At the Saint John’s Cancer Institute, we employ a multi-disciplinary approach and personalized care to diagnose and treat uterine cancer. Our care teams are ready to support you and answer any questions you may have.
What is Uterine Cancer?
The uterus is a hollow, pear-shaped reproductive organ in the pelvis where pregnancy develops. Cancer can sometimes develop in the inner lining (endometrium) or the muscles of the uterus (uterine sarcoma). These are the two types of uterine cancer.
Endometrial cancer is the most common type, primarily found in postmenopausal women. It is typically diagnosed at an early stage because it often causes abnormal vaginal bleeding. If detected early, surgical removal often cures endometrial cancer.
Uterine sarcoma is a rarer type of uterine cancer that forms in the muscles of the uterus. It can be caused by a variety of factors, including past radiotherapy treatments, long-term use of Tamoxifen (an estrogen modulator), genetic changes within the RB1, TP53, and PTEN genes, age (over 40, with an average age of around 60), and race, with African American women at higher risk.
Causes of Uterine Cancer
Uterine cancer is multifactorial, with various factors increasing the risk of developing the disease. It is known that a genetic mutation occurs within the cells that form the endometrium or the uterine muscle. This mutation transforms healthy cells into abnormal cells, causing them to grow and multiply uncontrollably. These abnormal cells build up into a mass (tumor) and can spread to other parts of the body (metastasis).
What are the Signs and Symptoms of Uterine Cancer?
lower abdominal pain.
The signs and symptoms of uterine (endometrial) cancer can vary, but here are some common ones that may include:
- Vaginal bleeding after menopause
- Vaginal bleeding or abnormal discharge (watery or blood-tinged) not related to periods
- Pain or Cramping: Lower abdominal pain or cramping in the pelvis
- Pain During Intercourse: Discomfort or pain during sexual intercourse
- Difficulty or Painful Urination: This can be a sign of the cancer spreading
- Unexpected Weight Loss: Unexplained weight loss can be a symptom
- Weakness and Pain: Weakness and pain in the lower abdomen, back, or legs if the cancer has spread to other organs.
Early detection can make a significant difference in treatment outcomes.
Diagnosis of Uterine Cancer
Uterine cancer may not be revealed through a pap smear, which screens for cervical cancer. To diagnose uterine cancer, a sample of endometrial tissue must be examined under a microscope for cancer cells. This can be done using the following procedures:
Endometrial biopsy
A thin, flexible tube resembling a straw is inserted through the cervix and into the uterus to obtain tissue from the inner lining (endometrium) of the uterus. A pathologist views the tissue under the microscope to look for cancer cells. The endometrial biopsy can be performed in your doctor’s clinic.
Dilation and Curettage (D&C)
The dilation and curettage procedure are performed under anesthesia in the operating room. The cervix is dilated, and a curette is used to remove a small amount of tissue. A pathologist views the tissue under the microscope to verify if cancer cells are present. Your doctor may perform dilation and curettage simultaneously with hysteroscopy, which is a procedure that visualizes the inside of the uterus. A hysteroscope (thin, tube-like instrument with a lens and light) is inserted through the cervix into the uterus to look for abnormal areas.
Other tests and procedures to diagnose endometrial cancer include the following:
Pelvic exam
During a pelvic exam, your doctor carefully inspects the outer portion of your genitals as well as the vagina in order to inspect the vagina and cervix. Your doctor will also perform a bimanual exam to feel the size, shape, and position of the uterus and ovaries by inserting two fingers of one hand into the vagina and the rectum while using the other hand to press on your lower abdomen.
Transvaginal ultrasound
During a transvaginal ultrasound, a wand-like instrument is inserted into the vagina that generates sound waves to form an image of the cervix, uterus, fallopian tubes, ovaries, and bladder. Your doctor can use these ultrasound images to identify tumors or abnormalities in the thickness or texture of the endometrial lining.
PET/CT scan (Positron Emission Tomography)
This is an advanced imaging technique for identifying cancer tumors throughout the body. A small amount of radioactive sugar is injected into a vein. The PET scanner rotates around the body and generates images of where the sugar dissipates as it is consumed in the body. Cancer cells appear as bright areas in the images because they are usually more active and take up more glucose than normal cells. The CT scanner generates a series of detailed pictures inside the body from different angles.
Follow up includes repeat exams and PAP smears to detect recurrence. Sometimes imaging is recommended as well. We provide advice to help you reduce the risk of recurrence using nutrition and lifestyle choices.
Risk Factors of Uterine Cancer
Increased exposure to estrogen made by the body
The ovaries produce two primary hormones in females: estrogen and progesterone. A disease or condition that increases endometrial exposure to estrogen without a balanced exposure to progesterone can increase the risk of endometrial cancer. Examples include menstruating at an early age (which means more years of menstruation), never being pregnant, starting menopause at a later age, and polycystic ovarian syndrome, which causes irregular ovulation patterns.
Hormone Replacement Therapy (HRT) After Menopause
Taking estrogen alone can increase the risk of endometrial cancer. This risk may be reduced by combining estrogen with progesterone.
Older Age
Your risk of endometrial cancer increases as your age increases. Endometrial cancer is most commonly diagnosed after menopause.
Obesity
Increased fat tissue increases your body’s production of estrogen, which increases your risk of endometrial cancer.
Type 2 Diabetes and Metabolic Syndrome
Diabetes has been related to an increased risk of endometrial cancer.
Tamoxifen Therapy for Breast Cancer
Women who taken tamoxifen as treatment for breast cancer are at increased risk of developing endometrial cancer. In most cases, the benefits of tamoxifen outweigh the small risk of endometrial cancer.
Prior Radiation to the Pelvis
Radiation therapy to the pelvic area can increase the risk of uterine sarcoma.
Genetic Conditions
Lynch Syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is an inherited syndrome in which a genetic mutation is passed from parents to children. This mutation increases the risk of colon cancer and other cancers, including endometrial cancer. Patients diagnosed with Lynch Syndrome should talk to their doctor about recommended cancer screening tests.
Treatment of Uterine Cancer
Treatment of uterine cancer typically includes surgery, chemotherapy, biological targeted therapy or radiation, or a combination of these depending on the stage. Surgical intervention at the Saint John’s Cancer Institute utilizes cutting-edge minimally invasive robotic-assisted technology. Fertility-sparing surgery is also available.
Before a specific treatment plan can be developed for you, we consider:
- Your age, overall health and medical history
- The extent of the disease
- Your tolerance of specific medicines, procedures or therapies
- Expectations for the course of the disease
Please see Treatment for Uterine Cancer.
If you have questions regarding uterine (endometrial) cancer or would like an expert second opinion, please call today or click here to schedule an appointment.
