Uterine Cancer

What is uterine cancer?
The uterus or womb is a hollow pear-shaped organ that is part of a woman’s reproductive system. Uterine cancer is cancer of the uterus. The main type of uterine cancer is Endometrial cancer and accounts for approximately 95% of uterine cancers. Endometrial cancer involves the tissue lining the uterus. Uterine sarcoma is the other type of uterine cancer and involves the muscles or supporting tissue in the uterus.

What are risk factors for uterine cancer?
There are several risk factors for uterine sarcoma and endometrial cancer. These risk factors do not mean a woman having one or more will get uterine cancer. It means she is at higher risk than a woman who has no risk factors. Often women with uterine cancer do not have any risk factors.

Endometrial cancer
> Diet – Obesity is the biggest risk factor. Women who are obese, diabetic, or have a diet high in fact are at increased risk. Diabetes is more common in obese individuals, this might contribute to the risk. However women with type I diabetes also are at increased risk.
> Age of onset of menstruation and menopause – Beginning menstruation before age 12 or menopause late may increase the risk.
> Childbearing and breastfeeding – Women who never had a child or who never breastfed are at an increased risk.
> Polycystic Ovarian Syndrome – Women with polycystic ovarian syndrome are at an increased risk.
> Hormone replacement therapy – Women who use estrogen replacement therapy alone for more than five years are at an increased risk.
> Tamoxifen – This drug used to treat women with breast cancer increases the risk for endometrial cancer.
> Nonpolyposis colorectal cancer – Women who carry this hereditary abnormality are at increased risk for endometrial cancer.
> Prior pelvic radiation therapy – This may increase the risk for endometrial cancer.

Uterine sarcoma
> Prior pelvic radiation therapy – pelvic radiation increases the risk for uterine sarcoma and accounts for less than one third of this cancer and is diagnosed 5 to 25 years after exposure.
> Age – uterine cancer is found more often in middle aged and older women, though it can occur in young women.
> Race – uterine cancer is more common in African American women than white or Asian women.

What are prevention strategies for uterine cancer?
Uterine sarcoma
Most cases of uterine sarcoma cannot be prevented. The benefits of pelvic radiation to treat other diseases outweigh the risk of uterine sarcoma.

Endometrial cancer
Like uterine sarcoma, most endometrial cancers cannot be prevented. However there are things a woman can do to decrease her risk of developing this cancer.
> Regular menstrual cycles – For women with irregular menstrual cycles caused by hormonal problems using the combination of estrogen and progestin oral contraceptive or taking a progestin for several days every few months decreases the risk of endometrial cancer. However, it’s important to discuss the use of combined oral contraceptive with your healthcare provider as it increases the risk for breast cancer.
> Diet – It is important to maintain a healthy body weight by consuming a diet low in fat and high in fruits and vegetables and through physical activity. Women who are slim decrease their risk for endometrial cancer.

Is screening available?
Currently, there are no established national screening guidelines for uterine cancer. If a woman is at high risk for uterine cancer, she should discuss warning signs of uterine cancer this with her healthcare provider. Women with familial risk for endometrial and colon cancer (hereditary nonpolyposis cancer) may benefit from annual ultrasound and endometrial sampling.

What are the symptoms of uterine cancer?
Most cases of uterine cancer are in post menopausal women. These symptoms do not necessarily indicate uterine cancer, however it is important to report any changes and symptoms to your healthcare provider.
> Change in menstruation such as prolonged periods or bleeding between periods
> Unusual bleeding, spotting or discharge
> Any bleeding after menopause
> Pink, watery or white vaginal discharge
> Pelvic pain
> Pain during sexual intercourse
> Unexplained weight loss

How is uterine cancer diagnosed?
If uterine cancer is suspected, a woman may be referred to a gynecologic oncologist, a healthcare provider who specialized in female reproductive cancers. Following are some of the tests that may be used to diagnose uterine cancer.
> History and physical exam – The healthcare provider will assess a woman’s risk factors, symptoms, family history as well as conduct a physical examination.
> Endometrial biopsy – The healthcare provider will remove a small piece of tissue from the lining of the uterus. This is usually done in the healthcare providers office and does not require anesthesia.
> Dilation and curettage (DxC) - If an insufficient amount of tissue is obtain from the biopsy or it suggests cancer with out diagnosing it, this procedure may be done. It is done in an operating room under anesthesia as an outpatient procedure. Tissue is scraped from the lining of the uterus.
> Transvaginal ultrasound – This also may be used to rule out other conditions. A wand-like device is inserted into the vagina and used to create a video image of the uterine lining using sound waves. This is a painless procedure. Women with thickened lining may need endometrial biopsy or DxC.
Other tests may be used to determine if the cancer has spread beyond the uterus.

What is staging?
Staging describes the extent of the cancer. It determines if the cancer has spread and if so, what parts of the body are affected. Staging a cancer is important to assist the healthcare provider with determining the appropriate course of treatment and assessing an accurate prognosis.
The most common staging system is the TNM.
> T – size of the tumor
> N – degree to which regional lymph nodes are involved
> M – the absence or presence of distant metastases
Once the TNM has been determined, then a stage of I, II, III or IV is assigned.
> Stage I – cancers are small and local and usually curable
> Stage II x III – typically these are locally advanced and could involve the lymph nodes
> Stage IV – cancer has metastasized and can be inoperable.

What are treatment options?
Surgery is the most common treatment for uterine cancer. Radiation, chemotherapy and hormone therapy are other treatments that may also be used in addition to surgery. Treatment often depends on factors such as stage and type of cancer.

What clinical trials are available?
Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer. Clinical trials test new approaches to treatment, such as, new drugs, new approaches to surgery or radiation therapy, or a combination of treatments. Learn more about clinical trials.

What questions should I ask my healthcare provider?
It is often helpful to make a list of questions before an appointment. This will help to remember what the healthcare provider says. Patients and care givers can write notes or ask if they may use a tape recorder. Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen. Below are a few suggested questions a patient may ask their healthcare provider.

Will you please write down the type of cancer that I have?
What stage is my cancer and what does that mean?
What are my treatment options?
What treatment do you recommend and why?
What are the risks and benefits of each treatment?
What are possible side effects of treatment?
How will you help manage my side effects?
How will treatment affect my normal activities?
Are there specific things I must do to get ready for treatment?
Are there other things I can be doing to help with my treatment, such as diet and exercise?
What resources can I use to learn more about my cancer and help me deal with it?

Make an appointment

Resources
American Cancer Society – 1-800-ACS-2345
Centers for Disease Control and Prevention (CDC), DES Update – 1-888-232-6789
Gynecologic Cancer Foundation – 1-800-444-4441 or 312-644-6610
National Cancer Institute – 1-800-4CANCER