Female uterus contains a lining known as endometrium that contains tissue full of blood vessels. Under healthy condition, this endometrium lining is built up (by cell multiplication) for up to one month for probable pregnancy. If there is no possibility of pregnancy, then, after one month of cycle, this lining full of tissues breaks down as menses.
Under diseased condition, the cells of the endometrium lining begin to grow out of control, causing endometrial cancer. The cancer is staged according to where the cancer cells are found, from Stage I being completely within the uterus to Stage IV, where cancer has spread beyond the boundaries of the pelvis.
SYMPTOMS OF ENDOMETRIAL CANCER
Unusual vaginal bleeding: About 90% of women diagnosed with endometrial cancer have abnormal vaginal bleeding, such as a change in their periods or bleeding between periods or after menopause. This symptom can also occur with some non-cancerous conditions, but it is important to have a doctor look into any irregular bleeding.
Vaginal discharge: Non-bloody vaginal discharge may also be a sign of endometrial cancer. Your doctor should check out any abnormal discharge.
Pelvic pain & Weight loss: Pain in the pelvis along with unintentional weight loss can also be a symptom of endometrial cancer. These symptoms are more common in later stages of the disease.
HOW PCOS INCREASE THE RISK OF ENDOMETRIAL CANCER?
Women with PCOS (Polycystic Ovary Syndrome) are reported to be at a higher risk of developing endometrial cancer. It has been seen in many females that the PCOS suffering females are three times more prone to endometrial cancer as compared to normal females. But it is also clear that it’s not mandatory for a PCOS female to develop endometrial cancer. Whenever PCOS is at extreme levels, then, it might cause endometrial cancer.
PCOS is associated with irregularity in the hormonal balance, which produces cyst(s) in the ovaries of the females. During healthy condition, shedding of endometrium lining is inhibited only during pregnancy. But in PCOS, irregular hormones also do not allow the endometrium lining to break down during menses. This irregularity of hormones involves very lesser quantity of progesterone (causes shedding of endometrium in menses) & higher amount of estrogen (causes ovulation). Thus, endometrium lining grows to a much thicker level than normal due to deficiency of progesterone. This condition leads to pre-cancerous situation called endometrial hyperplasia. If this condition is left untreated, it develops to endometrial cancer.
MANAGEMENT OF PCOS-GENERATED ENDOMETRIAL CANCER
The endometrial cancer can be managed in two ways as given below:
- Reduce the risk of development of endometrial cancer
- Treat the developed endometrial cancer
It is up to the stage of the cancer in the patient through which the treatment strategy can be opted. It there is only a risk of development of the cancer, but it has not developed yet, then, first option can be chosen. If the cancer has already developed in PCOS suffering female, then, second option can be chosen. Following treatment strategies have been given accordingly.
REDUCE THE RISK OF DEVELOPMENT OF ENDOMETRIAL CANCER
- PCOS treatment: When you know that the PCOS is the obvious reason for the risk of developing endometrial cancer, then, it should be treated first. If left untreated, hormone levels will remain abnormal and affect your whole body and your cancer risk.
PCOS is generally treated with the help of oral contraceptives. These medications are prescribed by doctor. Oral contraceptives containing progesterone-only pills are best to reduce endometrial cancer risk. But these do not come with their side effects.
PCOS can also be managed with the help of a clinically proven dietary supplement in the form of fenugreek seed extract i.e. Furocyst™. It has been proven to be safe & effective for the management of PCOS. It has been clinically evaluated and patented and has no known side effects.
- Healthy body weight: Most of the women with PCOS are obese or overweight. Obesity or overweight contributes highly to the development & progression of PCOS. Obesity is also known to be one of the risk factors of endometrial cancer because it also increases estrogen levels in the body.
Regular exercise and sticking to a healthy diet can lose excess weight and minimize the endometrial cancer risk.
- Regular examinations: If you already know you are at a greater risk for endometrial cancer because of your PCOS, it’s important to keep an eye on the early signs of cancer. Thus, it is a big requirement for regular –
- Pap smears: Tests for the presence of precancerous or cancerous cells on the cervix (opening of the uterus).
- Pelvic exam: Examination of vulva and internal reproductive organs including cervix, ovaries, fallopian tubes, uterus and vagina.
TREAT THE DEVELOPED ENDOMETRIAL CANCER
If a female is diagnosed with endometrial cancer along with PCOS, it is very important to talk with a specialist as soon as possible. A number of treatments are available and only a specialist can help determine the best option. The option can be one of the following:
- Surgery: Surgery is the main treatment for most of the women with endometrial cancer. It is carried out according to the stage of this cancer. If the cancer is limited only to the uterus then, the doctors opt for hysterectomy e. removing uterus from the body. If the cancer has spread to other organs such as fallopian tube, ovaries, part of vagina, etc, then, they may need to be removed as well.
- For any of these procedures, general anesthesia is used so the patient is asleep or sedated during the operation.
- The doctor may feel that chemotherapy or radiation treatment is necessary as well to prevent cancer from spreading.
- The patient is recovered after surgery by staying in the hospital for 5-7 days. Complete recovery takes 4-6 weeks.
- The only disadvantage of this surgery is infertility (not being able to start or maintain a pregnancy).
- Radiation: This type of therapy involves killing the cancer cells by exposing them to high-energy radiation. It can be done in two ways:
- Either from a machine (sends the radiation through the body towards the cancer cells)
- Or internally with seeds, needles or catheters which are placed directly in contact with cancer.
- With one radiation machine strategy, the device is usually left in place for about 1 to 4 days. The patient needs to stay immobile to keep the radiation sources from moving during treatment and so she is usually kept in the hospital overnight.
- Another radiation machine strategy is a bit intense. Each dose takes a very short time (usually less than an hour) and the patient can go home the same day.
- Chemotherapy: When this type of treatment is opted, special chemicals are introduced into the body, either by mouth or intravenously, which directly kill the cancer cells. These chemicals enter the bloodstream and reach throughout the body, making this treatment potentially useful for cancer that has spread beyond the endometrium.
- Combination chemotherapy sometimes works better in treating cancer than one drug alone. Combination chemotherapy sometimes works better in treating cancer than one chemical/drug alone.
- Chemo is often given in cycles e. a period of treatment, followed by a rest period. The chemo chemicals/drugs may be given on one or more days in each cycle.
- These chemicals kill cancer cells but can also damage some normal cells. This produces side effects including nausea and vomiting, loss of appetite, mouth or vaginal sores and hair loss.
- Most of the side effects of chemotherapy stop when the treatment is over, but some can last a long time.
- Hormone therapy: If cancer responds to hormonal stimulation, there are medications, which can help block the hormone from interacting with cancer. This can help prevent further growth of cancer. Hormone treatment for endometrial cancer includes:
- Progesterone: Slows the growth of endometrial cancer cells.
- Tamoxifen: Prevent the circulation of estrogen hormone. Also prevents estrogen from nourishing the cancer cells.
- Luteinizing hormone agonist: It switches off the estrogen production by the ovaries in women who are premenopausal. They are injected every 1-3 months.
- Aromatize inhibitors: Even after the ovaries are removed (or are not functioning); estrogen is still made in the fat tissue. This becomes the body’s main source of estrogen. Drugs called aromatase inhibitors can stop this estrogen from being formed and lower estrogen levels even further.
YOU QUERIES TO DOCTOR AFTER TREATMENT
When the treatment has been completed, following questions should be asked by the patient to the doctor for satisfactory completion of treatment as well as for future health:
- Are there any limits on what I can do?
- What symptoms should I watch for?
- What kind of exercise should I do now?
- What type of follow-up will I need after treatment?
- How often will I need to have follow-up exams and imaging tests?
- Will I need any blood tests?
- How will I know if the cancer has come back? What should I watch for?
- What will my options be if the cancer comes back?
- When can I resume my usual activities at work and/or around the house?
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REDUCING THE RISK OF ENDOMETRIAL CANCER IN PCOS