Disease: Cancer of the Uterus
(Uterine Cancer or Endometrial Cancer)

Uterine cancer facts

*Uterine cancer facts medical author: Charles Patrick Davis, MD, PhD

  • The uterus is a hollow organ in females located in the pelvis, commonly called the womb. The uterus functions to support fetal development until birth. The uterus is shaped like an upside down pear; the top is the fundus, the middle is the corpus, and bottom is the cervix.
  • Uterine cancer is the abnormal (malignant) growth of any cells that comprise uterine tissue.
  • Although the exact causes of uterine cancers are not known, risk factors include women with endometrial overgrowth (hyperplasia), obesity, women who have never had children, menses beginning before age 12, menopause after age 55, estrogen therapy, taking tamoxifen, radiation to the pelvis, family history of uterine cancer, and Lynch syndrome (most commonly seen as a form of inherited colorectal cancer).
  • Common signs and symptoms of uterine cancer are abnormal vaginal bleeding or discharge, pain with urination and sex, and pelvic pains.
  • Uterine cancer is diagnosed usually with a pelvic exam, ultrasound, and biopsy.
  • Uterine cancer stages (0 to IV) are determined by biopsy, chest X-ray, and/or CT or MRI scans.
  • Treatment options may include one or more of the following: surgery, radiation, hormone therapy, and chemotherapy. Treatment depends on the cancer stage with stage IV as the most extensive and usually caused by the most aggressive type of cancer cells.
  • Surgical therapy usually involves removal of the uterus, ovaries, fallopian tubes, adjacent lymph nodes, and part of the vagina.
  • Radiation therapy may be by external radiation or by internal radiation (brachytherapy).
  • Chemotherapy usually requires IV administration of drugs designed to kill cancer cells.
  • Hormone therapy (usually progesterone) is used on cancer cells that require another hormone (estrogen) for growth.
  • Second opinions can be obtained by referrals made by your doctor to others in the local medical society, or to other doctors elsewhere.
  • Follow-up care is important. Complications can be treated early and possible cancer recurrence can be diagnosed early.
  • Support groups are varied and many are local. The National Cancer Institute (NCI) can help locate support groups and possible clinical trials.

The uterus

The uterus is part of a woman's reproductive system. It's a hollow organ in the pelvis.

The uterus has three parts:

  • Top: The top (fundus) of your uterus is shaped like a dome. From the top of your uterus, the fallopian tubes extend to the ovaries.
  • Middle: The middle part of your uterus is the body (corpus). This is where a baby grows.
  • Bottom: The narrow, lower part of your uterus is the cervix. The cervix is a passageway to the vagina.

The wall of the uterus has two layers of tissue:

  • Inner layer: The inner layer (lining) of the uterus is the endometrium. In women of childbearing age, the lining grows and thickens each month to prepare for pregnancy. If a woman does not become pregnant, the thick, bloody lining flows out of the body. This flow is a menstrual period.
  • Outer layer: The outer layer of muscle tissue is the myometrium.

Cancer Cells

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the uterus and the other organs of the body.

Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Tumors in the uterus can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:

  • Benign tumors (such as a fibroid, a polyp, or endometriosis):
    • are usually not a threat to life
    • can be treated or removed and usually don't grow back
    • don't invade the tissues around them
    • don't spread to other parts of the body
  • Malignant growths:
    • may be a threat to life
    • usually can be removed but can grow back
    • can invade and damage nearby tissues and organs (such as the vagina)
    • can spread to other parts of the body

Cancer cells can spread by breaking away from the uterine tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lung, liver, bone, or brain. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about uterine cancer that has spread.

Picture of the uterus

Risk Factors

When you get a diagnosis of uterine cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman gets uterine cancer and another doesn't.

However, we do know that women with certain risk factors may be more likely than others to develop uterine cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for uterine cancer:

  • Abnormal overgrowth of the endometrium (endometrial hyperplasia): An abnormal increase in the number of cells in the lining of the uterus is a risk factor for uterine cancer. Hyperplasia is not cancer, but sometimes it develops into cancer. Common symptoms of this condition are heavy menstrual periods, bleeding between periods, and bleeding after menopause. Hyperplasia is most common after age 40.

    To prevent endometrial hyperplasia from developing into cancer, the doctor may recommend surgery to remove the uterus (hysterectomy) or hormone therapy with progesterone and regular follow-up exams.
  • Obesity: Women who are obese have a greater chance of developing uterine cancer.
  • Reproductive and menstrual history: Women are at increased risk of uterine cancer if at least one of the following apply: Have never had children Had their first menstrual period before age 12 Went through menopause after age 55
  • History of taking estrogen alone: The risk of uterine cancer is higher among women who used estrogen alone (without progesterone) for menopausal hormone therapy for many years.
  • History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of uterine cancer.
  • History of having radiation therapy to the pelvis: Women who had radiation therapy to the pelvis are at increased risk of uterine cancer.
  • Family health history: Women with a mother, sister, or daughter with uterine cancer are at increased risk of developing the disease. Also, women in families that have an inherited form of colorectal cancer (known as Lynch syndrome) are at increased risk of uterine cancer.

Many women who get uterine cancer have none of these risk factors, and many women who have known risk factors don't develop the disease.

Symptoms

The most common symptom of uterine cancer is abnormal vaginal bleeding. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.

These are common symptoms of uterine cancer:

  • Abnormal vaginal bleeding, spotting, or discharge
  • Pain or difficulty when emptying the bladder
  • Pain during sex
  • Pain in the pelvic area

These symptoms may be caused by uterine cancer or by other health problems. Women with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible.

Diagnosis

If you have symptoms that suggest uterine cancer, your doctor will try to find out what's causing the problems.

You may have a physical exam and blood tests. Also, you may have one or more of the following tests:

  • Pelvic exam: Your doctor can check your uterus, vagina, and nearby tissues for any lumps or changes in shape or size.
  • Ultrasound: An ultrasound device uses sound waves that can't be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the pelvis. The echoes create a picture of your uterus and nearby tissues. The picture can show a uterine tumor. For a better view of the uterus, the device may be inserted into the vagina (transvaginal ultrasound).
  • Biopsy: The removal of tissue to look for cancer cells is a biopsy. A thin tube is inserted through the vagina into your uterus. Your doctor uses gentle scraping and suction to remove samples of tissue. A pathologist examines the tissue under a microscope to check for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.

You may want to ask the doctor these questions before having a biopsy:

  • Why do I need a biopsy?
  • How long will it take? Will I be awake? Will it hurt?
  • What is the chance of infection or bleeding after the biopsy? Are there any other risks?
  • How soon will I know the results? How do I get a copy of the pathology report?
  • If I do have cancer, who will talk with me about treatment? When?

Grade

If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal uterine tissue. It may suggest how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Staging

If uterine cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if uterine cancer spreads to the lung, the cancer cells in the lung are actually uterine cancer cells. The disease is metastatic uterine cancer, not lung cancer. It's treated as uterine cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" disease.

To learn whether uterine cancer has spread, your doctor may order one or more tests:

  • Lab tests: A Pap test can show whether cancer cells have spread to the cervix, and blood tests can show how well the liver and kidneys are working. Also, your doctor may order a blood test for a substance known as CA-125. Cancer may cause a high level of CA-125.
  • Chest x-ray: An x-ray of the chest can show a tumor in the lung.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis, abdomen, or chest. You may receive an injection of contrast material so your lymph nodes and other tissues show up clearly in the pictures. A CT scan can show cancer in the uterus, lymph nodes, lungs, or elsewhere.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your uterus and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in the uterus, lymph nodes, or other tissues in the abdomen.

In most cases, surgery is needed to learn the stage of uterine cancer. The surgeon removes the uterus and may take tissue samples from the pelvis and abdomen. After the uterus is removed, it is checked to see how deeply the tumor has grown. Also, the other tissue samples are checked for cancer cells. These are the stages of uterine cancer:

  • Stage 0: The abnormal cells are found only on the surface of the inner lining of the uterus. The doctor may call this carcinoma in situ.
  • Stage I: The tumor has grown through the inner lining of the uterus to the endometrium. It may have invaded the myometrium.
  • Stage II: The tumor has invaded the cervix.
  • Stage III: The tumor has grown through the uterus to reach nearby tissues, such as the vagina or a lymph node.
  • Stage IV: The tumor has invaded the bladder or intestine. Or, cancer cells have spread to parts of the body far away from the uterus, such as the liver, lungs, or bones.

Treatment

Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.

The treatment that's right for you depends mainly on the following:

  • Whether the tumor has invaded the muscle layer of the uterus
  • Whether the tumor has invaded tissues outside the uterus
  • Whether the tumor has spread to other parts of the body
  • The grade of the tumor
  • Your age and general health

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat uterine cancer include gynecologists, gynecologic oncologists (doctors who specialize in treating female cancers), medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping.

Also, NCI's Cancer Information Service can answer your questions about supportive care. Call 1–800–4–CANCER (1–800–422–6237). Or chat using LiveHelp, NCI's instant messaging service, at https://livehelp.cancer.gov/app/chat/chat_launch.

You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of uterine cancer. See the Taking Part in Cancer Research section.

You may want to ask your doctor these questions before you begin treatment:

  • What is the grade of the tumor? What is the stage of the disease? Has the tumor invaded the muscle layer of the uterus or spread to other organs?
  • What are my treatment choices? Which do you suggest for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a research study (clinical trial) be a good choice for me?
  • Can you recommend other doctors who could give me a second opinion about my treatment options?
  • How often should I have checkups?

Surgery

Surgery is the most common treatment for women with uterine cancer. You and your surgeon can talk about the types of surgery (hysterectomy) and which may be right for you.

The surgeon usually removes the uterus, cervix, and nearby tissues. The nearby tissues may include:

  • Ovaries
  • Fallopian tubes
  • Nearby lymph nodes
  • Part of the vagina

The time it takes to heal after surgery is different for each woman. After a hysterectomy, most women go home in a couple days, but some women leave the hospital the same day. You'll probably return to your normal activities within 4 to 8 weeks after surgery.

You may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.

It's common to feel tired or weak for a while. You may have nausea and vomiting. Some women are constipated after surgery or lose control of their bladder. These effects are usually temporary.

If you haven't gone through menopause yet, you'll stop having menstrual periods after surgery, and you won't be able to become pregnant. Also, you may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your doctor or nurse about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.

Surgery to remove lymph nodes may cause lymphedema (swelling) in one or both legs. Your health care team can tell you how to prevent or relieve lymphedema.

For some women, a hysterectomy can affect sexual intimacy. You may have feelings of loss that make intimacy difficult. Sharing these feelings with your partner may be helpful. Sometimes couples talk with a counselor to help them express their concerns.

You may want to ask your doctor these questions before having surgery:

  • What type of surgery do you recommend for me? Why?
  • Will lymph nodes and other tissues be removed? Why?
  • How will I feel after surgery? If I have pain, how can it be controlled?
  • How long will I be in the hospital?
  • When will I be able to return to normal activities?
  • What are the long-term effects of the surgery?
  • How will the surgery affect my sex life?

Radiation Therapy

Radiation therapy is an option for women with all stages of uterine cancer. It may be used before or after surgery. For women who can't have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.

Doctors use two types of radiation therapy to treat uterine cancer. Some women receive both types:

  • External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment is usually given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each session takes only a few minutes.
  • Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. Usually, a treatment session lasts only a few minutes and you can go home afterward. This common method of brachytherapy may be repeated two or more times over several weeks. Once the radioactive substance is removed, no radioactivity is left in the body.

Side effects depend mainly on which type of radiation therapy is used, how much radiation is given, and which part of your body is treated. External radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in your genital area. Also, your skin in the treated area may become red, dry, and tender.

You are likely to become tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

For women who have not had surgery to remove the ovaries, external radiation aimed at the pelvic area can harm the ovaries. Menstrual periods usually stop, and women may have hot flashes and other symptoms of menopause. Menstrual periods are more likely to return for younger women.

After either type of radiation therapy, you may have dryness, itching, or burning in your vagina. Your doctor may advise you to wait to have sex until a few weeks after radiation therapy ends.

Also, radiation therapy may make the vagina narrower. A narrow vagina can make sex or follow-up exams difficult. There are ways to prevent this problem. If it does occur, however, your health care team can tell you about ways to expand the vagina.

Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort.

You may want to ask your doctor these questions about radiation therapy:

  • Why do I need this treatment?
  • Which type of radiation therapy do you suggest for me?
  • When will the treatments begin? When will they end?
  • Will I need to stay in the hospital?
  • How will I feel during treatment?
  • How will radiation therapy affect my sex life?
  • How will we know if the radiation treatment is working?
  • Will I have any long-term side effects?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat uterine cancer that has an increased risk of returning after treatment. For example, uterine cancer that is a high grade or is Stage II, III, or IV may be more likely to return. Also, chemotherapy may be given to women whose uterine cancer can't be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.

Chemotherapy for uterine cancer is usually given by vein (intravenous). It's usually given in cycles. Each cycle has a treatment period followed by a rest period.

You may have your treatment in an outpatient part of the hospital, at the doctor's office, or at home. Some women may need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive system: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Other possible side effects include skin rash, tingling or numbness in your hands and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

The uterus

The uterus is part of a woman's reproductive system. It's a hollow organ in the pelvis.

The uterus has three parts:

  • Top: The top (fundus) of your uterus is shaped like a dome. From the top of your uterus, the fallopian tubes extend to the ovaries.
  • Middle: The middle part of your uterus is the body (corpus). This is where a baby grows.
  • Bottom: The narrow, lower part of your uterus is the cervix. The cervix is a passageway to the vagina.

The wall of the uterus has two layers of tissue:

  • Inner layer: The inner layer (lining) of the uterus is the endometrium. In women of childbearing age, the lining grows and thickens each month to prepare for pregnancy. If a woman does not become pregnant, the thick, bloody lining flows out of the body. This flow is a menstrual period.
  • Outer layer: The outer layer of muscle tissue is the myometrium.

Cancer Cells

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the uterus and the other organs of the body.

Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Tumors in the uterus can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:

  • Benign tumors (such as a fibroid, a polyp, or endometriosis):
    • are usually not a threat to life
    • can be treated or removed and usually don't grow back
    • don't invade the tissues around them
    • don't spread to other parts of the body
  • Malignant growths:
    • may be a threat to life
    • usually can be removed but can grow back
    • can invade and damage nearby tissues and organs (such as the vagina)
    • can spread to other parts of the body

Cancer cells can spread by breaking away from the uterine tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lung, liver, bone, or brain. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about uterine cancer that has spread.

Picture of the uterus

Risk Factors

When you get a diagnosis of uterine cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman gets uterine cancer and another doesn't.

However, we do know that women with certain risk factors may be more likely than others to develop uterine cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for uterine cancer:

  • Abnormal overgrowth of the endometrium (endometrial hyperplasia): An abnormal increase in the number of cells in the lining of the uterus is a risk factor for uterine cancer. Hyperplasia is not cancer, but sometimes it develops into cancer. Common symptoms of this condition are heavy menstrual periods, bleeding between periods, and bleeding after menopause. Hyperplasia is most common after age 40.

    To prevent endometrial hyperplasia from developing into cancer, the doctor may recommend surgery to remove the uterus (hysterectomy) or hormone therapy with progesterone and regular follow-up exams.
  • Obesity: Women who are obese have a greater chance of developing uterine cancer.
  • Reproductive and menstrual history: Women are at increased risk of uterine cancer if at least one of the following apply: Have never had children Had their first menstrual period before age 12 Went through menopause after age 55
  • History of taking estrogen alone: The risk of uterine cancer is higher among women who used estrogen alone (without progesterone) for menopausal hormone therapy for many years.
  • History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of uterine cancer.
  • History of having radiation therapy to the pelvis: Women who had radiation therapy to the pelvis are at increased risk of uterine cancer.
  • Family health history: Women with a mother, sister, or daughter with uterine cancer are at increased risk of developing the disease. Also, women in families that have an inherited form of colorectal cancer (known as Lynch syndrome) are at increased risk of uterine cancer.

Many women who get uterine cancer have none of these risk factors, and many women who have known risk factors don't develop the disease.

Symptoms

The most common symptom of uterine cancer is abnormal vaginal bleeding. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.

These are common symptoms of uterine cancer:

  • Abnormal vaginal bleeding, spotting, or discharge
  • Pain or difficulty when emptying the bladder
  • Pain during sex
  • Pain in the pelvic area

These symptoms may be caused by uterine cancer or by other health problems. Women with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible.

Diagnosis

If you have symptoms that suggest uterine cancer, your doctor will try to find out what's causing the problems.

You may have a physical exam and blood tests. Also, you may have one or more of the following tests:

  • Pelvic exam: Your doctor can check your uterus, vagina, and nearby tissues for any lumps or changes in shape or size.
  • Ultrasound: An ultrasound device uses sound waves that can't be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the pelvis. The echoes create a picture of your uterus and nearby tissues. The picture can show a uterine tumor. For a better view of the uterus, the device may be inserted into the vagina (transvaginal ultrasound).
  • Biopsy: The removal of tissue to look for cancer cells is a biopsy. A thin tube is inserted through the vagina into your uterus. Your doctor uses gentle scraping and suction to remove samples of tissue. A pathologist examines the tissue under a microscope to check for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.

You may want to ask the doctor these questions before having a biopsy:

  • Why do I need a biopsy?
  • How long will it take? Will I be awake? Will it hurt?
  • What is the chance of infection or bleeding after the biopsy? Are there any other risks?
  • How soon will I know the results? How do I get a copy of the pathology report?
  • If I do have cancer, who will talk with me about treatment? When?

Grade

If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal uterine tissue. It may suggest how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Staging

If uterine cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if uterine cancer spreads to the lung, the cancer cells in the lung are actually uterine cancer cells. The disease is metastatic uterine cancer, not lung cancer. It's treated as uterine cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" disease.

To learn whether uterine cancer has spread, your doctor may order one or more tests:

  • Lab tests: A Pap test can show whether cancer cells have spread to the cervix, and blood tests can show how well the liver and kidneys are working. Also, your doctor may order a blood test for a substance known as CA-125. Cancer may cause a high level of CA-125.
  • Chest x-ray: An x-ray of the chest can show a tumor in the lung.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis, abdomen, or chest. You may receive an injection of contrast material so your lymph nodes and other tissues show up clearly in the pictures. A CT scan can show cancer in the uterus, lymph nodes, lungs, or elsewhere.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your uterus and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in the uterus, lymph nodes, or other tissues in the abdomen.

In most cases, surgery is needed to learn the stage of uterine cancer. The surgeon removes the uterus and may take tissue samples from the pelvis and abdomen. After the uterus is removed, it is checked to see how deeply the tumor has grown. Also, the other tissue samples are checked for cancer cells. These are the stages of uterine cancer:

  • Stage 0: The abnormal cells are found only on the surface of the inner lining of the uterus. The doctor may call this carcinoma in situ.
  • Stage I: The tumor has grown through the inner lining of the uterus to the endometrium. It may have invaded the myometrium.
  • Stage II: The tumor has invaded the cervix.
  • Stage III: The tumor has grown through the uterus to reach nearby tissues, such as the vagina or a lymph node.
  • Stage IV: The tumor has invaded the bladder or intestine. Or, cancer cells have spread to parts of the body far away from the uterus, such as the liver, lungs, or bones.

Treatment

Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.

The treatment that's right for you depends mainly on the following:

  • Whether the tumor has invaded the muscle layer of the uterus
  • Whether the tumor has invaded tissues outside the uterus
  • Whether the tumor has spread to other parts of the body
  • The grade of the tumor
  • Your age and general health

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat uterine cancer include gynecologists, gynecologic oncologists (doctors who specialize in treating female cancers), medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping.

Also, NCI's Cancer Information Service can answer your questions about supportive care. Call 1–800–4–CANCER (1–800–422–6237). Or chat using LiveHelp, NCI's instant messaging service, at https://livehelp.cancer.gov/app/chat/chat_launch.

You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of uterine cancer. See the Taking Part in Cancer Research section.

You may want to ask your doctor these questions before you begin treatment:

  • What is the grade of the tumor? What is the stage of the disease? Has the tumor invaded the muscle layer of the uterus or spread to other organs?
  • What are my treatment choices? Which do you suggest for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a research study (clinical trial) be a good choice for me?
  • Can you recommend other doctors who could give me a second opinion about my treatment options?
  • How often should I have checkups?

Surgery

Surgery is the most common treatment for women with uterine cancer. You and your surgeon can talk about the types of surgery (hysterectomy) and which may be right for you.

The surgeon usually removes the uterus, cervix, and nearby tissues. The nearby tissues may include:

  • Ovaries
  • Fallopian tubes
  • Nearby lymph nodes
  • Part of the vagina

The time it takes to heal after surgery is different for each woman. After a hysterectomy, most women go home in a couple days, but some women leave the hospital the same day. You'll probably return to your normal activities within 4 to 8 weeks after surgery.

You may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.

It's common to feel tired or weak for a while. You may have nausea and vomiting. Some women are constipated after surgery or lose control of their bladder. These effects are usually temporary.

If you haven't gone through menopause yet, you'll stop having menstrual periods after surgery, and you won't be able to become pregnant. Also, you may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your doctor or nurse about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.

Surgery to remove lymph nodes may cause lymphedema (swelling) in one or both legs. Your health care team can tell you how to prevent or relieve lymphedema.

For some women, a hysterectomy can affect sexual intimacy. You may have feelings of loss that make intimacy difficult. Sharing these feelings with your partner may be helpful. Sometimes couples talk with a counselor to help them express their concerns.

You may want to ask your doctor these questions before having surgery:

  • What type of surgery do you recommend for me? Why?
  • Will lymph nodes and other tissues be removed? Why?
  • How will I feel after surgery? If I have pain, how can it be controlled?
  • How long will I be in the hospital?
  • When will I be able to return to normal activities?
  • What are the long-term effects of the surgery?
  • How will the surgery affect my sex life?

Radiation Therapy

Radiation therapy is an option for women with all stages of uterine cancer. It may be used before or after surgery. For women who can't have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.

Doctors use two types of radiation therapy to treat uterine cancer. Some women receive both types:

  • External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment is usually given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each session takes only a few minutes.
  • Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. Usually, a treatment session lasts only a few minutes and you can go home afterward. This common method of brachytherapy may be repeated two or more times over several weeks. Once the radioactive substance is removed, no radioactivity is left in the body.

Side effects depend mainly on which type of radiation therapy is used, how much radiation is given, and which part of your body is treated. External radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in your genital area. Also, your skin in the treated area may become red, dry, and tender.

You are likely to become tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

For women who have not had surgery to remove the ovaries, external radiation aimed at the pelvic area can harm the ovaries. Menstrual periods usually stop, and women may have hot flashes and other symptoms of menopause. Menstrual periods are more likely to return for younger women.

After either type of radiation therapy, you may have dryness, itching, or burning in your vagina. Your doctor may advise you to wait to have sex until a few weeks after radiation therapy ends.

Also, radiation therapy may make the vagina narrower. A narrow vagina can make sex or follow-up exams difficult. There are ways to prevent this problem. If it does occur, however, your health care team can tell you about ways to expand the vagina.

Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort.

You may want to ask your doctor these questions about radiation therapy:

  • Why do I need this treatment?
  • Which type of radiation therapy do you suggest for me?
  • When will the treatments begin? When will they end?
  • Will I need to stay in the hospital?
  • How will I feel during treatment?
  • How will radiation therapy affect my sex life?
  • How will we know if the radiation treatment is working?
  • Will I have any long-term side effects?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat uterine cancer that has an increased risk of returning after treatment. For example, uterine cancer that is a high grade or is Stage II, III, or IV may be more likely to return. Also, chemotherapy may be given to women whose uterine cancer can't be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.

Chemotherapy for uterine cancer is usually given by vein (intravenous). It's usually given in cycles. Each cycle has a treatment period followed by a rest period.

You may have your treatment in an outpatient part of the hospital, at the doctor's office, or at home. Some women may need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive system: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Other possible side effects include skin rash, tingling or numbness in your hands and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

Source: http://www.rxlist.com

When you get a diagnosis of uterine cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman gets uterine cancer and another doesn't.

However, we do know that women with certain risk factors may be more likely than others to develop uterine cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for uterine cancer:

  • Abnormal overgrowth of the endometrium (endometrial hyperplasia): An abnormal increase in the number of cells in the lining of the uterus is a risk factor for uterine cancer. Hyperplasia is not cancer, but sometimes it develops into cancer. Common symptoms of this condition are heavy menstrual periods, bleeding between periods, and bleeding after menopause. Hyperplasia is most common after age 40.

    To prevent endometrial hyperplasia from developing into cancer, the doctor may recommend surgery to remove the uterus (hysterectomy) or hormone therapy with progesterone and regular follow-up exams.
  • Obesity: Women who are obese have a greater chance of developing uterine cancer.
  • Reproductive and menstrual history: Women are at increased risk of uterine cancer if at least one of the following apply: Have never had children Had their first menstrual period before age 12 Went through menopause after age 55
  • History of taking estrogen alone: The risk of uterine cancer is higher among women who used estrogen alone (without progesterone) for menopausal hormone therapy for many years.
  • History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of uterine cancer.
  • History of having radiation therapy to the pelvis: Women who had radiation therapy to the pelvis are at increased risk of uterine cancer.
  • Family health history: Women with a mother, sister, or daughter with uterine cancer are at increased risk of developing the disease. Also, women in families that have an inherited form of colorectal cancer (known as Lynch syndrome) are at increased risk of uterine cancer.

Many women who get uterine cancer have none of these risk factors, and many women who have known risk factors don't develop the disease.

Source: http://www.rxlist.com

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