Gynecologic Cancers

Uterine Cancer

Background

The most common type of uterine cancer is called endometrial cancer. Endometrial cancer arises from the cells lining the uterus, called the endometrium. Other more rare types of uterine cancer include sarcomas, which arise from the muscle cells of the uterus. Routine pelvic exams may improve the likelihood of early detection.

Of note, cervical cancer arises from the lower portion of the uterus, called the cervix. Cervical cancer is diagnosed and treated differently from uterine/endometrial cancer. A Pap test samples cells from the inner lining of the cervix and helps to detect precancerous or cancerous cells. A Pap test, however, is not effective in detecting endometrial cancer.

Symptoms

Possible signs of uterine cancer include:

  • Abnormal bleeding or spotting, including vaginal bleeding between periods or after menopause
  • Persistent itching that doesn't go away, and is sometimes accompanied by burning pain
  • Vaginal discharge, a non-specific symptom that could indicate a yeast infection; However, unusual vaginal discharge has been described as a symptom in some patients with uterine cancer.
  • Pelvic pain/pressure or mass; Some women diagnosed with uterine cancer experience pelvic pain or a feeling of fullness in their pelvis. Doctors may also feel a mass during a pelvic exam.
  • Weight loss (non-intentional)

Risk Factors

Factors that may increase the risk of uterine cancer include:

  • Age. The risk of endometrial cancer increases with age. The majority of women diagnosed with endometrial cancer are over age 55.
  • Early menstruation/late onset of menopause. The total amount of time menstruating has been correlated with the risk of developing endometrial cancer. Therefore, the greater the number of years of menstruation, the higher the risk. This would include women starting menstruation at an early age and/or women who developed menopause at a later age.
  • Absent history of pregnancy. Absence of pregnancy is correlated to an increased risk of endometrial cancer, although the reason why is not well understood.
  • Obesity. Obesity can increase the production of estrogen by fatty tissue, thereby, increasing the risk of endometrial cancer.
  • Diabetes. This may be related to the higher obesity rates found in diabetic patients.
  • Estrogen replacement therapy; Estrogen stimulates the growth of the endometrium. Therefore, estrogen replacement may increase the risk of uterine cancer.
  • Tamoxifen. Tamoxifen can be used as part of breast cancer treatment therapy. Although, it used as an estrogen blocker, it does have estrogen-like characteristics that can result in growth stimulation of the endometrial lining.
  • Personal history of breast cancer or ovarian cancer. If you've had breast or ovarian cancer, you may have an increased risk of endometrial cancer, because all of these cancers share some of the same risk factors. However, the vast majority of women who have either breast or ovarian cancer never develop endometrial cancer.
  • Hereditary nonpolyposis colorectal cancer (HNPCC). Women with HNPCC have a significantly higher risk of colon cancer and other gynecological cancers.

Staging

Stage I: Cancer is found in the uterus only. Stage I is divided into Stages IA, IB, and IC, based on how far the cancer has spread.

    Stage IA: Cancer is in the endometrium only.

    Stage IB: Cancer has spread into the inner half of the myometrium (muscle layer of the uterus).

    Stage IC: Cancer has spread into the outer half of the myometrium.

Stage II: Cancer has spread from the uterus to the cervix, but has not spread outside the uterus. Stage II is divided into Stages IIA and IIB, based on how far the cancer has spread into the cervix.

    Stage IIA: Cancer has spread to the glands where the cervix and uterus meet.

    Stage IIB: Cancer has spread into the connective tissue of the cervix.

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 how far the cancer has spread within the pelvis.

    • the outermost layer of the uterus; or
    • tissue just beyond the uterus; or
    • the peritoneum.
  • Stage IIIA: Cancer has spread to one or more of the following:

    Stage IIIB: Cancer has spread beyond the uterus and cervix, into the vagina.

    Stage IIIC: Cancer has spread to lymph nodes near the uterus.

Stage IV: Cancer has spread beyond the pelvis. Stage IV is divided into Stages IVA and IVB, based on how far the cancer has spread.

    Stage IVA: Cancer has spread to the bladder and/or bowel wall.

    Stage IVB: Cancer has spread to other parts of the body beyond the pelvis, including lymph nodes in the abdomen and/or groin.

Treatment

Stage I endometrial cancer
Treatment of Stage I endometrial cancer may include:

  • Surgery that involves total abdominal hysterectomy and bilateral salpingo-oophorectomy, lymph nodes in the pelvis and abdomen may also be removed.
  • Surgery that involves total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen, followed by internal radiation therapy or external radiation therapy to the pelvis. After surgery, a plastic cylinder containing radioactive material may be placed in the vagina.
  • Radiation therapy alone for patients who cannot have surgery.
  • Clinical trials of radiation therapy and/or chemotherapy.

Stage II endometrial cancer

Treatment of Stage IIA endometrial cancer usually involves a combination of therapies, such as internal and external radiation therapy and surgery.

Stage IIA endometrial cancer
Treatment of stage IIA endometrial cancer may include:

  • Surgery that involves total abdominal hysterectomy and bilateral salpingo-oophorectomy. Lymph nodes in the pelvis and abdomen may also be removed.
  • Surgery that involves total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen, followed by internal radiation therapy or external radiation therapy to the pelvis. After surgery, a plastic cylinder containing radioactive material may be placed in the vagina.
  • Radiation therapy alone for patients who cannot have surgery.
  • Clinical trials of radiation therapy and/or chemotherapy.

Stage IIB endometrial cancer
Treatment of Stage IIB endometrial cancer may include:

  • Surgery that involves total abdominal hysterectomy, bilateral salpingo-oophorectomy, and removal of lymph nodes in the pelvis and abdomen for examination, followed by radiation therapy.
  • Internal radiation therapy and external radiation therapy, followed by surgery that involves hysterectomy and bilateral salpingo-oophorectomy, and removal of lymph nodes in the pelvis and abdomen.
  • Surgery that involves radical hysterectomy with or without removal of lymph nodes in the pelvis.
  • Clinical trials. For more information, check with the National Cancer Institute's PDQ Cancer Clinical Trials Registry, which is now accepting patients with Stage II endometrial carcinoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug.

Stage III endometrial cancer
Treatment of Stage III endometrial cancer may include:

  • Surgery that involves radical hysterectomy and removal of lymph nodes in the pelvis, followed by internal radiation therapy and external radiation therapy.
  • Radiation therapy alone for patients who cannot have surgery.
  • Hormone therapy for patients who cannot have surgery or radiation therapy.
  • Clinical trials of chemotherapy.

Stage IV endometrial cancer
Treatment of stage IV endometrial cancer may include:

  • Internal radiation therapy and external radiation therapy.
  • Hormone therapy.
  • Clinical trials of chemotherapy.

References
National Cancer Institute, Mayo Clinic, Cancer Treatment Centers of America.