Disease: Uterine Cancer

What Is Uterine Cancer?

There are several factors that increase your risk of developing uterine (or endometrial) cancer.

Uterine cancer begins in the uterus (womb), the pear-shaped organ that carries a developing baby during pregnancy.

The most common type of uterine cancer is endometrial cancer. It grows in the lining of the uterus, known as the endometrium. Other types of uterine cancer begin in the supporting connective tissue and muscle cells of the uterus.

In the United States, uterine cancer is the fourth most common cancer in women. It’s also the most common cancer of women's gynecologic cancers.

Every year about 52,000 U.S. women are diagnosed with uterine cancer, according to the National Cancer Institute — and about 8,500 of these women die of the disease annually.

Like most cancers, the earlier uterine cancer is detected, the better the prognosis. There are more than 600,000 women who are survivors of endometrial cancer, according to the American Cancer Society.

Risk Factors of Uterine Cancer

While experts still don't know the exact cause of uterine cancer, they do know that certain women are at higher risk.

Risk factors include:

  • Being over age 50
  • Being obese
  • Taking estrogen-only hormone replacement therapy after menopause
  • Having a history of irregular menstrual periods
  • Difficulty getting pregnant
  • Taking tamoxifen (Soltamox), which helps treat some breast cancers
  • A family history of cancer of the uterus, colon, or ovaries
  • Starting your periods early, before age 12, and being menopausal later than average (about age 50)
  • Never being pregnant
  • Having an abnormal overgrowth of cells in the lining of the uterus (known as endometrial hyperplasia)
  • Having radiation therapy to your pelvic area

Even if you have some of these risk factors, it doesn’t mean you’ll get uterine cancer.

However, having these risk factors does mean that you should discuss with your doctor if you need more frequent check-ups, should lose excess weight, or take other measures to reduce your chance of developing uterine cancer.

Types of Uterine Cancers

There are several different types of uterine cancer, and each type progresses differently. Ask about having a specialist review the pathology of your specific cancer, once diagnosed.

Carcinomas: Endometrial cancers, which start in the cells that line the uterus, belong to a group of cancers called carcinomas. The majority of endometrial carcinomas are cancers of the cells that form glands in the endometrium. These are called adenocarcinomas.

The most common types of endometrial cancers are endometrioid adenocarcinomas. Less common are squamous cell, undifferentiated, clear cell, serous carcinoma, and poorly differentiated carcinoma.

Based on features of your cancer, you will learn the grade of an endometrioid cancer. The grade typically ranges from 1 to 3, with grade 3 being the most aggressive type.

Sarcomas: When cancer starts in the connective tissue and muscular cells of the uterus, the cancers are uterine sarcomas. They are much less common than the endometrial cancers and include stromal sarcoma and leiomyosarcomas.

Symptoms

Abnormal vaginal bleeding, such as bleeding after menopause or between periods, is one of the most common early symptoms of uterine cancer. Other symptoms that could indicate uterine cancer (as well as other problems) include:

  • Abnormal vaginal discharge, such as a watery substance
  • Pain in your pelvic region
  • Pain during intercourse

Treatment of Uterine Cancer

The earlier you get treatment, the better. If you get a diagnosis of uterine cancer, the Centers for Disease Control and Prevention (CDC) recommend asking your doctor for a referral to a gynecologic oncologist, who has been trained to treat uterine and other gynecologic cancers.

Treatment depends on the exact type of uterine cancer and how extensive it is, and whether it is localized or has spread (metastasized).

Among the options:

  • Surgery: Your surgeon will remove the tissue that is cancerous (removal of the uterus, or hysterectomy).
  • Radiation: High-beam radiation, similar to X-rays, is used to kill the cancer.
  • Hormone therapy: This treatment affects hormone levels in the body to stop the cancer cells from growing.
  • Chemotherapy: This drug therapy can be taken orally or injected. The drug targets the cancer to shrink or kill the cancer cells.

Besides a gynecologic oncologist, your treatment team may include surgeons, medical oncologists (who prescribe medication) and radiation oncologists.

If the available treatments do not work for you, your doctor may recommend joining a clinical trial, which tests new treatment options.

Sources:

  • "Endometrial Cancer," Mayo Clinic
  • "Endometrial Cancer," National Cancer Institute
  • "About Uterine (Endometrial) Cancer," Memorial Sloan-Kettering Cancer Center
  • "What is endometrial cancer?" American Cancer Society

Uterine Cancer Symptoms

What are the warnings signs of uterine (or endometrial) cancer?

Uterine cancer, also called cancer of the womb, can cause symptoms early in the course of the cancer as well as during more advanced stages.

Perhaps the most significant early warning sign is unusually heavy or prolonged vaginal bleeding. In fact, roughly 90 percent of women diagnosed with this cancer report abnormal vaginal bleeding.

Abnormal bleeding includes bleeding that occurs after menopause, or bleeding that occurs between periods.

If you are still menstruating, it could also be bleeding that is not typical for you, such as very heavy bleeding. In fact, any abnormal bleeding should be reported to your doctor immediately.

Other Symptoms of Uterine Cancer

Several other symptoms warrant a call to the doctor right away, including:

  • An abnormal vaginal discharge (even with no traces of blood)
  • Pain in your pelvic area (which often occurs in more advanced stages)
  • A mass in your pelvic area
  • Unexpected weight loss

All of these could be the result of other conditions besides uterine cancer, but nonetheless, it's important to be examined.

Diagnosis of Uterine Cancer

When you see your doctor, you will be asked to describe your symptoms. So it may help to write down what they are, when you first noticed them, and other details before your appointment.

Next, after taking a careful history, your doctor may order a range of tests, including:

  • Pelvic exam: You might have a pelvic exam as part of your regular checkup. During the exam, your doctor will inspect your outer genital area, and then insert two fingers into the vagina while pressing the other hand on the abdominal area. In this way, the doctor can feel for abnormalities in the uterus and the ovaries. The doctor will insert a speculum, a device to view the area for problems.
  • Transvaginal ultrasound: This test uses sound waves to create a picture of your uterus. A wand-like device known as a transducer is inserted into your vagina and a video image is created so that your doctor can examine the thickness of the uterine lining, which is a way to determine abnormalities.
  • Hysteroscopy: During this test, your doctor inserts a lighted tube (hysteroscope) into your vagina to examine inside the uterus and the uterine lining.
  • Endometrial biopsy: Performed in a doctor’s office, typically without anesthesia, your doctor will remove a piece of tissue from the uterine lining so it can be sent to the laboratory and analyzed.
  • Dilation and curettage (D&C): If the biopsy sample doesn't provide clear results after analysis, your doctor may do a D&C. This test involves scraping tissue from the lining of the uterus so it can be analyzed under a microscope for cancer cells.

Uterine Cancer Stages

If cancer is found, the next step is to estimate how advanced it is. At this time, your doctor may order more tests, including scans such as computerized tomography (CT) or positron emission tomography (PET) and blood tests.

In some cases, your doctor will not be able to tell the stage of your cancer — meaning how advanced it is — until after surgery.

Stages of endometrial cancer include:

  • Stage I is found in the uterus only.
  • Stage II is found in both the uterus and the cervix (the neck of the uterus).
  • Stage III has spread further than the uterus but not to the rectum or bladder; lymph nodes in the pelvic area may be involved.
  • Stage IV has progressed beyond the pelvic area, perhaps to the bladder, rectum, and other areas of your body.

Sources:

  • "Endometrial cancer," Mayo Clinic
  • "Signs and symptoms of endometrial cancer," American Cancer Society (ACS)
  • "What Are the Symptoms of Uterine Cancer?" Centers for Disease Control and Prevention (CDC)
  • "What You Need to Know About Cancer of the Uterus," National Cancer Institute (NCI)

Uterine Cancer Treatment

Women with uterine (or endometrial) cancer have a good prognosis, especially when diagnosed early.

The best treatment for uterine cancer depends on a number of factors, including the type and stage of your cancer, your general health, and your personal treatment preferences.

Cancer of the uterus is classified into several types. Your doctor will discuss your options for treatment, based on the type of uterine cancer you have as well as other factors.

Basically, the choices may include:

  • Surgery
  • Hormone medication
  • Chemotherapy
  • Radiation
  • A combination of the above

Surgery for Uterine Cancer

The main treatment for endometrial cancer is a hysterectomy, the removal of both the uterus and the cervix (the lower end of the uterus, near the vagina).

In this surgery, the surgeon may also remove the ovaries and fallopian tubes (bilateral salpingo-oophorectomy).

However, if you have not yet gone through menopause, you need to discuss with your doctor whether it would be better to preserve the ovaries. The removal of your ovaries can trigger premature menopause.

Your doctor may also remove lymph nodes from the pelvic area to test for any cancer that may have spread outside of the uterus.

Hysterectomies are done in different ways. In some, the uterus is removed through an abdominal incision (abdominal hysterectomy). Sometimes the uterus is removed through the vagina.

Recovery time depends on the type of surgery and whether there are any complications. In general, however, it can take two to six weeks for recovery. Hospital stays also vary, from about three days to a week.

Hormone Therapy

If your doctor recommends hormone therapy, you will be given hormone medication that decreases the levels of hormones that your body makes, or blocks hormones from working. The goal is to stop the cancer cells from growing.

Chemotherapy

The goal of chemotherapy is to prescribe medication to shrink or kill the cancer cells. Chemotherapy can be taken orally in pill form, or given to you intravenously — or sometimes both ways.

Radiation Therapy

If your doctor recommends radiation therapy, it may be given internally or externally. High-energy rays, somewhat like X-rays, are used to kill the cancer cells.

Internal radiation, also called brachytherapy, is done in the radiology department of a hospital or cancer care center. This involves inserting a cylinder with a source of radiation (pellets) into the vagina.

External beam radiation is typically given for four to six weeks, five days a week. You must be in the same position for each treatment so the radiation gets to the correct spot.

If both types of radiation therapy are required, external beam radiation is often given first.

If you are to undergo radiation after surgery, you will be given time to heal from the surgery first. That typically requires four to six weeks.

Uterine Cancer Prognosis

When your doctor recommends a treatment plan, it’s wise to ask about the prognosis, or outlook, for each type of treatment.

You can also inquire about any side effects of treatment. If you don’t feel comfortable with the answers, don’t hesitate to consult another doctor for a second opinion.

Uterine Cancer Survival Rates

When diagnosed early, women with uterine cancer have a very good prognosis, according to the American Cancer Society.

For endometrial adenocarcinoma, a common type, those diagnosed at stage 1A have an 88 percent survival rate at five years. Those diagnosed with the highest stage, IVB, have a 15 percent survival rate.

For uterine carcinosarcoma, the survival rate at five years is 70 percent, but drops to 15 percent for state IV, the highest stage. For this type of cancer, experts give what is called relative survival.

The rates are based on the assumption that some people will die of other causes besides cancer, and compare the observed survival with that expected for those who don't have cancer.

To give you an idea of your prognosis, your doctor will review the survival statistics gathered for other women who have had the same type of uterine cancer.

Remember that these are averages over the five years after diagnosis, and that some women do much better than average.

Sources:

  • "How Is Uterine Cancer Treated?" Centers for Disease Control and Prevention (CDC)
  • "Endometrial cancer," Mayo Clinic
  • "Survival by stage of endometrial cancer," American Cancer Society (ACS)
  • "Surgery for endometrial cancer," American Cancer Society (ACS)
  • "Radiation therapy for endometrial cancer," American Cancer Society (ACS)

What Is Endometrial Hyperplasia?

The condition, though non-cancerous, is sometimes associated with uterine cancer.

Endometrial hyperplasia describes a condition in which the lining of the uterus, called the endometrium, becomes too thick.

The condition itself is not cancerous; however, it sometimes can lead to uterine cancer.

Causes of Endometrial Hyperplasia

If your body has too much of the hormone estrogen without the hormone progesterone, you may develop endometrial hyperplasia.

To understand how endometrial hyperplasia develops, it may help to first understand how hormonal changes during a typical menstrual cycle affect your uterine lining.

Estrogen is made by the ovaries during the first part of your cycle. That leads to growth of the lining to prepare your body for pregnancy.

However, after an egg is released (ovulation), progesterone increases with the goal of supporting a fertilized egg.

But if pregnancy does not happen, levels of both hormones decline. That decrease in progesterone is what triggers your period, the shedding of the lining.

If you do not ovulate, progesterone is not made and the lining does not shed. So the lining may keep growing in response to the estrogen and, in time, the cells in the lining can become abnormal.

In some women, the overgrowth, called hyperplasia, can lead to cancer.

Risk Factors for Endometrial Hyperplasia

While there are many risk factors that increase the chances of developing endometrial hyperplasia, having one or more of these does not mean that you will develop the condition.

Some common risk factors include:

  • Being above age 35
  • Being Caucasian
  • Starting periods early or menopause late
  • Obesity
  • Being a cigarette smoker
  • Having a family history of uterine, colon, or ovarian cancer
  • Having a history of diabetes, polycystic ovary syndrome, gallbladder disease, or thyroid disease

Symptoms of Endometrial Hyperplasia

Abnormal uterine bleeding (heavier than usual bleeding between periods) is the most common symptom. If you have it, call your doctor right away and get checked out.

If you have a menstrual cycle shorter than 21 days, check with your doctor. Count from the first day of your period to the first day of your next one.

If you are post-menopausal, report any uterine bleeding to your healthcare provider.

How Is Endometrial Hyperplasia Diagnosed?

If you have abnormal uterine bleeding, your doctor may order certain tests and exams, including:

  • Transvaginal ultrasound: A small device, which converts sound waves into a video image of your pelvic organs, is placed into your vagina. Your doctor can look at the thickness of the uterine lining to determine if you have hyperplasia.
  • Biopsy: This involves taking a sample of tissue from the uterine lining to see if it has cancer cells.
  • Dilation and curettage (D&C): This involves scraping some uterine tissue and then examining it under the microscope for cancer cells.
  • Hysteroscopy: In this exam, your doctor inserts a lighted tube with a lens (hysteroscope) through your vagina to examine the uterus and its lining.

Types of Endometrial Hyperplasia

Your doctor and other healthcare providers will look to see whether certain cell changes are present before diagnosing the exact type of endometrial hyperplasia. If abnormal changes are found, the diagnosis is called atypical.

If the diagnosis is endometrial hyperplasia, it could be called:

  • Simple hyperplasia (the most benign type)
  • Complex hyperplasia
  • Simplex atypical hyperplasia
  • Complex atypical hyperplasia

Treatment for Endometrial Hyperplasia

Endometrial hyperplasia can often be treated with progestin. This synthetic hormone is given either orally, topically as a vaginal cream, in an injection, or with an intrauterine device.

If you have simple or “mild” hyperplasia, which is the most common type, the risk of it becoming cancerous is very small.

If you have atypical hyperplasia, the chances of cancer developing are higher. For simple atypical, the chances of it turning into cancer is about 8 percent if left untreated. Complex atypical turns into cancer in 29 percent of untreated cases.

If the diagnosis is atypical, and you are done bearing children, your doctor may recommend removal of the uterus (hysterectomy), as the risk of uterine cancer rises with atypical hyperplasia.

Sources:

  • "Endometrial hyperplasia," American College of Obstetricians and Gynecologists (ACOG)
  • "What are the risk factors for endometrial cancer?" American Cancer Society (ACS)
  • "Endometrial cancer," American Academy of Family Physicians (AAFP)

Source: http://www.everydayhealth.com

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