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Uterine Cancer

Uterine cancer manifests in different ways - endometrial cancer and uterine sarcoma. Most instances of uterine cancer occur in the endometrial tissue lining the uterus. While instances of uterine cancer are on the rise, they are curable if detected early. Uterine cancer typically affects a woman after menopause. The noticeable symptoms of uterus cancer is abnormal vaginal bleeding, But not all abnormal bleeding is related to cancer. A doctor can examine the patient and diagnose the condition. Pelvic pain and change in bowel routine are noticed when the cancer of the uterus is at an advanced stage. Certain conditions predispose some women to developing uterine cancer. Obesity is a major factor that increases a woman's risk of developing this disease. Excessive fat cells lead to increased production of estrogen that builds up in the uterine lining. Use of estrogen replacement therapy (ERT) can greatly increase a woman's risks of developing cancer of the uterus. Women who have few or no children and have had a delayed menopause are also at greater risk. Birth control pills containing only estrogen puts a woman at increased risk of uterine cancer. Heredity also plays a role in whether a woman is susceptible to uterine cancer.


A doctor can examine the medical history and conduct a physical examination to check the uterus, vagina, ovaries and rectum. A pap smear is recommended annually for women over the age of 21, especially for those who have been sexually active. A few cells from the cervix and upper vagina are scraped and taken for testing. This test aids in detecting any malignant and pre-malignant changes in the cervix. Uterine cancer is treated with surgery, radiation therapy or chemotherapy or hormones. Often, some of these treatment options are used in combination. Surgery involves removal of uterus and cervix. Chemotherapy involves use of drugs to treat cancer while radiation uses high-intensity rays to kill cancer cells. But women undergoing treatment may experience side effects such as diarrhea, vaginal burning sensation, pain during intercourse, loss of appetite and nausea. Chemotherapy may lead to hair loss, vomiting and drop in blood count.

Contraceptive injection progestin

Just like oral contraceptives, birth control injections work at suppressing ovulation. With a success rate of nearly 99.7 %, these hormonal injections are effective for 12 weeks. The hormonal birth control shots are also known as DMPA - depot medroxyprogesteroneacetate.


It is effective for women who cannot take estrogen. There is lesser menstrual cramping as well as lesser chance of anemia when on such birth control injections. Besides, it decreases the risk of endometrial cancer, ovarian cancer and pelvic inflammatory disease. Contraceptive shots can be used while breastfeeding.

Progestin injection is not recommended for long-term use since it has some side effects. Irregular bleeding is a common side effect. Some women complain of longer or heavier menstrual bleeding. Some women who are on birth control injections also experience depression, skin rash, weight gain and nausea. Hair loss or increased hair growth on the face and body can also result from use of birth control shots. It is noticed that some women experience decreased sexual drive. Some studies have shown that women using contraceptive injections may experience loss of bone density that may increase their risk of osteoporosis.


Therefore women who are on birth control injections are advised to take plenty of calcium and keep up an exercise regimen. Women taking medication for Cushing's syndrome may not receive adequate birth control protection from this injection. Birth control shots do not offer any protection against sexually transmitted infections. Sometimes, there is a slight delay of return to fertility in some women.

Birth control shots are not recommended for women who want to become pregnant in the near future or those who have unexplained vaginal bleeding. Women who are diabetic or have recently suffered from liver disease are allowed to use injectable birth control shots only under close medical supervision.


Pyometra

Pyometra is an uterine condition that involves accumulation of pus in uterine cavity, caused by interference with natural drainage of uterus. It is a rare disorder that normally occurs in post-menopausal woman with concurrent medical conditions. Most pyometra cases are associated with malignant disease of the uterus. Other causes include:


  • Foreign bodies

  • Puerperal infections or Postpartum infections

  • Uterine anomalies

  • Fibroid degeneration

  • Senile Cervicitis

  • Uterine compression sutures used for postpartum hemorrhage to avoid hysterectomy

  • Genital tuberculosis.

Symptoms

Most often, Pyometra does not present with any symptoms and the condition could be incidentally found through imaging performed for different purpose. Some of the symptoms of Pyometra include


  • Blood-stained purulent vaginal discharge

  • Symmetrical uterine enlargement

  • Post menopausal bleeding

  • Lower abdominal pain

  • Nausea and vomiting

  • Diarrhea

  • Pyrexia (rarely)

Very rarely, pyometra leads to spontaneous perforation. It is a medical emergency and requires an immediate attention and treatment.


Diagnosis

Diagnostic tests are planned and performed on the lines of underlying condition that has resulted in Pyometra. If prevailing tuberculosis is causing symptoms of pyometra, diagnosis can be confirmed by tuberculin testing, histology, Hysterosalpingogram or PCR. Ultrasound scan, CT scan and MRI are generally recommended to diagnose the condition. Doppler scanning is used when pyometra has occurred due to endometrial cancer. X-ray shows the presence of spontaneous perforation of the uterus.


Treatment

Dilatation of the cervix and pus drainage is the treatment of choice, and it is important to rule out the possibility of cancer and differentiate the malignancy. However regular monitoring is necessary to look for recurrence. In few cases, Hysterectomy may be advised to avoid future complications. Medicine therapy with antibiotics becomes necessary if there is an infection. Tubercular pyometra should is treated with appropriate anti-tubercular chemotherapy.


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Bibliography / Reference

Collection of Pages - Last revised Date: August 20, 2019