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See also: Uterine Cancer, Endometrial Cancer, and Cancer

Cancer of the Uterus: Stage III
Other names	Uterine Cancer, Womb Cancer.
Specialty	Oncology
Symptoms	Vaginal bleeding, Abnormal discharge, Pelvic pain, Pain during urination or intercourse.
Types	Stage IIIA, Stage IIIB, Stage IIIC.
Causes	The abnormal growth of cancerous tumour cells. Unknown why these cells initially grow.
Risk factors	Older age, obesity, Type 2 Diabetes, High Blood Pressure, HRT, family history, previous radiation treatments.
Diagnostic method	Physical pelvic exam, Ultrasound, Biopsy, Hysteroscopy, Diagnostic Radiography Imaging.
Prevention	Healthy Lifestyle, HRT; combination of estrogen and progesterone.
Treatment	Surgery, Radiation Therapy, Medication.
Medication	Chemotherapies; Paclitaxel, Carboplatin, Doxorubicin.
Prognosis	Prognosis
Frequency	Frequency
Deaths	Death statistics

Stage III: Cancer of the Uterus is a specific stage of Uterine Cancer; a disease occurring in females, in which abnormal cells grow and divide to ultimately form a tumour and destroy body tissue. Stage III occurs when the malignant cancerous cells that have formed in the uterus, spread outside of the uterine tissue, however are confined within the pelvic area. This means the tumour has spread to the surrounding internal reproductive body parts and organs of the female body.

To further explain the spread of the cancer throughout the pelvis and body, Stage III Uterine Cancer is additionally graded into four sub-stages; Stage IIIA, Stage IIIB, Stage IIIC1, and, Stage IIIC2. Each sub-stage specifically describes to what extent and where in the pelvis the tumour has grown and extended to. Stage IIIA occurs when the cells invade the lining of the pelvis and/or fallopian tubes. In stage IIIB, the cancer cells have invaded the vagina. Stage IIIC involves cancer cells found in the lymph nodes of the groin, including pelvic and para-aortic.

Of all gynaecological cancers diagnosed, Uterine Cancer is the most common and has the highest diagnosis rate world wide. In the United States it is the fourth most commonly diagnosed gynaecological cancer amongst women, and in Australia it is the fifth most commonly diagnosed gynaecological cancer.

Although the immediate cause of the growth of these cancer cells remains unknown, and is yet to be researched and determined, there are a variety of risk factors that contribute to the likelihood of being diagnosed with the disease. Obesity, older age and family history are some of the factors that put a woman at risk.

Diagram of the Uterine organ.

Background on Uterine Cancer

Uterine Cancer is a specific class of cancer which forms in the uterus of females. Also known as cancer of the uterus, or womb cancer, the cancer is initiated by abnormal cell growth in the lining of uterine tissue (endometrium) or the muscle tissue (myometrium).

There are two main uterine cancers that are distinguished by the initial site of the cancer growth.

• Endometrial Cancer: The cancer forms in the internal endometrium lining of the uterine tissue.
• Uterine Sarcoma: The cancer develops in the myometrium muscles of the external support tissues surrounding the uterus.

Cancer in the Uterine muscle tissue.

Diagram of the female reproductive system.

Classifications

Uterine Cancer can be differentiated into four stages, according to the growth of the cancerous cells. In certain stages, it can been further divided and sub-categorised.

• Stage I: The cancer is restricted to growth only in the uterus.
  • Stage IA - The cancer is confined in the endometrium or to partial of the myometrium muscle tissue.
  • Stage IB - The cancer has spread to over half of the myometrium.
• Stage II: The cancer has advanced from the uterus and now extends to the cervix.
• Stage III: The cancer has increased in growth in the uterus and the cervix, but is confined to the pelvic area. It has now expanded to the fallopian tubes, ovaries, vagina and lymph nodes, both .
  • Stage IIIA - The cancer cell growth extends to the uterine serosa tissue, the fallopian tube tissue, and to the ovaries.
  • Stage IIIB - The cancer cell growth has expanded to the vagina.
  • Stage IIIC1 - The cancer cell growth has advanced to the lymph nodes in the pelvis.
  • Stage IIIC2 - The cancer cell growth has proliferated into the para-aortic lymph nodes near the aorta and lumbar vertebrae in the groin.
• Stage IV: The cancer now a metastatic growth, and is unconfined and spreading to other distant organs of the body, such as the bladder, bowel, rectum.
  • Stage IVA - The cancer cell growth has expanded to the mucous of the bowel, specifically to the rectum or bladder.
  • Stage IVB - The cancer cell growth has proliferated to lymph nodes in the groin, as well as other organs of the body, such as bones, liver, or lungs.

Staging provides a good indication for the doctor or practitioner to adequately assess the extent of the cancer, as well as describe the cancer cells, in order to provide the correct and more appropriate prognosis and treatment plan to the patient.

A further way doctors assess the cancer, is by a grading system of the cells, describing to what extent the existing cancer cells are similar to normal healthy cells. This is done by making a comparison between the malignant cells of the tumour and other healthy cells in the body.

There are four grades that can be applied:

• GX: Undetermined grade - The grade can't be assessed.
• G1: Low grade - The cells are well differentiated.
• G2: Intermediate grade - The cells are moderately differentiated.
• G3: High grade - The cells are poorly differentiated or completely undifferentiated.

Risk Factors

Risk factors for the diagnosis of uterine cancer include:

• Older age.
• Obesity.
• Endometrial hyperplasia.
• Infertility, or choosing not to have children.
• Early menstruation (before the age of 13).
• Late menopause (after the age of 55).
• Use of Hormone Replacement Therapy (HRT) drugs.
• High blood pressure.
• Type 2 diabetes.
• Having previous ovarian tumours.
• Previous radiation treatments on the pelvis for cancer.
• Family history of cancer (Uterine, Ovarian, Breast, Bowel).
• Taking tamoxifen for Breast Cancer.

Stage III Uterine Cancer will develop due to more aggressive malignant tumour cells growing in the body. Risk factors for Stage III Uterine Cancer are:

• Late diagnosis.
• Lack of treatment.

Signs and Symptoms

The physical symptoms and signs of having uterine cancer include:

• Vaginal discharge and/or bleeding, unrelated to menstruation.

• Vaginal bleeding, after menopause.
• Experiencing difficulty or pain when urinating.
• Experiencing pain in sexual intercourse.
• Pelvic pain.

Investigation and Diagnosis

Initial techniques use for the diagnosis of uterine cancer include:

• Physical exam of the body.
• Pelvic exam.
• Family history check.
• Abdominal ultrasound exam.
• Trans-vaginal ultrasound exam.
• Blood and Urine tests.

However, other more invasive techniques are more commonly used for a correct and thorough diagnosis. These techniques work by taking a sample of tissue from the endometrium, and using this to examine the cells under a microscope, looking for cancer cells. The possible procedures that can be used include:

• Endometrial biopsy.
• Dilatation and Curettage; involving the dilation of the cervix of the uterus, and using a curette the lining of the endometrium is scraped and cells are taken to be investigated.
• Hysteroscopy.

After the initial diagnosis of uterine cancer, further tests must be carried out in order to further understand how the cancer cells have expanded in the uterus and pelvic region, and proliferated further to other organs of the female reproductive system and throughout the body. This commonly involves Diagnostic Imaging, and will allow doctors to diagnose a specific stage of uterine cancer to the patient. These diagnostic techniques are specifically important in diagnosing Stage III Uterine Cancer, as the cells have spread beyond the uterus throughout the pelvic region and to the lymph nodes. Diagnostic Imaging for Stage III involves:

• CT Scan.
• Lymph node dissection.
• MRI Scan.
• PET Scan.
• X-Ray Scans, are used more commonly to check for Stage IV of the cancer, when it has spread to major organs, however is also used for the diagnosis of Stage III as a precaution to ensure these major organs (such as the heart and lungs) are health for undergoing treatments and surgery.

These diagnostic techniques will help doctors and practitioners diagnose Stage III Uterine Cancer, as well as distinguish between the Stages I, II and IV.

Management and Treatment

Management and treatment of uterine cancer is heavily dependent on each individual case. Specific factors must be taken into account before doctors decide on the appropriate method to treat or manage the cancer, factors such as where the cancer is, the size of the tumour, the spread of the tumour, as well as the health and age of the patient.

There are two classifications for types of treatment for cancer: primary treatments, and, adjuvant treatments.

Primary treatments is the initial main form to treat the cancer. In stage III, the cancer has spread to a significant area of the pelvis, surgery is the primary treatment. Adjuvant treatments are treatments given after in addition to the primary treatment, in order to maximise the recovery for the patient. These treatments can include; radiation therapy, chemotherapy, and certain medications such as hormone therapy.

Primary Treatment: Surgery

As the cancer is already present and spread throughout the pelvis in this stage, surgery is the primary treatment option for patients who suffer from Stage III Uterine Cancer.

In stage III Uterine Cancer, the cancerous cell have now invaded the uterus, cervix, fallopian tubes, ovaries, vagina and lymph nodes. In order to treat this extensive spread of the cancer, two surgeries can be performed:

• Hysterectomy

• Bilateral salpingo-oophorectomy

Hysterectomy

A hysterectomy is an operation which involves the removal of the uterus from the pelvis, and in certain cases the cervix is removed also. As well in this procedure, the ovaries and fallopian tubes may or may not be removed depending on the spread and staging of the cancer.

There are three surgical procedures to remove the uterus through a hysterectomy:

• Vaginal hysterectomy
• Laparoscopic hysterectomy
• Total or laparotomic hysterectomy

The vaginal hysterectomy is the surgical removal of the uterus through the vagina. The operation is minimally invasive surgery, as no cuts or incisions are made to the abdomen. The procedure involves detaching the uterus from the surrounding supporting tissue, as well as the fallopian tubes, ovaries and vagina, and removing the uterus.

Adjuvant Treatment: Radiation Therapy

Radiation therapy.

Adjuvant Treatment: Medications and Drugs

Medications.

Chemotherapy.

Drugs.

Outcome and Prognosis

Removed

Surgically removed.

Recurrent

Recurrent cancer is cancer that has returned after treatment.

Epidemiology

Statistics and data.