Uterine Cancer

with Gerald Vitamvas, M.D., gynecologist with Advanced Healthcare

Posted: Aug. 1, 2004

There are two types of uterine cancer. The first, sarcoma of the muscle wall of the uterus, is extremely rare. The second, endometrial cancer, is the fourth most common cancer in women. According to Dr. Gerald Vitamvas, a gynecologist with Advanced Healthcare, about 34,000 new cases are diagnosed each year and the cancer causes approximately 6,000 deaths annually.

Fortunately, with early diagnosis and treatment, the five-year survival rate is over 85%. However, once the cancer metastasizes, the rate falls dramatically, so seeking treatment at the first sign of a problem is vitally important.

Gerald Vitamvas, M.D., Gynecologist with Advanced Healthcare "The days of ‘I'm the doctor and you’re the patient’ are gone. A patient has the right to make decisions about their options."

Lowering the risk
“There’s pretty good evidence that when used over several years, low dose birth control pills lower the risk for uterine cancer. For women who can’t use birth control pills, cycling with progesterone alone may reduce risk. Women with irregular periods should discuss this with their gynecologist,” Dr. Vitamvas said.

Diagnosing uterine cancer
Unfortunately, there are no screening tests for uterine cancer. The main warning sign is abnormal bleeding in women, which usually occurs before the cancer has spread. “Women in the menopausal age who experience an episode of bleeding more than one year after her last menses should consult a physician,” Dr. Vitamvas said.

He added that the warning sign might be missed in younger women; especially those used to spotting or menstrual irregularities, but believes an aggressive examination of any woman with abnormal bleeding is appropriate.

The doctor would likely begin with a medical history – women who are overweight, have never had children, began menopause after age 52 or who suffer from diabetes are at higher risk.

Usual diagnostic tools involve taking a tissue sample of the lining of the uterus for biopsy. This may be a small sample, done in the doctor’s office with a procedure that resembles a pap test. The doctor also may order an intravaginal ultrasound. While it cannot detect cancer, it does measure the thickness of the uterine lining, providing a clue that something might be wrong.

Unfortunately, there are no screening tests for uterine cancer. The main warning sign is abnormal bleeding in women, which usually occurs before the cancer has spread.

An additional test, called a hysteroscopy, utilizes a special scope that is passed through the cervix under anesthesia. It visualizes the inside of the uterus, allowing a directed biopsy to be done.

After the diagnosis
The exams and biopsies may come back negative, reveal precancerous conditions or cancer. “Fortunately, seventy-five percent of uterine cancers are at Stage I and very amenable to treatment,” Dr.Vitamvas said.

“For many precancerous conditions and cancer, treatment usually involves removal of the uterus and both ovaries. Depending on the stage, which means how far the cancer has spread, and the grade, sometimes additional therapy, usually radiation, is added,” Dr. Vitamvas said.

There are other options, such as shutting down the hormonal production that causes uterine cancers to grow. Dr. Vitamvas notes that these treatments are usually recommended only for patients with other conditions that would make surgery dangerous.

“One reason for a hysterectomy is that the biopsy only takes a small tissue sample. Until you examine all the tissue, you don’t know what stage or grade the cancer is at,” he said.

Usually during the surgery, lymph nodes also are removed. An examination of these will determine the stage of the cancer. If it is localized in the uterus, often further treatment is not necessary.

After surgery
Removal of the ovaries in younger women creates a sudden, early menopause so a doctor will usually discuss hormonal replacement. Because the risk of uterine cancer is gone, estrogen alone can be prescribed to many women.

“Because so many physicians have had the experience of seeing cancer cured with surgery and their patients miserable with menopausal symptoms, they feel comfortable prescribing this,” the doctor said.

Hormones serve another purpose as well. “Women who don’t have estrogen replacement have significant atrophy of the lining of the vagina. This makes sex painful and women miserable,” he said. For women who cannot take estrogen orally, there are estrogen creams that can be used vaginally to combat this.

The doctor-patient relationship
Dr. Vitamvas believes in working closely with his patients to ensure that they understand their condition, the options available to them and what the risks might be. “In some cases, patients aren’t equipped with the knowledge to allow them to make good decisions without a lot of help from their doctors. It’s important that they receive it. I think the days of ‘I’m the doctor and you’re the patient’ are over. Patients have the right to be informed and make their own decisions,” he concluded.

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