Home Page>Cancer of the Uterus
Cancer of the UterusDr Kingsley’s comments Cancer of the uterus (the womb) occurs predominantly in women who have passed the menopause, and it occurs in about 15 per 100,000 women in the UK. There are many accepted risk factors, which is interesting to me, because, by and large, if I can identify a possible cause in a patient and do something about it, it gives me something to work on. It is now accepted that tamoxifen, when used to prevent breast cancer recurrence if the tumour is oestrogen sensitive, can eventually cause cancer in the uterus. As there is also an accepted risk of developing it if a woman has been on an oestrogen-containing contraceptive pill and HRT, it is clear to me that oestrogen itself is probably one of the main culprits. I, and many other doctors, are aware that there is far too much oestrogen in our environment nowadays, much of it coming from xeno-oestrogens (false oestrogens) from pesticides, plasticisers and other chemicals, plus the urine from humans and farm animals that have taken, or been given, hormones getting into ground water. Two other risk factors are not having had a baby and late onset of the menopause, both of which mean that the woman has been exposed to that much more oestrogen over her lifetime. Even obesity and diabetes (which tend to go together) are risk factors for uterine cancer, which is interesting as oestrogen can be manufactured in body fat. While medical textbooks say that high blood pressure is also associated with cancer of the uterus, this goes with being overweight and having diabetes. Such books also suggest that ‘endometrial hyperplasia’, i.e. when the muscle of the wall of the uterus becomes thicker, is another risk factor. However, in my way of thinking, that is the result of the effect of too much oestrogen on the uterus over a lifetime. Perhaps you can now see why I am so convinced that oestrogen is somehow the culprit, or certainly the main one, in cancer of the uterus. Symptoms and Signs. By far the most common early symptom or sign of cancer of the uterus is postmenopausal bleeding from the uterus. When uterine cancer occurs in a woman before she has gone through the change of life, i.e. when she is still having regular periods, any change in her usual ‘bleeding’ pattern should alert her that something is wrong. As with cancer of the cervix, a vaginal discharge is also an indication. If any ‘gynaecological’ symptoms are investigated by a doctor carrying out an ‘internal examination’, an enlarged uterus may be palpable (felt), but such an examination may not reveal cancer of the uterus in the early stages. In late stages, however, there may be any number of indications that something is seriously wrong, such as pain, weight loss, loss of appetite, fatigue, etc, which are common in the later stages of most forms of cancer. Investigations. Once a suspicion has been raised of the possibility of cancer of the uterus being present, the standard starting point, apart from routine and specific blood tests, is a ‘dilatation and curettage’, better known as a D&C, when the inside of the uterus will be scraped clean, a sample being examined under a microscope. A chest X-ray will most likely be carried out, with or without an ultrasound or CT/MRI scan of the local area and the liver, as the lungs and liver are the most likely places for secondaries to appear. There are three names given to cancers of the uterus, by far the most common being an adenocarcinoma, the other two comparatively rare types being an adeno-acanthoma and a leiomyosarcoma. Conventional Treatment. Because it is usually obvious that something is wrong when the first signs and symptoms of some sort of abnormal bleeding occur, the diagnosis of cancer of the uterus is most commonly made early on, when the tumour is confined to the uterus itself, i.e. it has not yet spread. As a result, surgical removal of the whole of the uterus, plus the tubes and ovaries, is the most common approach in the first instance. It has the fascinating name of a ‘total abdominal hysterectomy and bilateral salpingo-oophorectomy’. While chemotherapy is rarely given for cancer of the uterus, radiotherapy is used if the cancer has spread outside the uterus itself, with or without any form of surgery being carried out, or it may be the only treatment if the patient is not fit for an operation. If the initial approach seems to have worked in the first instance, but uterine cancer reappears, a hormone called medroxyprogesterone acetate is sometimes prescribed, which can make patients sometimes fell generally better. It makes me wonder, therefore, why natural progesterone cream is not given right from the beginning. As with cancer of the cervix, radiotherapy to the lower abdominal area can lead to considerable collateral damage. The bladder, small bowel and rectum will inevitably receive a dose of radiation, however carefully the dose is beamed. There is, however, a lot that can be done to minimise these unwanted effects. An Explanation by Dr Kingsley Before Your Consultation about your Uterine Cancer Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having cancer in your uterus. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your uterine cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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