Culture and Sensitivity - Endometrium Health Feed

Uterine cancer is also known as endometrial cancer. It is a cancer which begins in the lining of the uterus. The uterus is the part of a woman's body where the fetus develops. Uterine cancer is one of those rare cancers in India, which can be diagnosed in its early stages. This is because excessive vaginal bleeding occurs, thus making it a very serious and an apparent symptom. It is also one of the few forms of cancer which can be cured as removing the uterus is often more than enough to cure the patient of uterine cancer.

Here are the causes, diagnosis and treatment of uterine cancer:

Causes

The exact cause of uterine cancer is not yet known, however, there is a theory on what causes uterine cancer. Hormones in a woman's body have been thought to increase the chances of getting uterine cancer. This is because it has long been thought that having high levels of estrogen is the cause of uterine cancer. Increased estrogen thickens the endometrium and thus, increases the likelihood of uterine cancer.

Diagnosis

There are several tests used to diagnose whether you have uterine cancer including:

1. Pelvic exam: This is an examination in which the vagina, bladder, rectum and uterus are scanned for lumps. If they are found, it might be due to uterine cancer.
2. Pap test: A pap test is a special test designed to scan for uterine cancer.
3. Transvaginal ultrasound: A transvaginal ultrasound uses high-intensity sound waves so that pictures of the uterus can be taken.
4. Biopsy: During a biopsy, the doctor will remove tissue from the endometrium and it will then be analyzed for cancerous growths.

Treatment

1. Surgery: This is the most common treatment as it removes the entire uterus and prevents the spreading of the cancer.
2. Chemotherapy: Chemotherapy involves giving drugs which kill cancerous cells. They are given through either an intravenous line or even in pill form.
3. Hormone therapy: This is a therapy in which either progesterone levels are increased or estrogen levels are decreased.
4. Radiation therapy: In this treatment, high energy laser beams are used to destroy cancerous cells.

Minimally invasive surgery or laparoscopic surgery is increasingly becoming popular in all fields of surgery including gynecological oncology. Given its many advantages, it is easy to see why people prefer this form of surgery. The use of laparoscopy in the field of gynecological oncology began in the late 1980s. The first laparoscopic-assisted hysterectomy was performed in 1989.

Laparoscopy and Endometrial Cancer:

The endometrium refers to the lining of the uterus. Endometrial cancer is rare are usually affect women over the age of 55 years. A hysterectomy is one of the forms of treatment for this condition. If detected in its early stages, this hysterectomy may be performed laparoscopically. As compared to traditional surgery, this reduces the hospital stay required and is associated with fewer postoperative complications. Laparoscopy may also be used to restage patients who have already undergone a hysterectomy.

Laparoscopy and Cervical Cancer:

The lowermost part of the uterus is known as the cervix. A pap smear can help in the early detection of cervical cancer. This can be treated surgically in the form of a lymphadenectomy or a radical hysterectomy. One of the factors crucial to the management of this type of cancer is an evaluation of the lymph nodes.

This is where laparoscopy is very useful. As in the case of endometrial cancer, laparoscopy may also be used for a hysterectomy procedure. A laparoscopic lymphadenectomy may also be performed to investigate the extent to which the cancer has spread. Advanced stages of cervical cancer can be treated with chemotherapy and radiation. In such cases, the role of laparoscopy may be limited to staging the patient before treatment.

Laparoscopy and Adnexal Masses:

Adnexal masses refer to ovarian abnormalities and development of masses in the fallopian tubes, uterus and other organs in the pelvic cavity. Laparoscopy is routinely used to treat benign Adnexal masses. It can also be used in the management of malignant adnexal masses. However, its role is less clearly defined in such cases. When using laparoscopic procedures to address adnexal masses, it is important to identify benign masses beforehand.

Laparoscopy and Uterine Cancer:

Laparoscopy can be used in a number of ways when it comes to the management and treatment of uterine cancer. These include staging apparent early stage cancer, determining the extent of the disease and resectability potential and to reassess a patient in cases of recurrent cancer. A hand assisted laparoscopy may also be used to resect the disease in some cases.

Endometrial cancer is a kind of cancer which can be traced in the uterus. Now, the uterus is the hollow pear-shaped pelvic organ which is a very important part of the women body. It is the uterus where development of the fetal occurs and the cancer affects the cells of this organ. The cancer begins in the cells which form the endometrium of the uterus or the inner lining. Endometrial cancer is usually easy detectable because it causes heavy and abnormal vaginal bleeding.

Endometrial cancer is sometimes even known by the name of uterine cancer. The uterus is prone to other types of cancer apart from the endometrial cancer as well like the uterine sarcoma. However, this cancer is much more rare when compared to the previous one.

Symptoms - There are some easily identifiable symptoms which will help you to understand whether you are suffering from Endometrial cancer or not. Here are some of them:

The woman may experience vaginal bleeding after her menopause stages.

She may observe irregular bleeding which can be heavy or mild between her periods.

Endometrial cancer is also identified when there is abnormal, watery or blood-tinged discharge of fluid from the vagina.

The woman may also experience acute pain in and around the pelvic region frequently.

So these are the symptoms of Endometrial cancer which you should be knowing of. If you experience any of these symptoms, then make sure that you visit a doctor quickly.



Causes - It is still not clear as to why Endometrial cancer is caused. However, doctors suspect that because of some genetical mutation within the endometrial cells which are present in the lining of the uterus. the cancer is caused. Due to the genetic mutation, the healthy and abnormal endometrial cells turns abnormal. Healthy cells grow at a rate which is at par with it's dying rate. But abnormal cells grow uncontrollably and do not die at the same time. That is the reason why, these abnormal cells start growing and eventually forms a tumor which becomes carcinogenic. These cancerous cells later on attack the other tissues and organs around the area and eventually it spreads.

Risk Factors - There are different kinds of risk factors present in endometrial cancer. Therefore you should be well aware of those risks and proceed with the treatment.

More Years Of Menstruation - When the menstruation starts at an early age which is usually before the age of 12, the risk of endometrial cancer is much more. This is because the more number of period you have experienced the more exposure your endometrium has had with estrogen.

Never Been Pregnant - Women who have never conceived or been pregnant before in their lives are more likely to be affected with endometrial cancer.

Obesity and Older Age - If the women is suffering from obesity or overweight or else have become older, usually more than 50 years of age, then they are more likely to suffer from this cancer.

So these are the most important information which you should be knowing about endometrial cancer.

Minimally invasive surgery or laparoscopic surgery is increasingly becoming popular in all fields of surgery including gynecological oncology. Given its many advantages, it is easy to see why people prefer this form of surgery. The use of laparoscopy in the field of gynecological oncology began in the late 1980s. The first laparoscopic-assisted hysterectomy was performed in 1989.

Laparoscopy and Endometrial Cancer-
The endometrium refers to the lining of the uterus. Endometrial cancer is rare are usually affect women over the age of 55 years. A hysterectomy is one of the forms of treatment for this condition. If detected in its early stages, this hysterectomy may be performed laparoscopically. As compared to traditional surgery, this reduces the hospital stay required and is associated with fewer postoperative complications. Laparoscopy may also be used to restage patients who have already undergone a hysterectomy.

Laparoscopy and Cervical Cancer-
The lowermost part of the uterus is known as the cervix. A pap smear can help in the early detection of cervical cancer. This can be treated surgically in the form of a lymphadenectomy or a radical hysterectomy. One of the factors crucial to the management of this type of cancer is an evaluation of the lymph nodes. This is where laparoscopy is very useful. As in the case of endometrial cancer, laparoscopy may also be used for a hysterectomy procedure. A laparoscopic lymphadenectomy may also be performed to investigate the extent to which the cancer has spread. Advanced stages of cervical cancer can be treated with chemotherapy and radiation. In such cases, the role of laparoscopy may be limited to staging the patient before treatment.

Laparoscopy and Adnexal Masses-
Adnexal masses refer to ovarian abnormalities and development of masses in the fallopian tubes, uterus and other organs in the pelvic cavity. Laparoscopy is routinely used to treat benign Adnexal masses. It can also be used in the management of malignant adnexal masses. However, its role is less clearly defined in such cases. When using laparoscopic procedures to address adnexal masses, it is important to identify benign masses beforehand.

Laparoscopy and Uterine Cancer-
Laparoscopy can be used in a number of ways when it comes to the management and treatment of uterine cancer. These include staging apparent early-stage cancer, determining the extent of the disease and resectability potential and to reassess a patient in cases of recurrent cancer. A hand assisted laparoscopy may also be used to resect the disease in some cases.

High vaginal swab (hvs) is a technique used in obstetrics and gynaecology to obtain a sample of discharge from the vagina. This is then sent for microscopy, culture and sensitivity. It is commonly used to test for the presence of candidiasis infection, bacterial vaginosis and trichomonas vaginalis.

No, it is not possible to know by endometrial thickness. For that you have to take follicular study.

Cancer that originates in the uterus is termed as Endometrial Cancers. The cancer is known to originate in the endometrium i.e. lining as well as the cells of the uterus. Abnormal vaginal bleeding causes cancer to be detected early and a consultation with the doctor should be done immediately. When other cancers originating from the uterus are considered, endometrial cancer is found to be the most common.

Causes: The exact cause of endometrial cancer is not known clearly. The cells in the endometrium tend to become abnormal due to the occurrence of a genetic mutation, which causes rapid multiplication of cells that ultimately lead to the formation of a tumour like mass. They begin to spread to other parts and proceed to affect the tissues in the surrounding areas.

Symptoms:
The typical symptoms of endometrial cancer include:

1. Irregular bleeding in between periods

2. A watery discharge from the vagina

3. Bleeding from the vagina postmenopausal

4. Pain in the pelvic floor muscles

Risk factors that might increase the chances of being affected by endometrial cancer include:

1. Aging increases the chances of this disease, especially post-menopause.

2. Obesity can cause hormonal imbalance.

3. Certain drugs used in hormone therapy

4. Early onset of menstruation, especially before 12 years of age

Treatment for Endometrial Cancer Includes:

Radiation therapy: This treatment procedure involves using radiations, such as X-rays to target and destroy the cancer cells. The two forms of radiation therapy are external radiation therapy (external machine is used to direct radiation on the cancer cells) and internal radiation therapy (radioactive substance enclosed within small and consumable items is placed near to or directly at the spot of cancer).
Hormone therapy: Medications are administered to eliminate imbalances in hormone levels and prohibit the growth of cancer cells in the body. This remedy is preferred if cancer progresses to an advanced stage.
Chemotherapy: This form of treatment uses oral administration or injection of chemicals into the veins so that the growth of cancerous cells is curbed, either by the elimination of the cells or by prohibiting cell division.
Surgery: In this surgery, the areas affected by cancer are surgically removed; i.e. the uterus in this case. The surgical procedures that might be used include total hysterectomy (total removal of uterus), radical hysterectomy (removal of the cervix, uterus and part of the vagina) and Bilateral salpingo-oophorectomy (removal of both the ovaries and the fallopian tubes)

With the modernization of all economies around the world, one health hazard that has become one of the largest perils within both developed and developing nations is the incidence of cancers of the female reproductive system, especially cervical and breast cancer.

Breast cancer

Breast cancer is the formation of malignant tumors within the breast tissues of a woman. Usually, breast cancer affects women in the age range of 40 to 50, but there have been many reports of it occurring earlier. About 48 % percent of the Indian women having breast cancer have been reported to be under 50. This is an almost 17 percent jump compared to figures 25 years earlier.

Alarming Signs of Breast Cancer:

The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded.
Swelling of all or part of a breast (even if no distinct lump is felt)
Skin irritation or dimpling
Breast or nipple pain
Nipple retraction (turning inward)
Redness, scaliness, or thickening of the nipple or breast skin
Nipple discharge (other than breast milk)
Screening Guidelines for Breast cancer:

Mammography: US Preventive Services Task Force (USPSTF) recommends mammography once in every 2 year for females between age group 50-75 years. Women with a family history has a benefit of starting at age 40 years. After 75 years there are insufficient evidence of benefit of screening mammography.
Breast Self Examination and annual Clinical examination: breast self examination is easy to learn and and any abnormality should be reported to the oncologist.
For High Risk/ Genetic risk factors: screening should start by age 25 or 10 years earlier of youngest relative affected. Annual mammogram and MRI or Doppler ultrasound alternating at 6 month interval can be considered.
Treatment Options:

Some of the common treatment options for breast cancers are:

Breast conservation surgery - This is where the tumors are removed without cutting out too much of the surrounding breast tissue.
Mastectomy - If the cancer has spread too far then large amounts of breast tissue has to be removed along with the tumor to stop its spread any further.
Sentinel lymph node Biopsy - it's part of both surgical procedures, it decreases morbidities of lymph node dissection first draining lymph nodes only are removed in patients with clinically negative axilla. If negative on frozen section further axillary dissection is avoided. It avoids the morbidity of complete axillary clearance.
Cervical cancer ( Carcinoma Cervix)

Cervical cancer is the cancer of the cervix, which is the opening of the uterus and connects the uterus to the vagina. Indian women in particular are susceptible to cervical cancer as more than 1/3rd of the cervical cancer related deaths in the entire world happens here in India, which is about 74000 deaths annually. The leading cause for cervical cancer is HPV or Human Papillomavirus infection, which if left untreated and unchecked will result in cancer.

Alarming Signs of Cervical Carcinoma:

Early lesions and precancerous lesions have no symptoms
Abnormal vaginal bleeding such as bleeding after vaginal intercourse, bleeding after menopause, bleeding and spotting between periods or longer/heavier periods
Abnormal vaginal discharge
Pelvic pain
Late stage disease may cause lower extremity swelling, problem with urine and/or stool passage
Screening Guidelines:

Cervical cancer screening is most effective screening programme of any cancer disease resulting in significant decrease in mortality from carcinoma cervix
United state preventive services task force (USPSTF) recommend cervical cancer screening starting at age 21 yrs.
Between age 21-30 years cytology recommended at 3 year interval and HPV testing is not recommended.
Between 30-65 years cytology every 3 year or cytology +HPV testing every 5 year.
If previously adequately screened screening can be discontinued after 65 years.
Women with prior total hysterectomy and no CIN can discontinue screening.
Apart from breast and cervical cancers, certain other cancers have also reported an alarming increase such as:-

Ovarian cancer (Carcinoma Ovary)

Starting in the ovaries, diagnosis of this type of cancer is usually delayed due to lack of visible symptoms in the initial stages. About 85% to 90% of ovarian cancers are epithelial ovarian carcinomas. Epithelial ovarian cancers tend to spread to the lining and organs of the pelvis and abdomen (belly) first. This may lead to the buildup of fluid in the abdominal cavity (called ascites). As it advances, it may spread to the lung and liver, or, rarely, to the brain, bones, or skin. The main treatments for ovarian cancer are surgery and chemotherapy.

Cancer of the endometrium (Carcinoma Endometrium)

Endometrium is the lining of the uterine wall and has along with ovarian, uterine and cervical cancer is also increasing in occurrences throughout India and the world.

The grade of an endometrial cancer is based on how much the cancer forms glands that look similar to those found in normal, healthy endometrium.

Grade 1 tumors have 95% or more of the cancerous tissue forming glands.
Grade 2 tumors have between 50% and 94% of the cancerous tissue forming glands.
Grade 3 tumors have less than half of the cancerous tissue forming glands. Grade 3 cancers tend to be aggressive and have a poorer outlook than lower-grade cancers.
Treatment Options:

Cervical cancer along with Ovarian, uterine and endometrial cancer can be treated using the following methods:

1. Surgery: Radical Hysterectomy primarily preferred option for early stage disease. Both open and minimal invasive approaches are suitable.

For precancer high grade lesion conisation is also option for compliant patient.
In young suitable patient willing for childbearing trachelectomy is also possible in very early lesion.
Depending on risk factors after surgery adjuvant treatment may be advised.
2. Radiation therapy or Combined Radiation therapy+Chemotherapy: Alternative to surgery in early stage and choice in late stage.

Prevention:

Certain prevention techniques that would be advisable to detect cancer in its early stages would be,

Regular Pap smear tests for cervical cancer
Taking vaccines for cervical cancer
Regular mammograms and checkups for breast cancer
Changing lifestyles to reduce stress
Changes in diet to reduce risks
Leading a healthy lifestyle with regular exercise

With the modernization of all economies around the world, one health hazard that has become one of the largest perils within both developed and developing nations is the incidence of cancers of the female reproductive system, especially cervical and breast cancer.

Breast cancer

Breast cancer is the formation of malignant tumors within the breast tissues of a woman. Usually, breast cancer affects women in the age range of 40 to 50, but there have been many reports of it occurring earlier. About 48 % percent of the Indian women having breast cancer have been reported to be under 50. This is an almost 17 percent jump compared to figures 25 years earlier.

Alarming Signs of Breast Cancer:

The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded.
Swelling of all or part of a breast (even if no distinct lump is felt)
Skin irritation or dimpling
Breast or nipple pain
Nipple retraction (turning inward)
Redness, scaliness, or thickening of the nipple or breast skin
Nipple discharge (other than breast milk)
Screening Guidelines for Breast cancer:

Mammography: US Preventive Services Task Force (USPSTF) recommends mammography once in every 2 year for females between age group 50-75 years. Women with a family history has a benefit of starting at age 40 years. After 75 years there are insufficient evidence of benefit of screening mammography.
Breast Self Examination and annual Clinical examination: breast self examination is easy to learn and and any abnormality should be reported to the oncologist.
For High Risk/ Genetic risk factors: screening should start by age 25 or 10 years earlier of youngest relative affected. Annual mammogram and MRI or Doppler ultrasound alternating at 6 month interval can be considered.
Treatment Options:

Some of the common treatment options for breast cancers are:

Breast conservation surgery - This is where the tumors are removed without cutting out too much of the surrounding breast tissue.
Mastectomy - If the cancer has spread too far then large amounts of breast tissue has to be removed along with the tumor to stop its spread any further.
Sentinel lymph node Biopsy - it's part of both surgical procedures, it decreases morbidities of lymph node dissection first draining lymph nodes only are removed in patients with clinically negative axilla. If negative on frozen section further axillary dissection is avoided. It avoids the morbidity of complete axillary clearance.
The other options to treat breast cancer are chemotherapy, hormone therapy, targeted therapy and radiotherapy.

Cervical cancer ( Carcinoma Cervix)

Cervical cancer is the cancer of the cervix, which is the opening of the uterus and connects the uterus to the vagina. Indian women in particular are susceptible to cervical cancer as more than 1/3rd of the cervical cancer related deaths in the entire world happens here in India, which is about 74000 deaths annually. The leading cause for cervical cancer is HPV or Human Papillomavirus infection, which if left untreated and unchecked will result in cancer.

Alarming Signs of Cervical Carcinoma:



Early lesions and precancerous lesions have no symptoms
Abnormal vaginal bleeding such as bleeding after vaginal intercourse, bleeding after menopause, bleeding and spotting between periods or longer/heavier periods
Abnormal vaginal discharge
Pelvic pain
Late stage disease may cause lower extremity swelling, problem with urine and/or stool passage
Screening Guidelines:

Cervical cancer screening is most effective screening programme of any cancer disease resulting in significant decrease in mortality from carcinoma cervix
United state preventive services task force (USPSTF) recommend cervical cancer screening starting at age 21 yrs.
Between age 21-30 years cytology recommended at 3 year interval and HPV testing is not recommended.
Between 30-65 years cytology every 3 year or cytology +HPV testing every 5 year.
If previously adequately screened screening can be discontinued after 65 years.
Women with prior total hysterectomy and no CIN can discontinue screening.
Apart from breast and cervical cancers, certain other cancers have also reported an alarming increase such as:-

Ovarian cancer (Carcinoma Ovary)

Starting in the ovaries, diagnosis of this type of cancer is usually delayed due to lack of visible symptoms in the initial stages. About 85% to 90% of ovarian cancers are epithelial ovarian carcinomas. Epithelial ovarian cancers tend to spread to the lining and organs of the pelvis and abdomen (belly) first. This may lead to the buildup of fluid in the abdominal cavity (called ascites). As it advances, it may spread to the lung and liver, or, rarely, to the brain, bones, or skin. The main treatments for ovarian cancer are surgery and chemotherapy.

Cancer of the endometrium (Carcinoma Endometrium)

Endometrium is the lining of the uterine wall and has along with ovarian, uterine and cervical cancer is also increasing in occurrences throughout India and the world.

The grade of an endometrial cancer is based on how much the cancer forms glands that look similar to those found in normal, healthy endometrium.

Treatment Options:

Cervical cancer along with Ovarian, uterine and endometrial cancer can be treated using the following methods:

1. Surgery: Radical Hysterectomy primarily preferred option for early stage disease. Both open and minimal invasive approaches are suitable.

For precancer high grade lesion conisation is also option for compliant patient.
In young suitable patient willing for childbearing trachelectomy is also possible in very early lesion.
Depending on risk factors after surgery adjuvant treatment may be advised.
2. Radiation therapy or Combined Radiation therapy+Chemotherapy: Alternative to surgery in early stage and choice in late stage.

Prevention:

Certain prevention techniques that would be advisable to detect cancer in its early stages would be,

Regular Pap smear tests for cervical cancer
Taking vaccines for cervical cancer
Regular mammograms and checkups for breast cancer
Changing lifestyles to reduce stress
Changes in diet to reduce risks
Leading a healthy lifestyle with regular exercise

Menstrual disorders are caused by a variety of factors and affect every woman in a different manner. In most cases, it manifests itself in the form of fluctuations in menstrual flow and irregularity in the monthly cycle. Certain disorders are not too severe and can be easily alleviated. Others are more complicated and require the immediate attention of a gynaecologist.

As mentioned, there are different specific causes of different kinds of disorders resulting from a range of factors such as hormone levels, the functioning of the central nervous system, health of the uterus, etc.

Some of the most common causes of menstrual disorders are as follows:

Hormonal imbalance: Fluctuating hormone levels in the body have a direct impact on the menstrual cycle. These fluctuations can be caused by dysfunction in the pituitary gland, thyroid gland or adrenal gland. It can also be a result of a malfunction in either or both ovaries and the secretion of hormones originating there.
Anatomic problems: One-fourth menstrual disorders are caused by problems of the anatomy. These include various gynaecological issues like the presence of uterine fibroids and polyps, reduced uterine contractile strength, adenomyosis (intrusion of uterine tissue into the muscular wall of the uterus), a uterus with an excessively large surface area, and endometrial cancer.
Clotting irregularities: Abnormality in clotting is a cause of heavy menstrual bleeding in women. It leads to exceeding blood loss from minor cuts and gashes and makes one easily prone to bruising. This may also include medical conditions such as thrombocytopenia (platelet dysfunction) and Von Willebrand disease.
Medications and supplements: There is a wide range of medications and nutritional or hormonal supplements which often cause menstrual disorders in women and lead to fluctuations in the menstrual cycle. These include medicines such as aspirin, ibuprofen, estrogen pills, Vitamin E supplements etc.
Miscellaneous factors: These are comparatively rare and require a greater degree of medical attention. It includes conditions such as cervical cancer, ovarian tumors, liver and kidney diseases, uterine infections, extreme psychological stress, obesity, etc. Incidents such as miscarriages and unsuspected pregnancies are also known to cause abnormal menstrual bleeding.