Endometrial Cancer (Uterine Cancer)

The uterus (uterus) is a pear-shaped organ found in women, located inside the pelvis, in which the fetus (baby) develops. There are different layers of the uterus.

• The outer layer is called the Myometrium. The myometrium is a thick layer of November muscle. The muscles that serve to push the baby during childbirth are located here. Nov.< / li>
• The inner layer is called the Endometrium. Among the people, this layer is called the uterine membrane. Dec. The endometrium thickens and falls out under the influence of hormones during a woman's menstrual cycle (menstruation). < / li>

Endometrial cancer has developed from this layer.

Cancer does not get better, but endometrial cancer patients are considered lucky. Because endometrial cancer is diagnosed at an early stage, leading to abnormal bleeding. In this way, many patients can completely get rid of this disease with proper surgery.

Symptoms (Signs)

• Vaginal bleeding after menopause
• Intermediate bleeding except during menstruation
Decapitation
• Pelvic pain

When Should I Go to the Doctor?

If the above-mentioned symptoms have become persistent and concern you, I recommend making an appointment with your doctor. But let's not forget, it is the most rational way to have your regular gynecological examinations.

Reasons

Mutations that develop in the DNA of cells located in the endometrial layer lead to the transformation of healthy cells into abnormal cells. Normal cells grow, multiply, and eventually die. Cancerous abnormal cells, on the other hand, grow, multiply uncontrollably and become immortal. This abnormal collection of cells forms a mass and it is called a tumor. Just as cancer cells can invade healthy tissues around them, they can also spread to distant tissues (metastasis).

Risk Factors

• Disruption of the hormone balance in women's bodies: The ovaries (ovaries) lead to the secretion of two main female hormones – estrogen and progesterone. There is a Decoupling between these two hormones. < / li>

  The deterioration of this balance in favor of estrogen and everything that leads to the continuous dominance of this estrogen increases the risk of endometrial cancer. As an example, we can give diseases such as polycystic ovary syndrome, obesity, diabetes.

• Menstruation for many years: Starting menstruation at an early age – menstruating before the age of 12 – or entering menopause late. Menstruation for a long time constitutes a risk factor by increasing the duration of endometrial exposure to estrogen.< / li>
• Never getting pregnant: The risk of endometrial cancer increases in women who have never conceived. A high dose of the hormone progesterone secreted during pregnancy has a reducing effect on the risk of endometrial cancer.< / li>
• Advanced age: Endometrial cancer is often seen after menopause. As age increases, our exposure to carcinogenic substances increases.< / li>
• Obesity: Excess adipose tissue disrupts the estrogen – progesterone balance and creates an estrogen-dominated environment, increasing the risk of endometrial cancer.< / li>
• Undergoing hormone therapy for breast cancer: The risk of endometrial cancer increases in patients taking a drug called Tamoxifen due to breast cancer. < / li>
• Hereditary Colon Cancer Syndrome: In an inherited disease called Lynch syndrome, the risks of colon cancer and various cancers have increased due to gene mutations passed on from parents. Endometrial cancer is also one of the cancers with an increased risk.< / li>

Protection

• You should talk to your doctor about hormone treatments used after menopause: hot flashes, sweating, etc. that develop after menopause. the most effective treatment to prevent symptoms is Hormone Replacement Therapy (HRT). These drugs usually contain synthetic hormones that are not bioequivalent. These non-bioequivalent hormone therapies may increase the risk of endometrial cancer. You should talk to your doctor about the risks and advantages of HRT. < / li>
• You may want to consider using birth control pills: Birth control pills, when used regularly, change the estrogen – progesterone balance and create a progestogenic environment. With these effects, they provide both protection and reduce the risk of endometrial cancer. By discussing this issue with your doctor, you can discuss the advantages and side effects of birth control pills. < / li>
• Stay at a healthy weight: Obesity increases endometrial cancer. By maintaining your ideal weight, you can reduce the risk of developing endometrial cancer. < / li>

Diagnosis

• Pelvic examination: Your doctor first observes the outer part of your genital area (vulva). It places a special device called a speculum inside your vagina and evaluates the inside of the vagina and the cervix (cervix). He can do your smear test if it has not been taken before. Then, he inserts two fingers into the vagina to check for a mass in the vagina and cervix. Some structures that are invisible to the eye are easier to feel with the fingertip. Again, during the procedure, your doctor presses on your stomach with the other hand, compressing the uterus from both sides and trying to find out if there is an abnormal condition.< / li>
• Transvaginal Ultrasonography: Images provided vaginally by a thin rod-shaped ultrasound probe offer us gynecologists unique information. We can evaluate all diseases established in the endometrium with this method. < / li>
• Endometrial sampling: In patients with abnormal bleeding, if there is a suspicion of cancer, the tissues taken by performing an endometrial biopsy should be sent to pathology. Cancer diagnosis can only be made under a microscope, sometimes with the help of special dyes. One of the special cases in our country is patients who are still virgins despite being in menopause. If there is also a suspicion of endometrial cancer in these patients, the hymen is cut under anesthesia, an endometrial biopsy is performed, and then the hymen can be re-stitched. < / li>
• Referral to a specialist: After all these processes, patients who come in as endometrial cancer as a result of pathology are referred to a specialist of this business, that is, Specialists in Gynecological Oncology Surgery. < / li>

Staging

The Specialty of Gynecological Oncology Surgery is one of the top specialties of Obstetrics and Gynecology. These doctors are selected by examination from among Obstetricians and undergo another 3-year training and become Decently competent in this field. If gynecological cancers are operated by these physicians, a significant survival advantage is obtained in patients. To put it even more clearly, the patients operated on by Gynecological Oncology Surgery Specialists live longer than those operated on by other physicians. Scientific studies have proven this. If you or someone close to you has endometrial cancer, I recommend contacting doctors with this specialty.

Patients diagnosed pathologically may also be required other tests for staging purposes. Advanced imaging methods such as tomography, MRI or PET will be requested if deemed appropriate by your doctor. Then, if there is nothing that will prevent the patient from having surgery, preparations for the standard treatment of endometrial cancer, that is, surgery, begin. Alternative treatments such as radiotherapy can be tried in very elderly, morbidly obese patients who are not suitable for surgery.

The real stage is determined by a pathological examination performed after surgery. Pathological findings, parameters such as the patient's own risk factors are combined to decide whether additional treatment (radiation therapy, chemotherapy, etc.) is needed. Oct.

• Detailed examination of the pelvic area: To determine the spread of cancer, your doctor may perform a detailed examination of the pelvis and groin.< / li>
• Imaging tests: Advanced tests such as tomography, MRI, PET Sa-CT can be used to determine the spread of cancer.< / li>

Surgical Technique

The standard treatment of endometrial cancer is surgery. Removal of the uterus, that is, hysterectomy surgery, is essential. Along with this, the ovaries (ovaries) and tubes (tubes) are usually removed as well. In addition, lymph nodes are often removed and if there is a suspicion of metastasis, these organs are also intervened.

There are various ways for these surgeries;

• Old-fashioned open surgeries: In this technique, an incision is usually made perpendicular to the abdominal wall. This large incision is difficult to heal, especially in oily patients, wound location problems are often encountered.< / li>
• Vaginal surgeries: The inside of the abdomen cannot be clearly evaluated with this method. But in extremely obese patients, the vaginal approach may be a good option.< / li>
• Minimally invasive methods: This is the method used in developed countries and preferred by patients. The operation is performed by inserting high–resolution cameras and special instruments through 0.5 - 1 cm incisions made on the abdominal wall. It is also popularly referred to as closed surgery. Dec. < / li>

Summary

In cancer surgery the right surgeon, the right technology and the right pathology are essential. I strongly recommend that you research your surgeon, get opinions from patients he has operated on before, and question the technologies that will be used in your surgery, and where and how the pathological examination will be performed.