Doctor’s Corner
IN last week’s introductory article on metrorrhagia, we defined the term metrorrhagia as profuse bleeding between periods.
Metrorrhagia is a common problem affecting up to 20 percent of healthy women in the world.
The social, psychological and financial implications of such a problem to women in Lesotho and around the world cannot be underestimated or taken for granted.
The causes of metrorrhagia include fibroids, endometrial hyperplasia (thickening of the wall or lining of the womb), endometrial polyps (swellings projecting from the lining of the womb) and endometrial cancer (cancer of the womb).
Last week we discussed the most common cause of metrorrhagia which is fibroids.
Notably and alarmingly, 60 percent of women have a fibroid. However, 40 percent — nearly half of these women — have asymptomatic fibroids, ie fibroids not causing any problems.
Depending on the size and symptoms the fibroid is causing, the doctor may treat you conservatively (pain relief and prevention of anaemia with iron tablets) or surgically which may involve removing just the fibroid and leaving the womb a surgical procedure called a myomectomy or complete removal of the womb (hysterectomy).
In this article we will address another cause of metrorrhagia: the life-threatening endometrial cancer (cancer of the womb).
Endometrial cancer is the most common pelvic cancer encountered in women.
The pelvis is the area where the female reproductive and urinary components are located in the body.
Endometrial cancer is the fourth most common cancer in women ranked behind cervical, breast and lung cancers.
It commonly affects women approaching and those in menopause (peri/post-menopausal women).
Research has shown that obesity, nulliparity (having no children), diabetes and reaching menopause after 52 years of age increase the risk of a woman developing endometrial cancer.
What is disturbing about endometrial cancer is that there is no useful screening test, and routine pelvic examinations rarely find the cancer.
Most women are diagnosed because they have symptoms.
The most common symptom is inter-menstrual bleeding (bleeding between periods), which is peri-menopausal (surrounding menopause) or postmenopausal (after menopause has been reached) bleeding.
Ninety percent of women with endometrial cancer complain of non-bloody vaginal discharge with 30 percent complaining of pelvic pain associated with a feeling of an enlarging mass in the pelvis.
By virtue of this cancer being malignant, it spreads and when it does it usually spreads locally to the cervix and vagina and distant to the lungs and bones, causing women to complain of a long-standing cough and bone pain.
Like fibroids, as the cancer grows larger and begins to push other organs in the pelvis such as the urinary bladder and rectum, which is the last part of the intestines, pressure symptoms begin to manifest.
These are problems that come about due to the bulkiness of the cancer pressing against other organs and these include pain and passing urine many times when the bladder is involved and constipation when the rectum is affected.
If a woman has any of the symptoms of endometrial cancer described above, she should visit a doctor immediately.
Endometrial carcinoma is diagnosed by taking samples from the uterus (womb). These samples are usually taken through the vagina.
The samples are then viewed under a microscope to detect the cancerous cells. Medically this is known as an endometrial biopsy.
It can also be diagnosed by ultrasound scan and in more developed countries by CT (computed tomography) scan or MRI (magnetic resonance imaging).
Treatment of endometrial cancer almost always is surgery, which involves the doctor removing the entire womb plus both fallopian tubes and ovaries.
Though the treatment sounds radical the survival rate (chances of surviving after surgery has been done) for women less than 50 years is 95 percent and those greater than 50 is 75 percent.
Please note that these figures depend on the stage (how far the tumor has spread) and the above-mentioned percentages are for stage one tumors which are those tumors that are located only in the womb.
However, the five-year survival rate for women with stage two cancer — when the cancer has spread from the womb to the cervix — is 60 percent.
Five-year survival rate means the chances of surviving for five years after surgery has been done.
When a woman has stage three cancer (cancer that has spread from the womb to the cervix and is now in the vagina as well) the five-year survival rate is 25 percent.
Stage four cancer is when the cancer has spread from the womb to the cervix and the vagina and has spread to either the urinary bladder, rectum, bone or lungs. The five-year survival rate for such women is 10 percent.
Sadly, women in Lesotho usually present themselves late when the cancer is at an advanced stage. As a result the chances of survival are very low.
With this knowledge of endometrial cancer all women that experience any of the symptoms mentioned above should immediately seek medical consultation.
