Uterine Cancer

Uterine cancer is the most common cancer of the female reproductive tract, according to the National Cancer Institute (NCI). Like all cancers, uterine cancer occurs when cells divide without control or order. (Read about "Cancer: What It Is") The American Cancer Society (ACS) says over 38,000 women discover they have uterine cancer each year. ACS estimates 6,600 die each year.

Cervical cancer (Read about "Cervical Cancer") is different from uterine cancer. It is important for a woman to understand that.

There are three main parts of the uterus:

• Cervix - the narrow lower part
• Corpus - the broad middle part
• Fundus - the domed shaped upper portion

There are different types of uterine cancer, depending on which cells become abnormal and where the cancer starts:

• Endometrial - The vast majority of uterine cancers start in the lining of the corpus called the endometrium. Because it does start in the lining, it is difficult to discover with a pap test, which is mainly a screening test for cervical cancer. In some cases an ultrasound (Read about "Ultrasound Imaging") may also be used for screening.
• Uterine sarcoma - Another type of cancer called uterine sarcoma originates in the muscle of the uterus. ACS estimates somewhere between 2 and 4 percent of uterine cancers are uterine sarcomas.

Symptoms

NCI says abnormal vaginal bleeding is the most common symptom of uterine cancer. Most uterine cancers show up after menopause but sometimes occur as menopause begins. (Read about "Menopause") NCI warns that abnormal bleeding should not just be viewed as part of menopause. Vaginal bleeding after menopause should be checked by a doctor at once.

Other symptoms that should send you to the doctor for an exam include:

• difficult or painful urination
• pain in the lower abdomen
• pain during sex

Any other abnormal vaginal discharge should be checked by a doctor as well. (Read about "Vaginal Discharge")

Risk Factors

As already mentioned, most of the time uterine cancer appears after menopause. Age therefore is a risk factor for uterine cancer. Other risk factors according to NCI are:

• endometrial hyperplasia which is an increase in the number of cells and thickness of the lining the uterus. It is considered a precancerous condition.
• estrogen replacement therapy (ERT) when not used in combination with progesterone
• excess weight doubles a woman's chances of developing uterine cancer. (Read about "Obesity" "Fighting Weight Gain")
• diabetes (Read about "Diabetes")
• high blood pressure (Read about "Women and Blood Pressure")
• previous cancer (Read about "Cancer Risk")
• tamoxifen treatment for breast cancer (Read about "Breast Cancer")
• race - whites have a greater chance of developing uterine cancer
• childless
• late menopause
• early menstruation
• infrequent ovulation as in polycystic ovary syndrome (PCOS) (Read about "Polycystic Ovary Syndrome")

Many of the risk factors involve increased levels of estrogen. ACS says because of that, women need to discuss carefully with their doctor the advantages and disadvantages of ERT as they age. NCI says that there is some evidence that women who use oral birth control that combine estrogen and progesterone have a lower risk of uterine cancer.

Tests and staging

If uterine cancer is suspected, there are different tests that may be used, according to NCI:

• Pelvic exam - A woman has a pelvic exam to check the vagina, cervix, uterus, ovaries and fallopian tubes. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.
• Transvaginal ultrasound - The doctor inserts an instrument into the vagina that aims high-frequency sound waves at the uterus. (Read about "Ultrasound Imaging") The pattern of the echoes they produce creates a picture.
• Biopsy - The doctor removes a small piece of tissue from the uterine lining. This can be done in the doctor's office, but is sometimes done in the hospital with anesthesia. (Read about "Anesthesia") A pathologist examines the tissue to check for cancer cells, hyperplasia and other conditions. For a short time after the biopsy, some women may have cramps and vaginal bleeding. (Read about "Biopsy")

If cancer of the uterus is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for uterine cancer, according to NCI:

• Stage I

  In stage I, cancer is found in the uterus only. Cancer is not found in the cervix (the canal between the uterus and the vagina). Stage I is divided into stages IA, IB, and IC, based on how far the disease has spread from the endometrium into the muscles of the uterus.

• Stage II

  In stage II, cancer has spread from the uterus to the cervix, but not beyond the cervix. Stage II is divided into stages IIA and IIB, based on how far the disease has spread into the cervix.

• Stage III

  In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB and IIIC, based on whether cancer has spread to the connective tissue holding the uterus in place, the ovaries, fallopian tubes, vagina and lymph nodes in the pelvis. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) (Read about "The Lymph System")

• Stage IV

  In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on whether cancer has spread to the lining of the bladder (the sac that holds urine), to the bowel, or to lymph nodes or other parts of the body beyond the pelvis. (Read about "The Urinary System")

NCI says most women with uterine cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormonal therapy. Some patients receive a combination of therapies. (Read about chemo, radiation, hormonal and other therapies in "Cancer Treatments")

The main treatment for uterine cancer is surgery called hysterectomy. (Read about "Hysterectomy") At the same time, the ovaries (Read about "The Ovaries") and the fallopian tubes are also removed (bilateral salpingo-oophorectomy). When the ovaries are removed, menopause occurs at once if a woman is not already in menopause. Any surgery should be done by a physician experienced in cancer surgery.

If the cancer has not spread, then the surgery will leave the patient cancer free. Radiation is also used in many cases. Radiation may be administered from an external source. It may also be administered by implanting a small amount of radioactive material in or near the cancer. Chemotherapy and hormonal treatment may also be used in some cases, according to NCI, either in addition to surgery or in place of it if surgery is not an option.

More Cancer Information:

    Cervical Cancer

    Ovarian Cancer

    Vaginal Cancer

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Endometriosis

    Uterine Fibroids

    Menstrual Disorders

    Polycystic Ovary Syndrome

    Menopause and Exercise

    Genital Health - Female

    Woman's Health Terms Glossary