Overview, Causes, & Risk Factors
Cancer of the uterus occurs in the lining of the uterus, called
the endometrium. It is sometimes called endometrial cancer. Cancer of the
uterus is the most frequent and most curable type of cancer that affects a
woman's reproductive system. Among women, it is the fourth most common cancer
after breast cancer,
lung cancer, and
colorectal cancer.
What is going on in the body?
The cells that line the uterus respond to signals sent by estrogen and
progesterone, 2 hormones made in the ovaries. In the first 2 weeks of a
woman's monthly cycle, estrogen makes these cells divide and grow as the uterus
prepares for pregnancy. During the second 2 weeks, progesterone prepares the
lining of the uterus for an embryo to implant.
If pregnancy does not occur, the levels of both hormones
fall sharply. This causes the lining of the uterus to slough off. This process
is known as menstruation. The monthly menstrual cycle keeps the endometrium from growing too much.
Some women's bodies do not make progesterone. Others make high
levels of estrogen. In both cases, the cells lining the uterus grow
continuously and are not sloughed off regularly. This makes it more likely that
precancerous changes of the endometrium will occur. If a woman is not treated
for this, cancer of the uterus may develop.
Cancer of the uterus is most common in women between the
ages of 50 to 65. But it can also occur in younger women.
What are the causes and risks of the disease?
No one knows exactly what causes cancer of the uterus, but certain factors
increase a woman's risk. For example, some women's bodies make high levels of estrogen
that are not balanced by progesterone. This is called unopposed estrogen.
Cancer of the uterus is also more likely in women who have the following conditions:
obesity, because fat cells can make extra estrogen
a history of infertility
late
menopause, meaning after age 55
polycystic ovary
syndrome, a condition in which fluid-filled sacs form on the
ovaries
estrogen therapy for more than 1 year without taking
progesterone as well
estrogen combined with less than 7 days of progesterone a
monthA woman may also have a higher risk for this
type of cancer if she has one of the following conditions:
high blood pressure
diabetes
cancer of the breast, ovaries, or colorectal cancer
few or no children. The more children a woman has delivered, the lower
her risk for uterine cancer.
past use of tamoxifen, a medication used to prevent breast cancer from coming back
a family history of cancer of the uterus
Symptoms & Signs
What are the signs and symptoms of the disease?
The most common symptom of this disease is abnormal vaginal
bleeding. Other symptoms include the following:
heavy periods
spotting or vaginal bleeding
between periods
bleeding after intercourse
bleeding or spotting after 6 months of not having any periods, in a
woman who is not taking hormone replacement
therapy
a feeling of pelvic heaviness
unusual pain and cramping in the lower belly that is not related to menstruation
Diagnosis & Tests
How is the disease diagnosed?
A
Pap smear is not intended to diagnose uterine cancer. This test is
used to diagnose cancer of the cervix. However, Pap smears occasionally show
changes in endometrial cells. If this occurs, a biopsy or dilatation
and curettage, or D&C, will be done. This involves scraping the
uterine wall to gather more cells from the lining of the uterus.
If advanced cancer is suspected, other tests may be
done, such as the following:
a complete blood count to rule out anemia, which is a low red blood cell
count
a test to make sure that cancer has not spread to the kidneys
ultrasound of the vagina
a
chest X-ray to make sure that the cancer has not spread to the
lungs
liver function tests to make sure that the cancer has not spread to
the liver
bone
scan to be sure that the cancer has not spread to the bones
Prevention & Expectations
What can be done to prevent the disease?
No one knows exactly what causes cancer of the uterus. However, a woman may be
able to lessen her risk of getting it by taking the following steps:
eating a diet low in
fat
maintaining a healthy weight
maintaining a normal blood
pressure level
reporting any pattern of abnormal vaginal bleeding to the healthcare
provider
having yearly pelvic
exams and Pap
smears
Also, a woman should talk with her healthcare provider about the risks of
taking estrogen without progesterone after menopause if she has not had her uterus removed. The risk for
cancer of the uterus may last as long as 10 years after adding progesterone or
stopping estrogen therapy completely.
What are the long-term effects of the disease?
When cancer of the uterus is diagnosed early and treated, more
than 80% of women will survive more than 5 years. Most are completely cured
when the cancer is diagnosed and treated early.
What are the risks to others?
Uterine cancer is not contagious, so there are no risks to others.
Treatment & Monitoring
What are the treatments for the disease?
Cancer of the uterus is treated by removing the uterus in a
procedure called an abdominal hysterectomy. Doing this surgery through
the abdomen rather than the vagina is recommended. It allows the surgeon to see
the entire pelvis and abdomen and to note any spread of the cancer. He or she
can also take samples of cells from the abdominal cavity to check for any tiny
floating cancer cells. The surgeon will also remove lymph nodes from the pelvic
area to be sure that the cancer has not spread.
Sometimes a surgeon will remove the uterus through the
vagina and then remove the lymph nodes through a small cut in the abdomen. This
avoids leaving a large scar on the abdomen and shortens the hospital stay. Not all
women are candidates for this procedure.
Because tumor cells may have spread to the ovaries and
fallopian tubes, these organs are usually removed also. For women with advanced disease, the preferred treatment
is surgery. If the surgeon finds that the cancer has not spread, there may be
no further treatment. Women who are at a higher risk of the cancer coming back
may have radiation treatments to the pelvis. Or they may have
chemotherapy. Because
this cancer comes from a tissue that is sensitive to hormones, treatment with
hormones may also be effective.
What are the side effects of the treatments?
After having a hysterectomy, a woman may experience the following:
inability to control urine
sexual problems
stress
swelling in the legs
ascites, which is an
accumulation of fluid in the abdomen
swelling in the veins of the lower legs that may lead to blood clots
surgical problems, such as a hole connecting the vagina and the
rectum
bleeding that requires a blood transfusion
Radiation therapy will usually produce some hair loss.
Chemotherapy is often associated with nausea, vomiting, and anemia, or a low red blood cell
count.
What happens after treatment for the disease?
A woman who has been treated for cancer of the uterus should try to take these steps:
Eat a balanced diet following the food guide pyramid.
Get plenty of rest.
Drink plenty of fluids to avoid dehydration.
Decrease stress.
Rely on family members and friends for help with daily activities when
feeling too tired to do them alone.If a woman tries
herbal remedies or
alternative medicines for her symptoms, she should tell her healthcare
provider. Sometimes toxic reactions can occur when certain therapies are
combined.
How is the disease monitored?
At least every 3 to 4 months after treatment, a woman should have a follow-up,
including:
a
pelvic
exam
a physical exam
blood tests
Depending on the stage of the cancer, other tests made be used, such as the following:
pelvic ultrasound
CT
scan
magnetic resonance imaging, or MRI
A woman should report any new or worsening symptoms that might
suggest that the cancer is coming back. She can then be treated quickly, if
necessary.
Following are some of the signs of recurrent endometrial cancer:
vaginal bleeding
abdominal bloating
changes in bowel or bladder habits
swelling of the lower
legs
persistent cough
loss of appetite
weight loss
fatigue
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