Uterine Cancer

Uterine cancer is the most common cancer of the female reproductive system in the United States. This year, about 40,000 women will be diagnosed with uterine cancer and more than 95% will be endometrial cancers, which affect the lining of the uterus (endometrium).

Most uterine cancers develop over a period of years and may arise from less serious problems such as endometrial hyperplasia. Although the majority of uterine cancers occur in postmenopausal women, up to 25% may occur before menopause. The survival rate for all stages of uterine cancer is approximately 84%, but if diagnosed at its earliest stage, survival increases to 90-95%.

Fortunately, most uterine cancers are discovered early because of warning signs such as irregular or postmenopausal bleeding. Awareness of these symptoms is important for both women and their physicians.

Uterine Cancer Symptoms

Ovarian, cervical and uterine cancers have similar symptoms. If you notice any postmenopausal vaginal bleeding or one or more of the following symptoms for more than two weeks, see your doctor, especially if you are post-menopausal.

• Premenopausal or perimenopausal bleeding
• Abnormal vaginal discharge
• Pelvic pain or pressure, usually occurring in later stages of the disease
• Weight loss

Although uterine cancer is the most common cancer of the female reproductive system in the United States, the good news is that many risk factors can be modified to help prevent this disease:

• See a physician immediately if you experience any post-menopausal bleeding or irregular bleeding
• Maintain a healthy weight
• If using hormone replacement therapy (HRT), it should include progesterone if you still have a uterus
• Talk to your physician about ways to regulate irregular menses

Additionally, the use of combination oral contraceptives by pre-menopausal women appears to decrease the risk of developing uterine cancer.

Risk Factors

Most uterine cancers are endometrial cancer, which develops in the lining of the uterus (the endometrium). Factors that may increase the risk of developing endometrial cancer include:

• Obesity
• Age: more than 95% of endometrial cancers occur in women age 40 and older
• Tamoxifen: this breast cancer drug can cause the uterine lining to grow
• Estrogen replacement therapy (ERT): estrogen hormonal therapy without progesterone increases risk
• Personal/family history of endometrial, ovarian or colon cancer may indicate Lynch syndrome (hereditary non-polyposis colorectal cancer), a significant risk factor. For more information on hereditary cancers, visit the Clinical Cancer Genetics web site
• Ovarian diseases: certain ovarian tumors can cause an increase in estrogen levels
• Complex atypical endometrial hyperplasia: a precancerous condition that may become cancerous if left untreated. Simple hyperplasia rarely becomes cancerous.
• Diabetes

Uterine Sarcoma is a rare type of cancer that occurs in the muscle of the uterus. The main risk factor for developing a uterine sarcoma is a history of high-dose radiation therapy in the pelvic area.

Screening

Screening for uterine cancer is not recommended for most women because the chance of disease is quite low. But for women with Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome), an annual endometrial biopsy is recommended beginning at age 35. Women at normal risk for uterine cancer should pay attention to their bodies, know the symptoms, and learn how to decrease the chances of developing certain gynecological cancers.

treatements

Surgery

The primary surgery for uterine cancer is a total hysterectomy with bilateral salpingo-oophorectomy. The uterus is removed along with both ovaries and fallopian tubes and sometimes the pelvic lymph nodes. In a radical hysterectomy, the uterus, cervix, surrounding tissue, upper vagina and usually the pelvic lymph nodes are removed. A hysterectomy can be done either through the abdomen or the vagina, depending on a patient's medical history and overall health.

Some uterine cancer patients may undergo a lymphadenectomy, or lymph node dissection. Lymph nodes are removed from the pelvic area and examined for the presence of cancerous cells, helping doctors determine the exact stage and grade of the cancer. This surgery may be done as a part of a hysterectomy. The procedure can be done through an abdominal incision or by laparoscope.

Radiation Therapy

Radiation therapy may be used to treat uterine cancer after a hysterectomy or as the primary treatment when surgery is not an option. Depending on the stage and grade of the cancer, radiation therapy may also be used at different points of treatment.

There are two types of radiation therapy and in some uterine cancer cases, both types are given.

External beam radiation involves a series of radioactive beams precisely aimed at the tumor from outside the body. Intensity-modulated radiation therapy and proton therapy are examples of external beam radiation. Patients generally undergo daily outpatient treatments five days a week for four to six weeks, depending on the treatment plan.

Brachytherapy involves tiny radioactive seeds that are inserted through the vagina into the uterus wherever cancer cells are located. The seeds remain in place for two to three days and then removed. Depending on your cancer, several treatments may be needed. Because brachytherapy delivers radiation to a localized area, there is little effect on nearby structures such as the bladder or rectum.

Hormone Therapy

The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have receptors where hormones can attach, drugs can be used to reduce the production of hormones or block them from working. In hormone therapy, progesterone-like drugs known as progestins are used to slow the growth of cancer cells.

Clinical Trials

New treatments are always being tested in clinical trials and some women with endometrial cancer may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Search MD Anderson's clinical trials database for a current listing of our endometrial cancer clinical trials.