Uterine cancer is the most common cancer of the female reproductive system in the United States. This year, about 40,000 women will be diagnosed with uterine cancer and more than 95% will be endometrial cancers, which affect the lining of the uterus (endometrium).
Most uterine cancers develop over a period of years and may arise from less serious problems such as endometrial hyperplasia. Although the majority of uterine cancers occur in postmenopausal women, up to 25% may occur before menopause. The survival rate for all stages of uterine cancer is approximately 84%, but if diagnosed at its earliest stage, survival increases to 90-95%.
Fortunately, most uterine cancers are discovered early because of warning signs such as irregular or postmenopausal bleeding. Awareness of these symptoms is important for both women and their physicians.
Ovarian, cervical and uterine cancers have similar symptoms. If you notice any postmenopausal vaginal bleeding or one or more of the following symptoms for more than two weeks, see your doctor, especially if you are post-menopausal.
Although uterine cancer is the most common cancer of the female reproductive system in the United States, the good news is that many risk factors can be modified to help prevent this disease:
Additionally, the use of combination oral contraceptives by pre-menopausal women appears to decrease the risk of developing uterine cancer.
Most uterine cancers are endometrial cancer, which develops in the lining of the uterus (the endometrium). Factors that may increase the risk of developing endometrial cancer include:
Uterine Sarcoma is a rare type of cancer that occurs in the muscle of the uterus. The main risk factor for developing a uterine sarcoma is a history of high-dose radiation therapy in the pelvic area.
Screening for uterine cancer is not recommended for most women because the chance of disease is quite low. But for women with Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome), an annual endometrial biopsy is recommended beginning at age 35. Women at normal risk for uterine cancer should pay attention to their bodies, know the symptoms, and learn how to decrease the chances of developing certain gynecological cancers.
The primary surgery for uterine cancer is a total hysterectomy with bilateral salpingo-oophorectomy. The uterus is removed along with both ovaries and fallopian tubes and sometimes the pelvic lymph nodes. In a radical hysterectomy, the uterus, cervix, surrounding tissue, upper vagina and usually the pelvic lymph nodes are removed. A hysterectomy can be done either through the abdomen or the vagina, depending on a patient's medical history and overall health.
Some uterine cancer patients may undergo a lymphadenectomy, or lymph node dissection. Lymph nodes are removed from the pelvic area and examined for the presence of cancerous cells, helping doctors determine the exact stage and grade of the cancer. This surgery may be done as a part of a hysterectomy. The procedure can be done through an abdominal incision or by laparoscope.
Radiation therapy may be used to treat uterine cancer after a hysterectomy or as the primary treatment when surgery is not an option. Depending on the stage and grade of the cancer, radiation therapy may also be used at different points of treatment.
There are two types of radiation therapy and in some uterine cancer cases, both types are given.
External beam radiation involves a series of radioactive beams precisely aimed at the tumor from outside the body. Intensity-modulated radiation therapy and proton therapy are examples of external beam radiation. Patients generally undergo daily outpatient treatments five days a week for four to six weeks, depending on the treatment plan.
Brachytherapy involves tiny radioactive seeds that are inserted through the vagina into the uterus wherever cancer cells are located. The seeds remain in place for two to three days and then removed. Depending on your cancer, several treatments may be needed. Because brachytherapy delivers radiation to a localized area, there is little effect on nearby structures such as the bladder or rectum.
The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have receptors where hormones can attach, drugs can be used to reduce the production of hormones or block them from working. In hormone therapy, progesterone-like drugs known as progestins are used to slow the growth of cancer cells.
An endometrial biopsy should be performed if a woman is experiencing any symptoms of uterine cancer. A thin, flexible tube is inserted through the cervix and into the uterus. Using suction, a small amount of endometrial tissue is removed through the tube. A pathologist views the tissue under a microscope to look for abnormal cells and confirms the diagnosis of endometrial cancer.
If the endometrial biopsy does not provide enough tissue or if a cancer diagnosis is not definite, a dilation and curettage (D&C) may be performed. This surgical procedure involves dilating the cervix with a series of increasingly larger metal rods, and then inserting an instrument (curette) to scrape cells from the uterine wall. D&C takes about an hour and is usually done as an outpatient procedure under general anesthesia.
Hysteroscopy is a diagnostic test used to help locate adhesions, abnormal growths and other problems inside the uterus. A thin, telescope-like device with a light (hysteroscope) is inserted into the uterus through the vagina, allowing the doctor to view the inside of the uterus and the openings to the fallopian tubes.
When hysteroscopy is used as part of a surgical procedure, tiny instruments will be inserted through the hysteroscope. Hysteroscopy can be done along with a D&C. The procedure may be done with local, regional or general anesthesia depending upon whether other procedures are being done at the same time.
Staging is used to determine how far advanced the cancer is and to measure progress of the disease. Certain procedures are used in the staging process. A hysterectomy with bilateral salpingo-oophorectomy (removal of the uterus, ovaries and fallopian tubes) and pelvic lymph node dissection will usually be done to determine how far the cancer has spread. After reviewing test results, your doctor will tell you the stage of your cancer and discuss the best treatment options.
Endometrial cancers are staged as follows:
Stage I tumors have a five-year survival rate of 90-95%:
Stage IA: Tumor limited to the endometrium (uterine lining)
Stage IB: Invades the inner half of the myometrium (muscle wall of uterus)
Stage IC: Spreads to outer half of the myometrium
Stage II tumors have a five-year survival rate of 75%:
Stage IIA: Involvement of the cervical glands only
Stage IIB: Tumor invades cervical connective tissue
Stage III tumors have a five-year survival rate of 60%:
Stage IIIA: Tumor spreads to outermost layer of uterus, tissue just beyond the uterus and/or the peritoneum (membrane lining the abdominal cavity)
Stage IIIB: Spreads to vagina
Stage IIIC: Spreads to lymph nodes near the uterus
Stage IV tumors have a five-year survival rate of 15-26%:
Stage IVA: Tumor invades the bladder and/or bowel wall
Stage IVB: Spreads beyond the pelvis, including lymph nodes in the abdomen or groin
Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, help is available in many forms. Listed below are just some of the ways to find help...and hope.
Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support web sites or message boards for those who may not have access to a traditional meeting.
Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, tai chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression; and traditional Eastern medicine such as acupuncture.
Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.
Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.
Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers.
Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.