Uterine cancer
Uterine cancer starts when cells in the uterus change (mutate) and grow out of control, even though your body doesn’t need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If uterine cancer is left untreated, the cells can invade nearby areas, or spread to other parts of the body (metastasize). About 50,600 women in the United States are diagnosed with uterine cancer annually, making it the fourth most common cancer type and the most commonly diagnosed gynecologic cancer.
The two main types of uterine cancer are endometrial cancer and uterine sarcoma.
Symptoms of uterine cancer
Uterine cancer can exhibit many symptoms. Some common ones include:
- Pain during intercourse.
- Painful urination.
- Pelvic pain.
- Vaginal bleeding between periods.
Uterine cancer symptoms often look like symptoms of other diseases. If you are experiencing any of these symptoms, be sure to talk to your doctor to get a proper diagnosis.
Risk factors for uterine cancer
Anyone with a uterus is at risk of developing uterine cancer, but in general the risk increases with age, especially after menopause.
In addition, a family history of colon cancer, cervical cancer or ovarian cancer can increase your risk of uterine cancer.
Endometrial cancer risk factors
Age. The older you are, the higher your risk of endometrial cancer increases, occurring frequently after menopause.
Early menstruation/late menopause. If you had your period before age 12 or began menopause late (after 55), you are at higher risk of endometrial cancer.
Having endometrial hyperplasia or atypical endometrial hyperplasia. This precancerous condition means your endometrial lining grows too thick, and can increase your risk of getting endometrial cancer.
Hormone changes or imbalances. The fluctuation of estrogen and progesterone hormones cause changes in the endometrium as part of the menstrual cycle. If either of these hormones are increased independently, the risk of endometrial cancer increases. Certain conditions that cause these imbalances include polycystic ovary syndrome or diabetes. If you are using hormone replacement therapy after menopause for either unopposed estrogen or progesterone, the risk of cancer is also elevated.
Hormone therapy. Taking drugs such as tamoxifen for breast cancer increases the risk of developing endometrial cancer.
Lynch Syndrome. This inherited colon cancer syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC) increases the risk of colorectal cancer as well as other cancers including endometrial cancer. This is caused by a genetic mutation that is hereditary, so if you have a family member with Lynch Syndrome, discuss with your doctor what kind of screening tests you should have.
Never having been pregnant. Someone who has never been pregnant is at higher risk of endometrial cancer than someone who has had at least one pregnancy.
Obesity. Excess body fat and being obese can alter your body’s hormone balance, increasing the risk of endometrial cancer.
Uterine sarcoma risk factors
Factors that increase your uterine sarcoma risk include:
- Past radiotherapy treatment in the pelvic region.
- Tamoxifen treatment for breast cancer.
How is uterine cancer diagnosed?
Your doctor can perform a variety of tests to determine if you have uterine cancer. Tests can also determine uterine cancer types and severity.
Diagnostic tests
- Endometrial biopsy. In a biopsy, a small amount of tissue from the endometrium is sampled and sent to a lab for analysis to check for cancerous cells. This is an outpatient procedure that can be done in your doctor’s office without a need for anesthetics.
- Your doctor may elect to perform a surgery known as Dilation and Curettage (D & C) if biopsy results are unclear. In this procedure, endometrial tissue is scraped from inside the uterus and inspected under a microscope for cancerous cells.
- Hysteroscopy. Your doctor may insert a thin, flexible tube with a light (hysteroscope) through the vagina into the cervix and uterus as another means of examining the uterine lining.
- Pelvic exam. The doctor will inspect the outside of your genitals (vulva), then insert two fingers into the vagina while pressing on the abdomen to feel if your uterus and ovaries are swollen or inflamed. A speculum may also be used to open the vagina so your doctor can examine the inside as well as the cervix for any abnormalities.
- Transvaginal ultrasound. Using a wand-like device (transducer) in the vagina, the doctor uses sound waves to create a picture of the inside of the uterus. This is to examine the thickness and texture of the endometrial lining and to check for abnormalities or to rule out other non-cancerous conditions.
PAP test. Note that a PAP test does not screen for uterine cancer, only cervical cancer. However, a PAP test should be included as part of your gynecologic examination if your doctor recommends it to prevent other diseases or infections.
Uterine cancer staging
After you have received a diagnosis, your doctor will determine the stage of your cancer. Staging is a way of talking about how advanced your cancer is and whether it has spread. Your doctor may order one or more of the following tests to stage your cancer:
- Blood tests. A blood sample is checked to measure certain substances released into the bloodstream. If there is an unusual amount of any substance, it can be an indicator of a disease.
- Chest X-ray. Using an energy beam, an X-ray of the organs and bones inside the chest can give your doctor a picture of the areas inside the body to look for metastasis or any complications.
- Computerized Tomography (CT) scan. This procedure makes a series of detailed images of areas around the body, taken from different angles. This creates a 3D image of your body for a clearer indication of any tumor, as well as their size and specific location.
- Cystoscopy. This procedure looks inside the bladder and urethra to check for abnormalities, using a cystoscope (a thin, tube-like lighted instrument with a lens) for viewing. This procedure can also take tissue samples to examine the cancerous cells.
- Positron Emission Tomography (PET) scan. Uses an injection of a short-lived radioactive substance to create detailed images of body structures that help identify cancer and areas of inflammation in different parts of the body.
Assigning a stage
Using information from the tests and procedures, your doctor will assign your cancer a stage by using Roman numerals from I to IV.
Lower stages indicate the cancer is within the uterus. By Stage IV, the cancer has spread beyond the uterus to nearby organs such as the bladder, or distant parts of the body such as the lungs.
Treating uterine cancer
Uterine cancer, like any gynecologic cancer, has a variety of treatment options, depending on the severity of your cancer, your overall health history and your preferences. You should always discuss with a gynecologic oncologist what treatments may be best for you. Certain uterine cancer treatment options are outlined below.
Chemotherapy. There are a variety of treatment methods using chemotherapy chemicals to kill cancer cells, either as an oral pill or intravenous (IV) solution. The medication enters the bloodstream and travels throughout the body (systemically) to kill cancerous cells. It is often used after surgery (adjuvant therapy) to prevent the cancer from returning, but can be done before surgery to shrink the tumor as well. Chemotherapy is most often used to treat advanced uterine cancer that has spread beyond the uterus, or to combat recurrent uterine cancer.
Hormone therapy. Hormonal therapy treatment is generally used to target cancerous cells that rely on hormones to grow. With hormonal therapy, medicines are taken to lower the level of hormones in the body, which in turn kills the cancerous cells that rely on them. This therapy is used to treat advanced, metastatic uterine cancer.
Immunotherapy. Cancer cells can sometimes produce chemicals that ‘blind’ your body’s immune cells, preventing your immune system from fighting off the cancer. Immunotherapy treatments interfere with these chemicals to help your own immune cells find and fight off the cancer. Immunotherapy is useful when other treatment options have not shown much success, especially for endometrial cancer.
Radiation therapy. Using powerful energy beams, radiation/radiotherapy treatment kills cancerous cells. It can be used to shrink a tumor before a surgery (neoadjuvant therapy), or by itself if surgery is out of the question. Radiotherapy is done either with a machine outside of the body (external beam radiation), or placed inside the body as small seeds (internal radiation/brachytherapy).
Surgery. To treat uterine cancer and prevent it from returning, an operation may be done to remove the uterus (hysterectomy), and possibly the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy may also require removing the cervix (total hysterectomy) or part of the vagina and all of the cervix (radical hysterectomy). During the surgery, the surgeon may inspect the surrounding tissue for signs of metastasis. They may also perform a lymph node biopsy to determine the cancer’s stage.
Having a hysterectomy will make it impossible for you to become pregnant in the future, so it is always encouraged to discuss with your doctor fertility preservation techniques if you wish to have a biological child. If the ovaries are removed, menopause will begin unless counteracted with hormone replacement therapy.
About palliative care
Focusing on providing pain relief and alleviating symptoms, palliative care treatment is specialized medicine to provide an extra layer of support alongside your ongoing cancer care. A team of doctors, nurses and other professionals will join your cancer care team to improve your quality of life while fighting cancer.
What is the prognosis for women who have uterine cancer?
The chance of recovering from uterine cancer (prognosis) depends on the following:
- If you have recurrent uterine cancer.
- The type and size of your tumor.
- Whether you have just received a diagnosis.
- Your cancer stage.
- Your overall health.
If you have questions about uterine cancer, talk with your healthcare provider. They can help you understand more about your cancer and the best approaches to treat it.
References
National Cancer Institute (NCI). Uterine Cancer (https://www.cancer.gov/types/uterine)
MedlinePlus: National Library of Medicine. Uterine Cancer (https://medlineplus.gov/uterinecancer.html)
Center for Disease Control and Prevention (CDC). Basic Information About Uterine Cancer (https://www.cdc.gov/cancer/uterine/basic_info/index.htm)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Uterine Cancer (https://www.ncbi.nlm.nih.gov/books/NBK562313/)