Most uterine cancers start as endometrial cancer. In another type of cancer, uterine sarcoma, the malignancy starts in the muscles and tissues of the uterus. Endometrial cancer and uterine sarcoma are usually treated differently.
Uterine cancer is the fourth most common cancer in women in the U.S. In 2017, 61,380 diagnoses of endometrial cancer were expected to be made, and it was estimated that there would be 10,920 deaths from this disease.
It normally affects those aged over 55 years.
- Endometrial cancer affects the female reproductive system.
- Early signs of endometrial cancer include unusual or heavy bleeding and a watery discharge.
- Treatments include surgery, radiation therapy, chemotherapy, and hormone therapy.
- The chance of surviving longer than 5 years is over 95 percent if diagnosis happens early.
Pain can occur in the pelvic area or less commonly, during sexual intercourse. Some women also experience pain when urinating or have difficulties emptying their bladder.
As the disease progresses, there may be:
- a feeling of a mass or heaviness in the pelvic area
- unintended weight loss
- pain in several parts of the body, including the legs, back, and pelvic area
It is important to rule out endometrial cancer if another condition is causing similar symptoms.
If cancer is detected, the grade of the tumor will be assessed to see how rapidly the cells are dividing and how quickly the cancer is likely to grow.
A higher-grade tumor is more likely to grow quickly and spread to other parts of the body.
Treatment will depend on the stage, or how far the cancer has spread.
The following stages may be used:
- Stage 0: Cancerous cells remain where they started, on the surface of the inner lining of the uterus.
- Stage 1: The cancer has spread through the inner lining of the uterus to the endometrium, and possibly to the myometrium.
- Stage 2: The tumor has spread to the cervix.
- Stage 3: The tumor has spread through the uterus to nearby tissue, including the vagina or a lymph node.
- Stage 4: The cancer has spread to the bladder or intestine, and possibly to other areas, such as bones, liver, or lungs.
When endometrial cancer spreads from the endometrium to other parts of the body, and when a new tumor forms in the lung, for example, that new tumor is not lung cancer. It is known as metastasized endometrial cancer.
Treatment depends on the age and general health of the woman with endometrial cancer, and the grade and stage of the tumor.
A physician will discuss options and possible adverse effects with the person who is about to receive treatment.
The options include surgery, radiation therapy, chemotherapy, and hormone therapy.
Surgical treatment for endometrial cancer normally takes the form of a hysterectomy, or the removal of the uterus together with the fallopian tubes and the ovaries. This normally involves a 2-night stay in a hospital, but resuming normal activities can take from 4 to 8 weeks.
A woman who has not yet undergone menopause will no longer menstruate after surgery, and she will not be able to conceive. She may experience symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness.
Radiation therapy uses powerful beams to kill cancer cells. It damages their DNA so that they can no longer multiply.
In external beam radiation (EBRT), a beam is directed at the pelvis and other areas with cancer. There may be up to five sessions each week for several weeks. A session lasts about 15 minutes.
Brachytherapy, or internal radiation therapy, uses small devices filled with radiation, such as wires, a cylinder, or small seeds. These are placed inside the vagina for a few minutes and then removed. The patient then returns home. The therapy is repeated two or more times over several weeks. Removing the device removes the radiation from the body.
Neo-adjuvant radiotherapy aims to shrink the tumor before surgery, making it easier to remove.
Adjuvant radiotherapy can also be applied after surgery to eliminate any remaining cancer cells.
Chemotherapy uses medication to destroy cancer cells. Combined with radiotherapy, it can remove the remains of a tumor.
In late-stage cancer, chemotherapy can slow the progression of the disease and prolong life expectancy.
Both radiotherapy and chemotherapy can help to relieve symptoms in patients with advanced cancer.
For endometrial cancer, chemotherapy is usually administered intravenously in cycles of treatment. There is a rest period to allow recovery. The cycle is repeated several times, depending on the stage and the treatment goals.
Possible side effects include a reduction in healthy blood cells, leaving the patient prone to bruising, bleeding, anemia, fatigue, and increased risk of infection. If these symptoms occur, the patient should seek medical advice.
Chemotherapy can also cause hair loss and gastrointestinal problems, including nausea, vomiting, diarrhea, and poor appetite. There may be lip and mouth sores.
These problems typically go away after treatment is completed.
Less common effects include swollen legs and feet, joint pain, balance problems, hearing difficulties, skin rash, and numbness and tingling in the hands and feet.
Hormone therapy may help patients with advanced endometrial cancer.
Women with very early-stage cancer and low-grade tumors who wish to become pregnant may choose hormone therapy rather than surgery.
This is not a standard treatment and needs close monitoring. If there is complete cancer remission after 6 months of hormonal therapy, the woman will be encouraged to conceive and give birth and then undergo a hysterectomy after childbirth to reduce the risk of cancer returning to the area.
Hormone therapy for endometrial cancer involves giving progestin, to help shrink the tumor and control symptoms, and reducing estrogen levels, making it harder for the cancer cells to grow.
Side effects include weight gain, mild muscle cramps, and mild nausea.
The cause of endometrial cancer is not known.
Cancer occurs when the genetic structure of a cell or group of cells changes. The cells start growing uncontrollably instead of dying at the normal point in their life cycle.
Research is still ongoing as to why these genetic changes occur.
While the direct causes of endometrial cancer are not known, there are several factors that have been identified as likely to increase the risk of the condition.
A major factor in endometrial cancer is increased exposure to high levels of estrogen. Women who are more at risk include those who have never been pregnant, those who start menstruating before the age of 12 years, or those who undergo menopause after 55 years of age.
Estrogen-only hormone replacement therapy (HRT) also contributes to the risk of endometrial cancer. This is often used by women following a hysterectomy. Polycystic ovarian syndrome (PCOS) can raise estrogen levels and is therefore also a risk factor.
Other factors include:
- endometrial hyperplasia, or abnormal overgrowth or thickening of the lining of the uterus
- use of Tamoxifen to prevent or treat breast cancer
- radiation therapy to the pelvis
- a family history of uterine cancer
- a previous diagnosis of ovarian or breast cancer
However, recent reports have disputed this.
It is important to recognize the early signs of endometrial cancer so that treatment can begin at a stage that is likely to resolve the cancer.
These early signs include:
- vaginal bleeding between menstrual periods
- periods that are heavier than usual
- vaginal bleeding in post-menopausal women
- abnormal vaginal discharge that is watery or tinged with blood
If you notice any abnormal vaginal discharge or unusual periods, visit a doctor immediately.
To diagnose this type of cancer, a physician will review the symptoms, as well as the medical and family history. They will also carry out a pelvic examination.
This involves inspecting and feeling the cervix, uterus, vagina, and labia to detect any lumps or changes in shape or size.
A transvaginal ultrasound (TVU) scan can determine the size and shape of the uterus and the texture and thickness of the endometrium to rule out other conditions. A transducer is inserted into the vagina, and sound waves create a video image of the uterus on a monitor.
Blood tests can also reveal cancerous cells.
A biopsy involves taking a sample of tissue or cells for examination under a microscope. This could be a hysteroscopy, in which a thin telescope is inserted into the vagina and the uterus, or an aspiration biopsy, using a small, flexible tube to take sample cells.
The average 5-year survival rate for endometrial cancer overall is around 81.3 percent, according to the American Cancer Society, and 95.3 percent for those diagnosed at the earliest stage.
To reduce the risk, the National Cancer Institute recommends avoiding smoking, exercising regularly, and following a healthy, balanced diet.