Uterine Cancer

What is the uterus?

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The uterus, also called the womb, is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum.

What are parts of the uterus?

• Cervix - the narrow, lower portion of the uterus

• Corpus - the broader, upper part of the uterus

• Serosa - the outer layer that covers the uterus

• Myometrium - the middle layer of the corpus; the thick muscle that expands during pregnancy to hold the growing fetus

• Endometrium - the inner lining of the uterus

What is uterine cancer?

Cancers that occur in each part of the uterus have their own names, such as cervical cancer or endometrial cancer, but are sometimes broadly defined as uterine cancer because the structure is part of the uterus. Cancer of the uterus spreads through the bloodstream or lymphatic system. According to the American Cancer Society (ACS), about 43,470 cases of cancer of the uterine corpus (body of the uterus) were expected to be diagnosed in the US during 2010.

What are noncancerous conditions of the uterus?

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Some conditions in the uterus, caused by abnormal, rapid, and uncontrolled division of cells, are not cancer. They are called benign conditions. Three of these benign conditions are:

• Fibroid tumors - are common benign tumors of the uterine muscle that do not develop into cancer. Fibroid tumors of the uterus are very often found in women in their forties. And, although single fibroid tumors do occur, multiple tumors are more common. Symptoms of fibroid tumors, which depend on size and location, include irregular bleeding, vaginal discharge, and frequent urination. For fibroids that press against nearby organs and cause pain, surgery may be necessary. Many times, however, fibroids do not cause symptoms and do not need to be treated. After menstrual periods cease, fibroid tumors may become smaller and may disappear altogether.

• Endometriosis - is a benign condition of the uterus that is common among women in their thirties and forties, especially women who have never been pregnant. Tissue that looks and acts like endometrial tissue begins to grow in unusual places, such as on the surface of the ovaries, on the outside of the uterus, and in other tissues in the abdomen.

• Hyperplasia - is an increase in the number of normal cells lining the uterus. Although it is not cancer, it may develop into cancer in some women. The most common symptoms are heavy menstrual periods, bleeding between periods, and bleeding after menopause.

What are risk factors for uterine cancer?

The following are risk factors for uterine cancer:

• Age - risk goes up as women get older

• History of endometrial hyperplasia

• Estrogen replacement therapy (ERT)

• Obesity

• Diabetes

• History of an inherited form of colon cancer

• History of breast or ovarian cancer

• History of taking tamoxifen for breast cancer treatment or prevention

• Race - African-American women are affected at a rate twice that of Caucasian or Asian women

• History of radiation therapy to the pelvic area

• High-fat diet

• History of polycystic ovarian syndrome (PCOS)

• Reproductive and menstrual history - increased risk is linked to never having children, having your first menstrual period before age 12, and/or going through menopause after age 55

What are the symptoms of uterine cancer?

The following are the most common symptoms of uterine cancer. However, each individual may experience symptoms differently. Symptoms may include:

• Unusual vaginal bleeding, spotting, or discharge

• Frequent, difficult, or painful urination

• Pain during sexual intercourse

• Pain in the pelvic area

Cancer of the uterus usually does not occur before menopause. It usually occurs around the time menopause begins. The occasional reappearance of bleeding should not be considered simply part of menopause. It should always be checked by a physician.

The symptoms of uterine cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

How is uterine cancer diagnosed?

When symptoms suggest uterine cancer, the following may be used to make a positive diagnosis:

• A detailed medical history - family and personal

• A thorough physical exam

• Pelvic examination of the uterus, vagina, ovaries, bladder, and rectum (may include a Pap test)

• Ultrasound to look at the uterus and nearby tissue and check for tumors

• Biopsy - removal of sample of tissue via a hollow needle or scalpel to see if the tissue contains cancer cells

• Dilation and curettage (D & C) - a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument); the removed lining is checked to see if it contains cancer cells

When cancer cells are found, other tests are used to determine if the disease has spread from the uterus to other parts of the body. These procedures may include:

• Blood tests

• Chest X-rays

• Computed tomography (CT or CAT) scans of various sections of the abdomen

• An ultrasound to view organs inside the body

• Special exams of the bladder, colon, and rectum

Treatment for uterine cancer:

Specific treatment for uterine cancer will be determined by your physician based on:

• Your overall health and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Methods of treatment may include:

• Hysterectomy - surgery to remove the uterus; sometimes done with salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries; nearby lymph nodes and part of the vagina may also be removed

• Radiation therapy

• Hormone therapy

• Chemotherapy