Uterine cancer (Endometrial & Cervical Cancer), Risk Factors, Diagnosis and Treatment options on the basis of staging.

1. Uterine Cancer
Faraza Javed
Ph.D Pharmacology

2. Uterine Cancer
The terms uterine cancer may refer to any of
several different types of cancer which occur in
the uterus, namely:
 Endometrial cancer: originate from cells in the
glands of the endometrium (uterine lining).
 Cervical cancer: arises from the transformation
zone of the cervix, the lower portion of the
uterus.

3. Pathophysiology
Endometrial cancer forms when there are errors
in normal endometrial cell growth. Usually,
when cells grow old or get damaged, they die,
and new cells take their place. Cancer starts
when new cells form unneeded and old or
damaged cells do not die as they should.

4. These abnormal cancer cells have many genetic
abnormalities that cause them to grow
excessively. Mutations are found in a tumor
suppressor gene, commonly p53 or over
expression of PI3k/Akt kinase pathway, which
promote cell growth in endometrial cancer.

5. Risk Factors
 Increased estrogen
 Hormone therapy
 Obesity
 Estrogen secreting tumors
 Older age
 Infertility
 Genetics

6.  Lynch syndrome (Hereditary colorectal cancer
(HNPCC) is a syndrome results due to gene
mutation that increases the risk of colon cancer
and other cancers, including endometrial
cancer).
 Endometrial Hyperplasia (The endometrium has
an average thickness of 6.7 mm).
 Viral Infection (Human Papilloma Virus)
 Some evidence shows that Tobacco Smoking
reduces the rate of progression of tumor.
Smokers have lower levels of estrogen and lower
rate of obesity.

7. Symptoms
 Bleeding or watery discharge from vagina
 Difficult or painful urination
 Back Pain
 Swelling in Legs
 In later stages of the disease, women may feel
pelvic pain and experience unexplained weight
loss.

8. Diagnostic Parameters
 Transvaginal Ultrasound:
An ultrasound uses sound waves to create a
picture of internal organs. If the endometrium
looks too thick, the doctor may decide to
perform a biopsy.
 Hysteroscopy:
Hysteroscope allows doctors to do a visual
examination of the endometrium.

9.  Biopsy:
Testing for endometrial cancer or endometrial
hyperplasia.
 CT Scan and MRI:
Both are used to measure the tumor’s size.
 CA 125 Blood Test:
CA 125 is a substance released into the
bloodstream. The normal value is less than 35
U/mL. A level above 35 U/mL is considered
abnormal. In someone with endometrial cancer,
a very high blood CA 125 level suggests that the
cancer has probably spread beyond the uterus.

10. Treatment
Once cancer has been diagnosed, treatment
strategy depends on the extent (stage) of your
cancer. Stages of endometrial cancer include:
 Stage I cancer is found only in uterus.
 Stage II cancer is present in both the uterus and
cervix.
 Stage III cancer has spread beyond the uterus,
but hasn't reached the rectum and bladder. The
pelvic area lymph nodes may be involved.

11.  Stage IV cancer has spread past the pelvic
region and can affect the bladder, rectum and
more-distant parts of your body.
Combinations of treatments are often
recommended.

12.  Surgery:
 Hysterectomy: Removal of uterus
 Lymph node dissection: Removal of lymph
nodes near the tumor if the cancer has spread
beyond the uterus.

13.  Radiation Therapy:
The radiation therapy is most often given after
surgery to destroy any cancer cells remaining in
the area but rarely given before surgery to shrink
the tumor. Radiation therapy options for
endometrial cancer may include radiation
directed towards the whole pelvis externally or
tiny radioactive seeds are placed in the body
close to tumor which is termed as
Brachytherapy.

14.  Chemotherapy:
 Hormone Therapy: Hormone therapy for
uterine cancer often involves the hormone
progesterone, given in a pill form. Other
hormone therapies include the Aromatase
inhibitors (AIs) often used for the treatment of
women with breast cancer, such as Anastrozole
and Letrozole. An AI is a drug that reduces the
amount of the hormone estrogen in a woman's
body by stopping tissues and organs other than
the ovaries from producing it with other types
of treatment.

15. Hormone therapy may also be used for women
who cannot have surgery or radiation therapy or
in combination.
 The chemo often includes the combination of
Doxorubicin+ Cisplatin+ Paclitaxel.
 Bevacizumab (Avastin) blocks angiogenesis
(the formation of new blood vessels) and is
under evaluation in clinical trials.
 Pazopanib blocks angiogenesis and stop the
growth of cancer cell.

16.  Vaccination: The World Health Organization
(WHO), as well as public health officials in
Australia, Canada, Europe, and the United States
recommend this vaccination against HPV. Two
vaccines have market approval in manycountries
as of 2014 (called Gardasil and Cervarix in the
US). Both vaccines protect against the two HPV
types (HPV-16 and HPV-18) that cause 70% of
cervical cancers. Both Gardasil andCervarix have
been shown to prevent cervical hyperplasia due
to viral infection.

17.  Both vaccines are given as a series of three
injections over a six-month period. The second
dose is given one to two months after the first
dose, and the third dose is given six months
after the first dose.

18. THANKYOU