What Is It?

Uterine cancer is the most prevalent cancer of the female reproductive tract and accounts for 13 percent of all cancers in women. There are two distinct points within the uterus where cancer may originate: the endometrium and the uterine wall.

• Endometrial cancer — The endometrium is the inner lining of the uterus; the most common type of uterine cancer, called endometrial cancer, occurs there. Its cause also has yet to be fully understood. Most endometrial cancers are cancers of glandular cells, or adenocarcinomas. Women between the ages of 50 and 65 are most affected. High levels of estrogen, while not a danger by itself, poses a risk for endometrial cancer when not offset by the hormone progesterone. Since progesterone levels decrease after menopause, post-menopausal women are particularly at risk. Other conditions associated with a high level of unopposed estrogen include obesity, a history of infertility, and long-term estrogen replacement therapy (for example, in the treatment of osteoporosis). Women with high blood pressure and diabetes also may be at risk for endometrial cancer, as well as those prescribed tamoxifen for treatment of breast cancer.
• Uterine sarcoma — The uterine wall consists of connective tissues, such as muscle, fat, bone and fibrous tissue. Cancers beginning in this type of tissue are called sarcomas. Uterine sarcoma is rare, constituting between 2 percent and 4 percent of all cancers of the uterus. While its cause is unknown, it occurs most often in middle-aged and elderly women. Those who have undergone pelvic radiation in treatment of other cancers may be at an increased risk. African-American women appear to be at a particular risk for one type of uterine sarcoma, leiomyosarcoma. The reason for this is unknown.
• Benign conditions — Are all tumors and abnormal growths in the uterus cancerous? No. Fibroids are common benign (non-cancerous) tumors generally found in women in their 40s. Endometrial tissue growing on the outside of the uterus, a benign condition called endometriosis, may occur with women in their 30s or 40s who have never been pregnant. It may cause symptoms and require treatment, but it does not lead to cancer. Endometrial hyperplasia, an increase in the number of cells lining the uterus, while also benign, may develop into uterine cancer.

The crucial symptom for all uterine cancers is abnormal bleeding: It’s the primary complaint of an estimated 90 percent of women diagnosed with endometrial cancer and 85 percent of post-menopausal women diagnosed with uterine sarcoma. For younger women, abnormal bleeding may include heavier than usual periods, spotting (bleeding between periods) and bleeding after intercourse. For older women, any bleeding that takes place six months after the onset of menopause may be a concern. Abnormal bleeding with the onset of menopause should also be reported to your doctor.

Pain may exist at the time of initial diagnosis of uterine sarcoma as well; although this only occurs in about a tenth of all cases. A palpable mass (one that you can feel) may accompany the pain. While sarcoma is a very rare cause of these symptoms, it is prudent to consult a doctor whenever pain occurs during urination, intercourse, or in the pelvic area in general.

While most abnormal vaginal discharges without visible blood are generally signs of infection or another benign condition, they may also rarely be an indication of uterine sarcoma.

Currently there are no routine tests or examinations to screen for uterine cancer in women without symptoms. If you have signs and symptoms of uterine cancer, your doctor will probably refer you to a gynecologic oncologist, a physician specializing in cancers of the female reproductive system. This specialist will assess your medical history before conducting a general physical examination, with special focus on the pelvic area. The Pap test, an examination of sample cells from the cervix and upper vagina, is often performed at this time. However, its results will usually only reveal uterine cancer that has spread outside the uterus.

When indicated, your doctor will take a sample of endometrial tissue for testing. Endometrial biopsy can be performed in the doctor’s office. During this procedure, the doctor suctions a small amount of tissue through a very thin tube inserted through the cervix into the uterus. A cramplike sensation is common with this procedure. A pathologist then examines the sample for cancerous cells.

If a clear diagnosis is not possible from the biopsy, the doctor may perform a dilation and curettage (D & C). In this procedure, performed on an outpatient basis, the cervix is dilated and tissue is then scraped from inside the uterus. Patients are placed under general anesthesia or conscious sedation. Bleeding, lasting a few days, is common after the procedure; however, few women complain of serious discomfort. A hysteroscopy allowing the doctor to view the inside of the uterus, may accompany the D & C.

Radiographic tests may also be used to discover the presence of cancer in the uterus. With a transvaginal sonogram, a probe is inserted into the vagina, emitting sound waves that bounce off uterine tissue. The created images help locate cancerous cells. During an ultrahysterosonogram, a specific type of transvaginal sonogram, saline is infused through a catheter into the uterus, more clearly outlining any abnormalities.

If cancer is confirmed, the next step is to determine if, and how far, it has spread outside the uterus. Blood tests are usually ordered along with routine imaging tests, such as a CAT scan and chest X-ray.

Staging is used to determine the scope of a patient’s cancer. Higher survival rates are associated with earlier stages. The following applies to uterine cancer:

• Stage I — The cancer is limited to the uterus.
• Stage II — The cancer has spread from the uterus to the cervix.
• Stage III — The cancer, spread beyond the uterus, is still confined to the pelvic region.
• Stage IV — The cancer has spread to the inner surface of the urinary bladder or rectum. This stage may also indicate that the cancer has moved into the lymph nodes in the groin, or into organs distant from the uterus, such as the lungs.

There is still much to understand about the causes of uterine cancer; therefore, much is left to learn in preventing it. The combination of a healthy diet (particularly low in salt and animal fat) and exercise aimed at controlling weight and blood pressure, while no guarantee, is always a good start.

Some research has suggested that oral contraceptives that combine estrogen and progesterone may reduce a woman’s risk for uterine cancer. For woman undergoing estrogen replacement therapy, ask your doctor about the need for regular examinations.

The benefits of tamoxifen for breast cancer treatment and pelvic radiation for other cancer treatments far exceed their risks for developing uterine cancer. If either of these risk factors (or any others, such as diabetes and obesity) apply to you, ask your doctor about your need for regular examinations.

Types of treatment for uterine cancer include surgery, radiation therapy, chemotherapy, and hormone therapy.

• Surgery — If you have uterine cancer, you will most likely undergo some form of surgery. Which procedure is used depends largely on the stage, type, and grade of the cancer. The more localized and less invasive the cancer, the more minimal the surgery. Age is another consideration; for example, with younger women still in their childbearing years, every effort is made to avoid removing both ovaries (oophorectomy) and the uterus (hysterectomy). Your general state of health may also play a factor. Complications are rare, but infertility results from both oophorectomy and hysterectomy.
• Radiation therapy — Radiation therapy also depends on the stage, type, and grade of cancer. If you requirement treatment over a larger area (the cancer has spread into the uterine wall, for example), you will be exposed to radiation from outside source, known as external-beam radiation. With brachytherapy, a form of internal radiation, a pellet of radioactive material is inserted near the tumor. There are side effects with both types, such as fatigue, skin irritation and diarrhea, but most soon disappear after completion of treatment.
• Chemotherapy — Chemotherapy, the use of drugs to kill cancer cells, is generally only used with uterine cancer when it has spread beyond the uterus. Which drugs are used depends on the particulars of the cancer and is still being evaluated in treatment studies.
• Hormone therapy — The aim of hormone therapy is to block cancer cells from getting the hormones they need to grow. With uterine cancer, it involves progesterone pills and sometimes, in cases of advanced or recurrent disease, tamoxifen (Nolvadex).

Although abnormal vaginal bleeding is often merely a sign of infection or of some other benign condition, it is vital to consult a doctor immediately. This symptom almost always accompanies uterine cancer.

Early treatment is key. About three-fourths of endometrial cancers are still contained with the uterus at the time of diagnosis; a good prognostic sign. In general, 80 percent of women with uterine cancer survive five years or more, with many completely cured. However, it is important to know that, even in the best of cases, there is a possibility of recurrence. Follow-up care and vigilance are necessary with all treatment.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.