Uterine Cancer

Uterine cancer is an abnormal growth of cancer tissue in the womb (uterus). Uterine cancer can spread to other parts of the body. Uterine cancer usually occurs after a woman stops having menstrual periods (menopause). However, it may also occur around the time that menopause starts.

The wall of the uterus has an inner layer of tissue called the endometrium and an outer layer of muscle tissue called the myometrium. The most common type of uterine cancer is endometrial cancer, and it starts in the endometrium. Cancer that starts in the myometrium (uterine sarcoma) is very rare.

What are the causes?

The exact cause of this condition is not known.

What increases the risk?

You are more likely to develop this condition if you:

• Are older than 50.
• Have a thicker than normal endometrium (endometrial hyperplasia).
• Have never been pregnant or cannot have children.
• Started menstruating when you were younger than 12 years old or are older than 52 and having menstrual periods.
• Have a history of cancer, including:
  • Cancer of the ovaries, or cancer of the intestines, colon, or rectum (colorectal cancer).
  • A family history of uterine cancer or hereditary nonpolyposis colon cancer.
• Have a long-term (chronic) condition, such as:
  • Diabetes.
  • High blood pressure.
  • Thyroid disease.
  • Gallbladder disease.
  • Obesity.
  • A personal history of enlarged ovaries with small cysts (polycystic ovarian syndrome).
• Have been exposed to:
  • Radiation.
  • Cigarette smoke.
  • Hormone therapy or a medicine called tamoxifen.

What are the signs or symptoms?

Symptoms of this condition include:

• Abnormal vaginal bleeding or discharge. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. This is the most common symptom. If you experience abnormal vaginal bleeding, do not assume that it is part of menopause.
• Vaginal bleeding after menopause.
• Unexplained weight loss.
• Bleeding between periods.
• Urination that is difficult, painful, or more frequent than usual.
• A lump in the vagina.
• Pain, bloating, fullness in the abdomen, or pelvic pain. You may also have pain during sex.

How is this diagnosed?

This condition may be diagnosed based on your medical history, symptoms, a physical exam, and a pelvic exam. During the pelvic exam, your health care provider will feel your pelvis for any growths, as well as for any enlarged lymph nodes. You may also have tests, including:

• Blood and urine tests.
• Imaging tests, such as X-rays, CT scans, ultrasound, or MRIs.
• Hysteroscopy. This involves inserting a thin, flexible tube with a light and camera on the end through the vagina to look inside the uterus.
• A Pap test to check for abnormal cells in the lower part of the uterus (cervix) and the upper vagina.
• Removal of a tissue sample (biopsy) from the uterine lining. The sample will be examined in a lab to check for cancer cells.
• Dilation and curettage (D&C). This procedure involves stretching the cervix and scraping the lining of the uterus to get a tissue sample to check for cancer cells.

The cancer is staged to determine its severity and extent. Staging is an assessment of the size of the tumor and if, or where, the cancer has spread.

The stages of uterine cancer are:

• Stage I. The cancer is only in the uterus.
• Stage II. The cancer has spread to the cervix.
• Stage III. The cancer has spread outside the uterus, but not outside the pelvis. The cancer may have spread to the lymph nodes in the pelvis. Lymph nodes are part of your body's disease-fighting (immune) system.
• Stage IV. The cancer has spread to other parts of the body, such as the bladder, rectum, and other organs.

How is this treated?

This condition is often treated with surgery to remove:

• The uterus, cervix, fallopian tubes, and ovaries (total hysterectomy).
• The uterus and cervix (simple hysterectomy).

The type of hysterectomy you will have depends on the extent of your cancer. Lymph nodes near the uterus may also be removed. Treatment may include one or more of the following:

• Chemotherapy. These are medicines to kill cancer cells or to slow their growth. Chemotherapy also kills other normal, healthy cells, including blood-forming cells in the bone marrow, hair follicles, and cells in the mouth, digestive tract, and reproductive system.
• Radiation therapy. This uses high-energy rays to kill cancer cells and prevent their spread.
• Chemoradiation. This treatment alternates chemotherapy with radiation treatments to enhance the effects of radiation.
• Brachytherapy. This involves placing small radioactive capsules inside the body where the cancer was removed.
• Hormone therapy. This includes taking medicines that lower the levels of estrogen in the body.
• Immunotherapy. These medicines help your immune system fight cancer.
• Targeted therapy. These medicines specifically kill cancer cells.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider if the medicine prescribed to you requires you to avoid driving or using machinery.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Get regular exercise. Aim for 30 minutes of moderate-intensity activity 5 times a week. Examples of moderate-intensity activity include walking and yoga. Be sure to talk with your health care provider before starting any exercise routine.

Lifestyle

• Eat a healthy diet. A healthy diet includes a lot of fruits and vegetables, low-fat dairy products, lean meats, and fiber.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Consider joining a support group to help you cope with stress. Your health care provider may be able to recommend a local or online support group.

General instructions

• Drink enough fluid to keep your urine pale yellow.
• Do not have sex, douche, or place anything in your vagina, such as a tampon or diaphragm, until your health care provider says that it is safe.
• Work with your health care provider to:
  • Manage any chronic conditions you have.
  • Manage any side effects of your treatment.
• Keep all follow-up visits. This is important.

Where to find more information

• American Cancer Society: www.cancer.org
• National Cancer Institute: www.cancer.gov

Contact a health care provider if:

• You have pain in your pelvis or abdomen that gets worse.
• You cannot urinate.
• You have abnormal vaginal bleeding.
• You have a fever.

Get help right away if:

• You develop sudden or new severe symptoms, such as:
  • Heavy bleeding.
  • Severe weakness.
  • Pain that is severe or does not get better with medicine.

Summary

• Uterine cancer is an abnormal growth of cancer tissue in the uterus. The most common type of uterine cancer starts in the endometrium and is called endometrial cancer.
• This condition is often treated with surgery to remove the uterus, cervix, fallopian tubes, and ovaries (total hysterectomy) or the uterus and cervix (simple hysterectomy).
• Work with your health care provider to manage any long-term (chronic) conditions you have, such as diabetes, high blood pressure, thyroid disease, or gallbladder disease.
• Consider joining a support group to help you cope with stress. Your health care provider may be able to recommend a local or online support group.