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Screen On Cancer
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Two forms of uterine cancers exist : cervix cancer, and corpus cancer.

1) Localization:
The uterus is part of woman's reproductive system.

The malignant tumors are located:
- Either on the cervix (narrow portion) of the uterus, at the end of the vagina. This is a cancer of the mucosa or endometrium. 20- 25 women out of 100.000 are affected each year, whatever the age, and starting at age 25. Very frequent among women in developing countries, South America , China , SE Asia and Africa .
- Or inside the womb (corpus cancer). 20- 25 women out of 100 000 per year, especially in the US and Canada : 30 times more in California than in Japan . Uterine cancers in the US represent 6% of all female cancers.

2) Risk factors:
Mostly in women over 50, but sometimes much younger.

a) Cervix cancer: associated with poor hygiene:
- sex hygiene: multiple sexual partners (either the woman's, or her partners') : such behavior can transmit infections, especially viruses (papilloma virus and herpes virus). This cancer is extremely rare in women with no sexual life (absent among nuns).
- tobacco use.

b) Corpus cancer:
- no pregnancy;
- obesity;
- Tamoxifen: taking this drug after breast cancer increases the risk of uterine cancer. Conversely, contraceptive pills lower the risk, even 5 years after stopping. Progesterone protects the uterus.

3) Development:
cervix cancer is preceded by "pre- cancerous" states: they are easily detected by the Pap test: simple exam, performed by Doctor: speculum inserted in the vagina, specimen from the mucosa, exam by a pathologist. The cancer develops from corpus, cervix, lymph nodes, pelvis, bladder, rectum, other body parts.

4) Symptoms:
- difficult, painful urination;
- abdominal pain;
- bleeding:
- cervix: abnormal vaginal bleeding, during sex, and/or out of menstrual periods.
- corpus: abnormal minor but regular bleeding after menopause.

5) Diagnosis of uterine cancer:
- cervix: - Pap smear, and now bright light technology called speculoscopy immediately after the Pap (but with increase of false positives) ; - biopsies ; - bladder exam with cystoscopy, urography.
- corpus: - hysterography (X rays inside the cavity) ; - ultrasound; - hysteroscopy; - biopsies.
- plus the tumor marker assays: SCC , Cyfra 21- 1.

6) Treatment of uterine cancer:
depends on size, stage and grade of the disease.
- hormone therapy;
- surgery : removal of the uterus (hysterectomy);
- radiation: This radiotherapy is also used before surgery, to shrink the tumor before its removal. The radiation is either external (radiation aimed at the tumor area), or internal (radioactive implants in vagina for several days), sometimes both are used.

7) Follow- up:
regular checkups to ensure there are no changes in general health.
- cervix: cure rates are high : close to 100%, when tumors are diagnosed at microscopic stage ; 80- 85% when tumor has not spread outside cervix; rates lower with the tumor spread.
- corpus: clinical exams, ultrasound.
For both cervix and corpus cancers, tumor marker assays are important.

8) Prevention:
- cervix: careful sex: condom use lowers the risks; systematic Pap test : must be done as soon at age 20, 21, then every 3 years. It will not be necessary after age 55 (on condition that it has been done regularly over previousyears !)
- corpus: any bleeding calls for immediate clinical exam.
- And tumor marker assays.

Cancer can be detected : do it NOW.


Uterine Cancer