UTERUS,CANCER OF
U
l i n i n g o f t h e u t e r u s
( s e e
e n d o m e t r it is );
a n d h o r m o n a l d i s o r d e r s . ( S e e a l s o
u t e r-
u s, p r o la p s e o f; u te ru s , re t ro v e rt e d .)
u te ru s , c a n c e r o f
A m a l i g n a n t g r o w t h i n t h e t i s s u e s o f t h e
u te ru s .
C a n c e r
o f
t h e
u t e r u s
m a i n l y
a f f e c t s t h e c e r v i x
( s e e
c e rv ix , c a n c e r o f)
a n d
e n d o m e triu m
( l i n i n g o f t h e u t e r u s ) .
R a r e l y , t h e u t e r i n e m u s c l e i s a f f e c t e d b y
a t y p e
o f c a n c e r
c a l l e d a
l e i o m y o s a r -
c o m a . T h e t e r m “ u t e r i n e c a n c e r ” u s u a l l y
r e f e r s t o c a n c e r o f t h e e n d o m e t r i u m .
CAUSES
R i s k f a c t o r s f o r e n d o m e t r i a l c a n c e r i n -
c l u d e a n y t h i n g t h a t m a y r a i s e l e v e l s o f
t h e f e m a l e s e x h o r m o n e o e s t r o g e n i n t h e
b o d y , s u c h a s
o b e s it y ,
a h i s t o r y o f f a i l u r e
t o o v u l a t e , o r t a k i n g
o e s t ro g e n h o rm o n e s
l o n g t e r m i f t h e s e a r e n o t b a l a n c e d w i t h
p ro g e s t o g e n d ru g s .
T h e
d r u g
ta m o x ife n ,
u s e d t o t r e a t b r e a s t c a n c e r , i n c r e a s e s t h e
r i s k
o f u t e r i n e
c a n c e r .
T h e
c a n c e r
i s
m o r e
c o m
m o n
i n
w o m e n
w h o
h a v e
h a d f e w o r n o c h i l d r e n .
SYMPTOMS
B e f o r e t h e
m e n o p a u s e ,
t h e f i r s t s y m p -
t o m
o f c a n c e r
o f t h e
u t e r u s
m a y
b e
m e n o rrh a g ia
( h e a v y p e r i o d s ) , o r b l e e d -
i n g
b e t w e e n
p e r i o d s
o r
a f t e r
s e x u a l
i n t e r c o u r s e . A f t e r
t h e
m e n o p a u s e ,
t h e
f i r s t s y m p t o m i s u s u a l l y a b l o o d s t a i n e d
v a g i n a l d i s c h a r g e .
DIAGNOSIS AND TREATMENT
D i a g n o s i s i s m a d e b y
h y s te ro s c o p y
( e x a m -
i n a t i o n o f t h e i n s i d e o f t h e u t e r u s u s i n g a
v i e w i n g i n s t r u m e n t ) , w i t h a
b io p s y
( t i s -
s u e s a m p l i n g f o r m i c r o s c o p i c a n a l y s i s ) .
V e r y e a r l y e n d o m e t r i a l c a n c e r i s u s u a l l y
t r e a t e d b y
h y ste re cto m y
( s u r g i c a l r e m o v a l
o f t h e u t e r u s ) a n d r e m o v a l o f t h e f a l l o p i -
a n t u b e s a n d o v a r i e s . I f t h e c a n c e r h a s
s p r e a d
b e y o n d
t h e
u t e r u s ,
ra d io th e ra p y
a n d
a n tic a n c e r d ru g s
m a y a l s o b e u s e d .
u te ru s , p ro la p s e o f
A c o n d i t i o n i n w h i c h t h e
u te ru s
d e s -
c e n d s f r o m i t s n o r m a l p o s i t i o n i n t o t h e
v a g in a .
T h e
d e g r e e
o f p r o l a p s e
v a r i e s
f r o m
f i r s t - d e g r e e
p r o l a p s e ,
i n
w h i c h
t h e r e i s o n l y s l i g h t d i s p l a c e m e n t o f t h e
u t e r u s , t o t h i r d - d e g r e e p r o l a p s e ( p r o c i -
d e n t i a ) , i n w h i c h t h e u t e r u s c a n b e s e e n
o u t s i d e t h e
v u lva .
T h e c o n d i t i o n m a y s o m e t i m e s b e a s s o -
c i a t e d w i t h
d e f e c t s
o f t h e v a g i n a t h a t
i n c l u d e
c y s to c e le ,
i n w h i c h t h e b l a d d e r
b u l g e s i n t o t h e f r o n t w a l l o f t h e v a g i n a ;
u re th ro c e le ,
i n w h i c h t h e u r e t h r a b u l g e s
i n t o t h e f r o n t w a l l
o f t h e v a g i n a ; a n d
re c to c e le ,
i n w h i c h t h e r e c t a l w a l l b u l g e s
i n t o t h e b a c k w a l l o f t h e v a g i n a .
CAUSES
S t r e t c h i n g o f t h e l i g a m e n t s t h a t s u p p o r t
t h e u t e r u s i s t h e m
o s t c o m
m
o n c a u s e
o f p r o l a p s e .
P r o l a p s e
o f t h e
u t e r u s
i s
a l s o a g g r a v a t e d b y o b e s i t y .
SYMPTOMS AND DIAGNOSIS
T h e r e a r e o f t e n n o s y m p t o m s , b u t t h e r e
i s s o m e t i m e s a d r a g g i n g f e e l i n g i n t h e
p e l v i s .
I n
s e v e r e
c a s e s ,
p a r t
o r
a l l
o f
t h e u t e r u s m a y b e v i s i b l e . A n a c c o m p -
a n y i n g c y s t o c e l e , u r e t h r o c e l e , o r r e c t o c e l e
m a y c a u s e l e a k a g e o f u r i n e o r d i f f i c u l t y
i n p a s s i n g u r i n e o r f a e c e s . D i a g n o s i s i s
m a d e b y e x a m i n a t i o n .
PREVENTION AND TREATMENT
P e lv ic f lo o r
e x e rc is e s
s t r e n g t h e n
t h e
m u s c l e s o f t h e v a g i n a a n d c a n t h e r e f o r e
r e d u c e t h e r i s k o f a p r o l a p s e , e s p e c i a l l y
f o l l o w i n g c h i l d b i r t h . O f t e n , s u r g e r y i s
n e c e s s a r y t o r e p a i r s t r u c t u r e s t h a t s u p -
p o r t t h e u t e r u s .
F o r a s e v e r e p r o l a p s e , t r e a t m e n t u s u -
a l l y
i n v o l v e s
h y s te re c to m y
( r e m o v a l
o f
t h e u t e r u s ) a n d t i g h t e n i n g o f t h e l i g a -
m e n t s . R a r e l y , i f s u r g e r y i s n o t a d v i s e d ,
a
p l a s t i c ,
r i n g - s h a p e d p e s s a r y
m a y b e
i n s e r t e d
i n t o
t h e
v a g i n a
t o
h o l d
t h e
u t e r u s
i n p o s i t i o n .
( S e e a l s o
c y s to c e le ;
re c to c e le ; u re th ro c e le .)
u te ru s , re tro v e rte d
A h a r m l e s s v a r i a t i o n i n t h e p o s i t i o n o f
t h e u t e r u s , w h i c h i s n o r m a l l y r e t r o v e r t e d
i n i n f a n c y , t i l t i n g f o r w a r d s a t p u b e r t y ; a
PROLAPSEOFTHE UTERUS
This condition is caused by weakening and slackness ofthe various ligaments,
muscles and connective tissues that help to keep the uterus in position in the
pelvis. Prolapse ofthe uterus, which is more common in women who have had
children, may occur in conjunction with a rectocele or cystocele. There are three
degrees ofuterine prolapse, as shown below.
First degree prolapse
In this, the least severe degree of prolapse,
strain causes the cervix (neck) ofthe uterus
to move farther down in the vagina;
however, it remains well within the vagina.
Second degree prolapse
The cervix protrudes beyond the vulva
during straining, but retracts on relaxation.
The vagina is partly everted (turned
inside out).
Third degree prolapse
The whole uterus projects outside the vulva.
The surface ofthe cervix and the everted
vaginal wall eventually dry out and are
replaced by thickwhite tissue.
Treatment of prolapse
Surgeryto repair the prolapse or, if necessary, to
perform a hysterectomy, is the usual treatment.
The uterus may be held in position by a plastic
pessary inserted into the vagina.
778
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