Endometrial (Uterine) Cancer and Its Impact on Future Pregnancies

Uterine cancer is more common in younger and postmenopausal women and is ranked fourth among gynecological cancers in India. There are two categories of uterine cancer. Uterine sarcoma grows in the myometrium, the muscle wall of your uterus, while endometrial cancer, which is more common, develops in the endometrium, the inside lining of your uterus.

Endometrial cancer accounts for 95% of the cases, hence the phrase “uterine cancer.”

Role of Uterus: Hormonal Imbalance & Cancer Risks

The uterus is a vital component of women, primarily serving as a reproductive organ because it is where fetuses develop. Your menstrual cycle causes monthly changes in your endometrium. In the event of no pregnancy levels of estrogen and progesterone harmone decline significantly and ultimatley reach a baseline level that initiates periods .

Hormonal imbalances that result in endometrial cancer occur when there is an excess of estrogen and insufficient progesterone to balance it.

Symptoms of Uterine Cancer

The following factors point to the possibility of uterine sarcoma or endometrial cancer: vaginal bleeding between periods before or after menopause; pelvic cramps or lower abdominal pain, below your abdomen; postmenopausal women who have thin, clear vaginal discharge; and women over 40 who experience heavy, prolonged, or frequent vaginal bleeding.

Causes & Risks

Uterine cancer’s precise cause is unknown. Obesity ,Diabetes, early menarche, late menopause, and polycystic ovarian syndrome (PCOS)are amongst few risk factors for uterine cancer .   Women who have never been pregnant are likewise at greater risk from chronic exposure to estrogen and are subsequently at risk for uterine cancer . Low amounts of progesterone and excessive levels of estrogen drives uncontrolled growth of cells ultimately leading to uterine cancer .

Other Complications

Although mortality is the most catastrophic consequence of endometrial cancer, a favorable prognosis is provided by early detection. Anemia, metastases, and a poor response to treatment are further problems.

Diagnosis

Transvaginal ultrasound, endometrial biopsy, and magnetic resonance imaging (MRI) are frequently used in the diagnosis of endometrial cancer to assess the disease’s stage and severity. The patient’s desire for future pregnancies and the stage at diagnosis determine the available treatment options.

• Surgical Intervention: The most popular therapy for endometrial cancer is a total hysterectomy, which includes removing the uterus, fallopian tubes, and ovaries. This approach eliminates the chance of a spontaneous pregnancy
• Fertility-Preserving Options: Conservative treatments, such as high-dose progestin medication, may be an option for women who want to become pregnant in the future but who have been  identified at an early stage. This hormone therapy shrinks the tumour .Disease remission is confirmed by doing a HPE(sampling of the Endometrial tissue ) after 3-6 months to confirm disease resolution . IVF(Invitro fertilization )treatment offers great benefit in reducing the time to pregnancy .However the patient has be under close medical follow up .Once the family is complete hysterectomy is done .

• Radiation and Chemotherapy: These therapies may be required in more advanced situations. Ovarian insufficiency brought on by these medicines can make conception difficult. Consult a fertility doctor about fertility preservation techniques, such as freezing eggs or embryos before treatment.

Is Pregnancy Safe After Treatment?

Even after undergoing fertility-sparing procedures and achieving remission, women may still have trouble getting pregnant spontaneously. It might be necessary to use assisted reproductive methods, such as IVF with saved eggs or embryos. Adoption or surrogacy become feasible options for parenthood in situations when the uterus has been removed.

According to research, getting pregnant after a successful fertility-preserving procedure does not raise the chance of cancer recurrence. To guarantee a healthy pregnancy, however, strict medical attention is necessary.

(Dr. T. Shilpa Reddy, Consultant – Reproductive Medicine, Milann Fertility Hospital, Bengaluru)