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Uterine Cancer by Michelle Badash, MS

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Definition

Uterine cancer is a disease in which cancer cells grow in the uterus (womb).

The lower portion of the uterus, which is closest to the vagina, is called the cervix. When cancer develops in this portion, it is called cervical cancer .

The walls of the uterus (not including the cervix) are made of the endometrium (the inner lining) and the myometrium (the muscular, outer lining). The most common type of uterine cancer, called adenocarcinoma, begins in the endometrium. Less common cancers, called sarcomas, begin in the myometrium. This fact sheet will focus on endometrial cancer.

Uterine Cancer

Cancer occurs when cells in the body (in this case uterus cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

Causes

The exact cause of uterine cancer is unknown. Exposure to estrogen seems to be strongly related to the development of this cancer.

Risk Factors

These factors increase your chance of developing endometrial cancer. Tell your doctor if you have any of these risk factors:

Age: 50-60 years old
Obesity (especially in women experiencing menopause early, before age 45)
High blood pressure
Polycystic ovary syndrome
Endometrial polyps
Infertility
No history of pregnancy
Early start of menstrual periods
Late menopause (longer exposure to estrogen)
Diabetes
Environment: living in an urban area

Symptoms

If you have any of these symptoms do not assume it is due to uterine cancer. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Abnormal bleeding between menstrual periods
Vaginal bleeding or spotting in postmenopausal women
Pain in the pelvic area
Pain during urination
Pain during intercourse

Diagnosis

The doctor will ask about your symptoms and medical history.

Tests may include:

Blood and urine tests
Pelvic exam—examination of the vagina, uterus, ovaries, bladder, and rectum
Pap test —scraping and testing tissue from the inside of the cervix and upper vagina
Biopsy of the uterine lining —removing a sample of tissue from the uterine lining for testing
Dilation and curettage (D&C) —procedure to get a sample of tissue from the uterine lining

Treatment

Once uterine cancer is found, staging tests are done to find out if the cancer has spread and, if so, to what parts of the body. Treatments for uterine cancer depend on the stage of the cancer. Special instructions will be given to you regarding your treatment.

Treatments include:

Surgery

A hysterectomy may be done to remove the uterus, fallopian tubes, ovaries, and possibly nearby lymph nodes.

Radiation Therapy

This is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

External radiation therapy—radiation directed at the tumor from a source outside the body
Internal radiation therapy (brachytherapy)—radioactive materials placed into the body near the cancer cells

Hormone Therapy

Drugs may be used to control cancer cells outside the uterus. This treatment is for women unable to have surgery, or who have recurrent cancer, or cancer that has spread (metastasized).

Chemotherapy

This is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Chemotherapy may have limited benefit for treating endometrial cancer.

Prevention

All women should have yearly pelvic exams to monitor any changes that may signal cancer. Using oral birth control may protect against uterine cancer.

RESOURCES:

American Cancer Society http://www.cancer.org/
Cancer Care http://www.cancercare.org/

CANADIAN RESOURCES:

Canadian Cancer Society http://www.cancer.ca/
Women's Health Matters http://www.womenshealthmatters.ca/

References:

Endometrial cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/endometrial . Accessed July 19, 2008.
Rodriguez AO. Chemotherapy for early stage endometrial cancer? Should we be using it? Curr Opin Obstet Gynecol . 2008;20:1-3.
8/31/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Thomas CC, Wingo PA, Dolan MS, Lee NC, Richardson LC. Endometrial cancer risk among younger, overweight women. Obstet Gynecol. 2009;114:22-27.
1/29/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Dey S, Hablas A, Seifeldin IA, et al. Urban-rural differences of gynaecological malignancies in Egypt (1999-2002). BJOG. 2010;117(3):348-355.

Last reviewed July 2010 by Mohei Abouzied, MD

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