uterine cancer
What is the most common type of uterine cancer?
What are some risk factors for uterine cancer?
What is a common early sign of endometrial cancer?
What are some treatment options for endometrial cancer?
uterine cancer, a disease characterized by the abnormal growth of cells in the uterus. Endometrial cancer, which affects the endometrium, or the lining of the uterus, is the most common cancer of the female reproductive tract. Other uterine cancers, known as uterine sarcomas, develop from underlying muscle or connective tissue. Uterine sarcoma is relatively rare but tends to be more aggressive than typical endometrial cancer.
The global incidence of uterine cancer is increasing in the 21st century. Most cases occur in Europe and the United States, where rising incidence is attributed in part to increases in the prevalence of overweight and obesity, which are major risk factors for uterine cancer.
Risk factors and symptoms
Although the causes of endometrial cancer vary and in many cases remain unknown, several factors have been identified that increase the risk of developing the disease. Many of these risk factors stem from an imbalance in which levels of the hormone estrogen in the uterus are regularly higher than levels of progesterone. Women who began their menstrual cycles at an early age (before 12 years) or who entered menopause after age 50 are at a higher risk for endometrial cancer, probably because of the increased exposure of the uterine wall to estrogen. Other factors associated with increased exposure to estrogen include lack of a previous pregnancy, obesity, and estrogen replacement therapy following menopause.
" height="20" alt="HEW Logo">
Women who have taken the breast cancer drug tamoxifen may have a slightly higher risk of developing endometrial cancer. Risk is also increased among women with diabetes. Other factors that raise a woman’s risk of uterine cancer include being over age 40, having had ovarian cancer, or having a family history of endometrial cancer. In addition, uterine cancer occurs more often in white women than in Black women.
The most common early sign of endometrial cancer is vaginal bleeding or other discharge, especially spotting or bleeding in postmenopausal women. Any such discharge warrants immediate attention by a physician. Other possible symptoms include pelvic pain with no clear cause, a noticeable lump or swelling, and unintended weight loss.
Diagnosis and prognosis
Diagnosis of uterine cancer is a multi-step process involving symptom evaluation, physical exam, imaging, and biopsy for microscopic analysis. A biopsy may be used to take samples of uterine tissue, or dilatation and curettage (D & C) may be used to scrape endometrial cells from the wall of the uterus for examination. Cancers of the uterus and surrounding tissues can also be detected by observing the reproductive, digestive, and urinary tracts with specialized viewing scopes. Internal imaging procedures often allow a more precise location and determination of the potential spread of uterine cancer. Methods include X rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound. An X-ray procedure known as an intravenous pyelogram uses an injected iodine solution to enhance a series of images taken of the urinary tract in cases where spread of cancer to these tissues is suspected.
Once uterine cancer has been diagnosed, its stage is then determined to indicate how far the cancer has progressed. Stage I cancers are localized to the main body of the uterus, whereas stage II tumors have spread to the cervix. Stage III cancers have spread outside the uterus to the vagina, regional lymph nodes, or peritoneum but are still contained within the pelvis. Stage IV cancers have spread to distant organs such as the lungs, bone, bladder, or digestive tract.
The trusted destination for professionals, college students, and lifelong learners.
SUBSCRIBE
Five-year survival for endometrial cancer is quite high—more than 90 percent—when the cancer is diagnosed early. Among patients whose cancer has spread to the cervix, five-year survival typically is between 65 and 80 percent. If the cancer has spread beyond the endometrium but remains confined to the pelvis, five-year survival is roughly 50 percent. However, once the cancer has metastasized to other organs, survival rate is very low.
Treatment
Surgery is used to treat most endometrial cancers. A simple hysterectomy removes the uterus and cervix, whereas a radical hysterectomy also removes underlying connective tissue (the parametrium) and ligaments along with the upper portion of the vagina. Either of these surgeries may be done in conjunction with the removal of the fallopian tubes and ovaries. Surgical removal of the uterus or ovaries results in infertility, and removal of the ovaries will also cause women to immediately enter menopause. Lymph nodes may also be removed during surgery.
Radiation therapy is sometimes used in conjunction with surgery. External beam radiation resembles traditional X rays in that the radiation is directed from outside the body toward an internal target tissue. In brachytherapy radioactive rods or pellets are implanted to focus the radiation on the cancer and greatly reduce side effects. Side effects of pelvic radiation therapy may include diarrhea, fatigue, premature menopause, bladder irritation, or narrowing of the vagina due to scar tissue buildup.
In cases where endometrial cancer has spread beyond the uterus, general or systemic approaches such as chemotherapy may be required so that as many cancerous cells as possible can be sought out and destroyed. Some uterine cancers can be treated in part by using hormonal therapy. If cancer cells are found to express progesterone receptors, the hormone progesterone may be used to slow the growth of the tumor. Targeted therapy may also be used for endometrial cancer; in this approach, specially designed drugs attack specific molecules or other aspects of cancer cells. Targeted therapy is often used for advanced cases and can work by blocking growth signals, blood vessel formation, or specific proteins.
Prevention
Long-term use of combined oral contraceptives (birth control pills containing both an estrogen and a progestin) reduces the risk of endometrial cancer. Regular exams may reveal benign growths in the uterine wall called hyperplasias, which can be removed to eliminate the possibility of their developing into malignant tumors. Some medical societies recommend an annual Pap test plus pelvic exam for all women once they reach age 18 or become sexually active, whichever is earlier.