Postmenopausal uterine fibroids often become malignant

Uterine cancer

After breast, colon and lung cancer, uterine cancer is the fourth most common malignant tumor in women. It mainly affects women during or after the menopause. The mean age of onset is 68 years, most often women are between the ages of 60 and 70. But younger women can also be affected. Around 20 percent of the cases affect women of childbearing age. About five percent fall ill before the age of 40.

The uterus is made up of three layers: the mucous membrane (endometrium) with which it is lined on the inside, the muscle layer (myometrium) and the top layer (perimetrium). Cancer of the uterus (corpus carcinoma) affects the uterine body and especially the mucous membrane. They shouldn't be confused with cervical cancer.

causes

More than 75 percent of tumors in the uterine body originate from the glandular cells of the mucous membrane and are therefore also referred to as endometrial carcinomas. A very rare malignant tumor is the uterine sarcoma, which originates either from the cells of the muscle wall (myometrium) or the connective tissue cells under the mucous membrane (endometrial stromal sarcoma). Particularly aggressive undifferentiated sarcomas are rare. A distinction is made between two types of endometrial cancer. Type 1 is mainly caused by an imbalance in female hormones. The main risk factors are:

  • Age (over 50 years),
  • Childlessness,
  • early first menstrual period,
  • late onset menopause (change) only after the age of 55 years,
  • long-term use of estrogen-containing drugs without added progestin during menopause ("hormone replacement therapy"),
  • hormonal disorders,
  • genetic factors,
  • Diabetes,
  • Overweight and obesity.

The risk of developing endometrial cancer seems to decrease with the use of birth control pills, (multiple) pregnancies and breastfeeding.

Symptoms

The following symptoms can indicate uterine cancer:

  • Changes and deviations in the usual duration and intensity of bleeding, intermenstrual bleeding (before and after the menstrual period) in premenopausal women,
  • Bleeding in postmenopausal women (postmenopausal bleeding),
  • bloody or bloody purulent discharge,
  • Pain in the lower abdomen,
  • unclear weight loss,
  • Blood in the urine,
  • Urinary tract infections,
  • Back pain.

diagnosis

With the earliest possible diagnosis and therapy, uterine cancer is curable in many cases. The treatment of choice is surgical removal of the uterus, fallopian tubes and ovaries and, depending on the risk assessment, also the regional lymph nodes. There is no early detection method for endometrial cancer in symptom-free women. It is therefore particularly important to have your gynecologist clarify any bleeding that occurs outside of the period or after menopause.

The uterus can be examined through the vagina using a speculum or ultrasound. However, the latter is only recommended in certain cases. Often a tissue sample is taken as part of a uterine specimen with a subsequent histological examination. If necessary, a clarification by means of hysteroscopy and curretage is necessary. If the diagnosis is confirmed, further examinations such as ultrasound, X-ray, computer tomography or magnetic field resonance tomography can determine how large the tumor is and whether it has already spread in the abdominal cavity.

therapy

The therapy of choice is total uterine surgery with removal of the fallopian tubes and ovaries, as they produce growth-promoting hormones (estrogens). If necessary, the pelvic lymph nodes and the lymph nodes next to the main artery are also removed. An operation in the early stages has a very high chance of recovery. Radiation therapy is sometimes recommended after surgery. If the disease extends beyond the uterus or if there is a high risk of surgery, radiation therapy is carried out alone or in combination with chemotherapy. In certain situations, hormone or antibody therapy can also be useful.

Whom can I ask?

If you experience abdominal discomfort, especially bleeding that occurs outside of your period or after menopause, you should contact a gynecologist.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. In principle, your doctor or the outpatient clinic will settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).
The costs will not be charged directly if you use a doctor of your choice (i.e. doctor without a health insurance contract) or a private outpatient clinic. In this case, you pay the amount incurred directly to the doctor and submit the invoice to your health insurance provider. You will be reimbursed a maximum of 80 percent of the tariff that a contract doctor or a contract outpatient clinic charges the health insurance provider.

If a hospital stay is required, the hospital costs will be invoiced. The patient has to pay a contribution to the costs per day. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

Further information can be found under What does the hospital stay cost?