Uterine cancer includes cancer of the muscle, called sarcoma and cancer of the inside lining called endometrial cancer. The most common form is endometrial cancer. In fact, it is the most common gynecological malignancy in the United States.

My personal course of treatment followed that for Ovarian Cancer since that was my primary cancer. Upon my surgery it was found that there was a tumor that filled my entire uterus. The wording on my pathology report is "the endometrial and left ovarian tumors appear to be independent primaries. The cul de sac and right ovary tumors likely represent metastasis from the left ovary" My gyn/oncologist refered to the Ovarian Cancer as primary and the Uterine Cancer as Secondary Primary. I had a TAH/BSO (Total Abdominal Hysterectomy and Bilateral Salpingo-Oopherectomy) This is the removal of the uterus including the cervix as well as the tubes and ovaries using an incision in the abdomen. I also had my omentum and appendix removed. This was followed by 6 cycles of Chemo; Carboplatin and Taxol.

Uterine cancer is a type of tumor that develops in the area of uterus. This cancer kills more than 40,000 people every year in America. This cancer is also known as endometrial cancer. Symptoms of this tumor are very difficult to detect. This tumor usually gets diagnosed in the advanced stages and tends to develop at a rapid rate. If proper preventive steps are taken the occurrence of this tumor can be avoided. Uterine cancer diagnosis includes all the techniques that are conducted to detect the location of the tumor and its widespread throughout the body. Uterine cancer detection done at early stages helps to start the treatment within proper time and thus prevents the spread of the tumor.

Uterine Cancer Diagnosis:-

Uterine cancer detections are done by conducting several tests. These tests include:-

• Endometrial Biopsy
  
• Dilation and Curettage
  
• Positron Emission Tomography
  
• Magnetic Resource Imaging
  
• Blood Tests

Explanation of Uterine cancer diagnosis:-

• Endometrial Biopsy :-
  
  This test is known for giving an accurate diagnosis of this tumor. In this test a small cut is made in the area of uterus. Then a small tube is inserted in the area of uterus and the samples of malignant cells are taken out. Later this sample is examined with the help of several tests and the type of tumor and its widespread throughout the body is detected. This tumor is later removed with the help of surgery.
  
  
• Dilation and Curettage :-
  
  Dilation and Curettage is considered as one of the finest test for diagnosing this tumor. A local anaesthesia is given before conducting this test. Later the cervix area is widened and a small part of the tumor is removed. This part is later examined by conducting several tests. If the tumor is of small type it is removed with the help of surgery and if the size of the tumor is big, Chemotherapy or radiation therapy are performed.
  
  
• Positron Emission Tomography :-
  
  This technique is considered as the latest breakthrough in the diagnosis department. This technique involves the use of radioactive glucose for detecting the tumor. The malignant cells of this tumor tend to consume more glucose than the normal ones. So in this procedure more amount of glucose is injected into the body. The malignant cells near the tumor area try to cosume a large amount of this glucose. Later radioactive waves are passed throughout the body and the spread of these malignant cells throughout the body is detected. This procedure helps to give an accurate diagnosis of the tumor but is generally avoided if the patient is found to be diabetic.
  
  
• Magnetic Resource Imaging :-
  
  This test is considered as the common technique for diagnose the tumor. In this technique highly transmissible radioactive waves are used. These waves travel throughout the area of the location and magnetic substances give a graphical analysis of the area of tumor, tumor type and the widespread of the malignant cells. These graphs are later examined and the type of treatment to be undertaken is decided.
  
  
• Transvaginal Ultrasound :-
  
  This test involves the use of sound waves for the detection of the tumor. This test is considered as the most common test conducted for uterine cancer detection. In this test certain sound waves are releases at the location of the tumor in a typical manner. When these waves travel throughout the location a graphical picture of the tumor gets developed. Later these pictures are examined and the type of tumor is diagnosed.

Uterine cancer diagnosis has to done as soon as the symptoms of this tumor are observed. Early Uterine cancer detection helps to cure the tumor successfully. Consultation of a reputed surgeon is recommended for the diagnosis of this tumor.

Read more onhttp://www.cancer8.com/endometrial-cancer/diagnosis.html

Cancer treatments (surgery, radiation, and medicines such as chemotherapy or targeted agents) all have significant risk. Physicians must understand why a patient is not able to make his/her own decision and incorporate this information into the decision-making process for treatment. For example, if an older patient has a brain tumor and can't make decisions regarding this, treatment for the brain tumor may help improve function. On the other hand, if a patient has a significant dementia, the dementia itself increases the risks of any treatments because cancer treatments generally have not been tested in patients with cognitive impairment and dementia. A patient who lacks decision-making capacity due to cognitive impairment may not be able to report side effects from treatments, may not be able to follow complex instructions regarding medications, and chemotherapy may worsen underlying cognitive capacity and cause delirium. Weighing risks and benefits of cancer treatment in a patient who lacks decision-making capacity must be done carefully with the patient and with a surrogate decision-maker. A surrogate decision-maker is usually chosen by the patient (and can be chosen by someone who is not able to make a decision) and may be close family member or friend. If there is no surrogate, one likely will need to be appointed by the court. For the most part, cancer treatments have very high risk in patients who have cognitive impairment and cannot make their own decisions and physicians should lean towards doing no harm and avoid high-risk procedures and treatments.

Yes, it is the standard of care to remove the cervix for uterine cancer as it is the lower part of the uterus. It is not a separate organ from the uterus.

Assessment for decision-making capacity involves determining whether or not a patient can make decisions for him or herself. Medical illnesses (such as dementia, severe depression, mental illness, delirium) can interfere with the ability of patients to make decisions about their health. Capacity refers to specific medical decisions and does not refer to the ability to make any or all health care decisions (which can only be determined by a court). A person who lacks competence may need surrogate appointed for the patient. For specific medical decisions, it is rare that a court needs to be involved.

A patient must have decision-making capacity to make autonomous decisions and make informed consent for medical treatments and procedures. Autonomy refers to the principle that physicians need to respect patients’ decisions even if they seem to be not in their best interest. If a person has decision-making capacity, decisions need to be respected. If capacity is impaired, though, other arrangements may need to be made in order to protect a patient from harm.

A patient can be considered to possess decision-making capacity if he/she: 1) can make and communicate a choice regarding a medical treatment or course of action; 2) can appreciate and feedback provided information regarding diagnosis, prognosis, options for treatment, risks vs benefits of options; 3) makes decisions consistent with previous values and goals; 4) decisions are made using logical reasoning.

In a medical encounter, it is the responsibility of the attending physician to determine decision-making capacity prior to embarking on a medical treatment and procedure. Cognitive impairment is quite common (with prevalence reports of 20% ) in older patients and may be present even in younger patients. Often family members provide the “voice” for a cognitively impaired older patient and under represent the degree of impairment. Physicians must directly ask the patient questions regarding the decision prior to consent being obtained. If only yes/no or simple answers are provided by the patient, the physician should ask for clarification and probe for the patient’s understanding of the situation. Mental status examinations may be helpful to document orientation to person, place, time as well as executive functioning and memory. These tests do not, however, evaluate decision-making capacity and a patient with an abnormal mental status examination still may have decision-making capacity. Patients also may have capacity to make simple decisions regarding health and not more complex decisions, depending on level of impairment.

Removal of both tubes and ovaries is recommended for comprehensive staging of endometrial cancer for two reasons. The first reason is the concern for microscopic spread of tumor to the tubes or ovaries that would go undetected if the organs were left in place. The second concern is the potential stimulation of microscopic residual cancer cells by the continued estrogen production if the ovaries are retained. These risks are theoretical and prior studies suggest that both are low. One concern, however, is that the risk of a separate ovarian cancer at the time of the endometrial cancer diagnosis (termed a "synchronous ovarian tumor") is higher in younger women and can be as high as 30%. There is a growing literature suggesting the safety of retaining the ovaries in young women with low-grade endometrial cancers with minimal invasion of the uterine muscle, although further studies are needed to confirm this. This is an important finding as the incidence of endometrial cancer is increasing and approximately 10-15% will be diagnosed in premenopausal women.

In the 1980’s, a large study was performed to identify the pathologic findings that truly influenced the risk of recurrence and the overall survival in endometrial cancer. Some easily determined uterine and extra-uterine factors were identified including the cell type, tumor grade, depth of invasion of the uterine muscle (myometrial invasion), metastases to the pelvic and para-aortic lymph nodes, and metastases to the fallopian tubes and ovaries. These findings ushered in the era of “surgical staging” of endometrial cancer, which had previously been staged by physical examination alone. Complete surgical staging requires a careful exploration of the abdomen and pelvis, a total hysterectomy, removal of both tubes and ovaries, and selective biopsy of the pelvic and para-aortic lymph nodes.

At the time, the only available mode of surgery to accomplish this staging was traditional open surgery (laparotomy). However, in the 1990’s improvements in laparoscopic equipment made it feasible to perform comprehensive staging without the large incision required for a laparotomy. Laparoscopic procedures (sometimes referred to as “keyhole” surgery) allow the surgeon to access the abdomen and pelvis through small incisions (usually 5-10 mm in diameter each). Because the uterus, cervix, tubes and ovaries can be removed through the vagina, there is no need for a larger incision. The first minimally invasive surgery to comprehensively stage endometrial cancer was a laparoscopic-assisted vaginal hysterectomy with removal of the tubes and ovaries and laparoscopic nodal sampling. Techniques for total laparoscopic hysterectomy and staging quickly followed. Presently, approximately 60% of endometrial cancers in the United States are managed via minimally invasive surgery, many utilizing robotic-assisted laparoscopy. Laparoscopy has been proven superior to laparotomy with regard to postoperative pain and recovery time in a number of clinical scenarios including endometrial cancer staging. The three to four day hospital stay following a laparotomy is typically reduced to one postoperative day for women that undergo minimally invasive staging. More importantly, the typical 6 week home recovery for laparotomy is routinely shortened to approximately 2 weeks for laparoscopy. Many studies have proven the equivalence of laparotomy and laparoscopy with regard to the risk of recurrence and survival in patients with endometrial cancer.