstrual period or after menopause or persistent unusual vaginal discharge. These symptoms should be checked by a physician immediately.*28/277/5*

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Once a diagnosis of endometrial cancer is made, then the main treatment is hysterectomy with removal of the uterus, cervix, fallopian tubes and ovaries, since spread to these organs can occur. If the cancer has spread it is usually only detected following removal of these organs when they are examined under the microscope. When the hysterectomy is undertaken, then the gynecological cancer surgeon usually decides whether or not to remove the lymph glands. Such a decision rests on the presence or absence of ‘high risk’ features, i.e. a high risk of spread to lymph glands.
At the time of surgery, a pathologist is usually present who will examine the uterus closely to see how much of the muscle has been invaded or if the cervix, tubes or ovaries are involved. In any of these cases, especially when the muscle is invaded more than halfway, then lymph gland removal from the pelvic sidewalls is undertaken.
If at the time of surgery the gynecological oncologist feels or sees enlargement of the lymph nodes, then these glands will be removed. If the pathologist finds malignant cells in the glands (the pathologist freezes the tissue, cuts it and then stains it to look at it under the microscope – ‘a frozen section’), then the glands higher up, outside the pelvis along the major blood vessels (‘para-aortic glands’) are also removed. In these circumstances radiation therapy will always be required after surgery and the exact site of spread within the lymph gland ‘chain’ must be ascertained, so that the radiation therapy can be delivered accurately.
Sometimes, if the woman is too overweight and access to the lymph glands is difficult, or they are found to contain malignant cells, the lymph glands may not be removed. Radiation to the lymph node bearing areas is then given, commencing usually six weeks following surgery.
Radiation treatment usually also covers the top of the vagina which is the most common site of recurrence of this cancer. In some cases where the lymph node bearing areas do not require radiation but the top of the vagina does, then brachytherapy’ will be recommended. This involves placing a tube up to the top of the vagina; radiation seeds are then pushed along this tube and high dose local irradiation given. This takes a very short time and four or five treatments are usually required in comparison to the external radiation therapy which is given to the lymph node bearing areas which takes about five to six weeks in sequences of five days, Monday to Friday.
Endometrial cancer has a very high overall cure rate. Should the cancer recur in an area that has not been treated previously by radiation, such as the top of the vagina, or bone, or lymph glands, it will be usually treated with radiation. This can sometimes be curative. For instance, if investigations reveal that the vagina is the sole site of recurrence of endometrial cancer then cure can be expected in many cases.
If the cancer recurs a type of hormonal therapy is often given.
There is a very limited place for anti-cancer drugs (‘chemotherapy’) in recurrent endometrial cancer, since side effects are common and it is not very effective.

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Thus radiation to the mouth, throat or nose can cause soreness and sometimes ulceration. Radiation to the stomach can cause a vague stomach ache, loss of appetite and nausea. Radiation to the intestines can cause diarrhoea. Radiation to the lungs can cause a dry irritating cough. Radiation to the bladder can cause cystitis-stinging and burning when passing, urine and a desire to pass urine frequently. Radiation to the skin can cause redness, soreness and ‘peeling’.
It is important to try not to place any extra demands on these areas during radiation. For example, you will be asked not to rub skin that is being radiated, and to avoid tight clothing and hot or cold applications. Steps will be taken to prevent infection in any of these areas—for example, by using antiseptic mouth washes if the mouth is being irradiated. Any infection that does occur must be treated promptly.
The bone marrow is another tissue which normally contains a high proportion of actively dividing cells. However, radiation of part of the bone marrow doesn’t usually cause any symptoms provided the rest of the marrow is normal. A large proportion of your active marrow must be irradiated to produce any change in radiation treatment the blood count. Even then, you would be unlikely to experience any symptoms as a result.
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Now let’s just see what this means for you in real life—what symptoms can result from those reactions?
These symptoms fall into two distinct groups. There are acute symptoms which occur during or immediately after radiation. There are also delayed symptoms that can occur long after radiation. The severity and nature of both acute and delayed symptoms depend on the type and dose of radiation and on what tissues are irradiated.
Many of the immediate symptoms are due directly to damage to actively dividing cells. There is normally a high proportion of actively dividing cells throughout the linings of the whole intestinal tract from mouth to anus, the whole respiratory tract from nose to bronchial tubes, and the bladder. The skin is another surface which is kept healthy by frequent replacement of its cells with new ones. Radiation stops the normal process of constant renewal of these surfaces.
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This is not to say that having an operation cannot possibly result in some patients dying of cancer a bit sooner than they would have otherwise. For example, it is known that anaesthetics and stress depress the function of the immune system. Experiments on animals with extensive cancer have shown that those that have a ‘look and see’ operation do die, on average, a little earlier than animals which do not. Notice that I said animals having a ‘look and see’ operation, not animals having an operation at which something is done to the cancer.

Try to keep these facts in perspective. If your cancer is apparently localised, surgery probably offers you the best, and maybe the only, chance of cure. If it is extensive, surgery could be the best way of controlling or preventing very unpleasant symptoms. If you stand to gain a lot from surgery, the possible temporary effects of the stress and anaesthetic on your immune system would not be enough to outweigh the probable benefit. On the other hand, they could be if your planned operation has only a small chance of achieving some minor and temporary benefit.


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