Corpus cancer

The uterus is a hollow, muscular organ located in the female pelvis. It consists of the body (corpus) and the cervix, with the ovaries and fallopian tubes attached to the upper part of the it. The uterine wall consists of 3 layers: endometrium (inner layer), myometrium (muscular middle layer), and perimetrium (outer layer).

The uterus plays a critical role in menstruation, fertility, and pregnancy. In fertile women, the uterine lining thickens in response to the hormonal fluctuations during the menstrual cycle. However, when cells in endometrium divide and proliferate in an uncontrolled way, they may eventually develop into tumours which may be benign or malignant. Corpus cancer is a type of cancer that originates in the endometrium. It may invade the muscular and outer layers of the uterus, the cervix, and in advanced stages, the adjacent organs, and spread to lymph nodes or distant organs.

The exact cause of corpus cancer is uncertain, but the following women are more susceptible:

• Age: in general, most women who develop corpus cancer are above 50 years old, after their menopause
• Menstrual cycle: women who had first menses before 12 or menopause after 55 are at higher risk
• Childbirth: women who have never given birth, or had first child after 35 years of age are at higher risk
• Obesity: fat tissue produces excess oestrogen, which can stimulate the growth of the endometrium
• Diet: prolonged intake of diet with high animal fat
• Lifestyle: smoking, drinking and lack of exercise
• Chronic illness: diabetes and hypertension are associated with increased risk of corpus cancer
• Genetics: certain inherited genetic conditions, such as Lynch syndrome increase the risk of developing corpus cancer
• Medications: prolonged use of hormonal replacement therapy, or the use of tamoxifen (for treatment of breast cancer) increase the risk of corpus cancer

Healthy lifestyle helps to lower the risk of corpus cancer. These include:

• Regular exercise
• Maintain healthy body weight
• Avoid diet that is high in fat and sugar
• Avoid smoking or heavy drinking

Most women with corpus cancer present with abnormal vaginal bleeding. Since the cure rate is high in early-stage disease, it is important to be aware of the common symptoms and seek medical advice if they develop.
 

Most women with corpus cancer present with abnormal vaginal bleeding, such as postmenopausal bleeding, menorrhagia, and bleeding in between menstrual cycles. Some patients may experience blood-stained or foul-smelling vaginal discharge, or pain in the pelvis.
If the cancer has invaded nearby organs, such as the bladder or rectum, it can cause bleeding, discomfort, or difficulty during urination or bowel movements.
 

In addition to medical history and clinical examination, the gynaecologist will often arrange the following tests:

• Ultrasound: to visualize the thickness of endometrium and detect any abnormalities
• Endometrial aspiration: to obtain cells from the endometrium for pathological examination
• Hysteroscopy: may be required for better visualisation of the uterine cavity and obtain tissue for pathological examination
• Blood tests: to evaluate general body condition and function of the liver and kidneys
• Chest X-ray
• Pelvic magnetic resonance imaging (MRI): to ascertain the local disease extent and stage
• Computer tomography scan (CT) or PET-CT: for disease staging, especially for patients with high risk of tumour spread to other organs

When the diagnosis is confirmed, options of treatment will depend on factors such as cancer stage, patient's age and background medical conditions:
 
Surgery
For most patients, radical surgery offers chance of cure. It involves removing the uterus and bilateral fallopian tubes and ovaries, and obtaining peritoneal fluid for evaluation. Based on disease stage, it may also include removal of part of the omentum, and lymph nodes in the pelvic and / or abdominal area.
 
Radiotherapy
Radiotherapy involves the utilisation of high-energy X-rays to target and destroy cancer cells. It is often used as adjunct to surgery to reduce risk of recurrence, and delivered externally (external beam radiation) or internally (brachytherapy). Radiotherapy is commonly combined with chemotherapy to enhance the treatment effect.
 
Chemotherapy
The use of anti-cancer drugs to destroy cancer cells or to slow down their growth. Chemotherapy may be recommended as an adjuvant treatment after surgery to reduce the risk of recurrence, or for control of cancer in women with advanced stages.
 
Immunotherapy
Based on the molecular profile of the cancer (such as MSI / MMR status), immunotherapy may be considered for women with advanced corpus cancer. It attacks cancer cells by stimulating the body’s own immune system.
 
Targeted therapy
May be considered for patients with advanced corpus cancer for disease control.

Treatment related side effects or complications may include:

• Wound infection or pain after surgery
• Lymphedema: patients are at small risk of chronic lower limb swelling after surgery or external beam radiotherapy.
• Radiotherapy may produce long term complications such as narrowing of the vagina, or uncommonly cystitis or proctitis, resulting in blood in urine or stool.
• During chemotherapy, side effects such as fatigue, nausea, poor appetite, diarrhoea, hair loss, oral ulcers, weakened immune system, and neuropathy (tingling or numbness of the fingers or feet) may occur.

Although treatment may induce side effects of variable severity, modern treatment has improved to reduce the rates of side effects and complications. Nursing care, medications as well as support from relatives and friends can help to relieve discomfort during the treatment process.

Patients and their caregivers should be made aware of various disease and treatment related information before and after treatment. Better understanding and being prepared in advance facilitates positive disease coping.

• Regular follow-up: to monitor for signs of relapse and treatment related complications. In general, the risk of relapse decreases with longer disease-free period.
• Healthy lifestyle: adequate rest, avoiding over-exertion and maintaining a balanced diet are recommended. Cancer treatment such as chemotherapy might weaken the immune system. Immunocompromised patients are advised to avoid intake of raw or undercooked meat, poultry, eggs, seafood, raw or unpasteurized dairy products, and ready-to-eat raw vegetables.
• Simple exercise to maintain general health, mobility and reduce risk of lower limb swelling.

Mental health: staying optimistic improves disease coping and facilitates treatment.