Overview
Uterine cancer (also known as endometrial cancer) is the most common cancer of the female reproductive system. The uterus is hollow and shaped like a pear and located in a woman’s pelvis between her bladder and rectum. The uterus is also known as the womb, where a baby grows when a woman is pregnant. It has three sections: the cervix (the narrow, lower section), the corpus (the broad, middle section), and the fundus (the dome-shaped top section). The inside of the uterus (the wall) has two layers of tissue: endometrium (an inner layer), and myometrium (the outer layer), which is muscle tissue.
Every month during a woman’s childbearing years, the lining of the uterus grows and thickens in preparation for pregnancy. If the woman does not get pregnant, this lining, which is bloody and thick, passes out of her body through her vagina during menstruation. This process continues until menopause.
Uterine cancer begins when cells in the uterus begin to change, grow uncontrollably, and eventually form a tumor. Tumors can be benign (noncancerous) or malignant (cancerous). Noncancerous conditions of the uterus include fibroids (benign tumors in the muscle of the uterus), endometriosis (endometrial tissue on the outside of the uterus or other organs), and endometrial hyperplasia (an increased number of cells in the uterine lining).
There are two types of uterine cancer.
Adenocarcinoma – This type of cancer makes up more than 95% of uterine cancers. It develops from cells in the lining of the uterus, the endometrium. This cancer is also commonly called endometrial cancer.
Sarcoma- This form of uterine cancer develops in the uterine muscle, the myometrium. Sarcomas account for only 2% to 4% of uterine cancers.
Risk factors
Age – Uterine cancer most often occurs in women over age 50; the average age is 60.
Ethnicity – White women are more likely to develop uterine cancer than black women.
Genetics – Uterine cancer may run in families where colon cancer is hereditary.
Other health conditions – Women may be at increased risk for uterine cancer if they have had endometrial hyperplasia (an increased number of cells in the uterine lining) or if they have diabetes.
Other cancers – Women who have had breast, colon, or ovarian cancers are at increased risk for uterine cancer.
Tamoxifen – Women taking the drug tamoxifen to prevent or treat breast cancer are at increased risk for developing uterine cancer. However, the benefits of tamoxifen may outweigh the risk of developing uterine cancer, so women should discuss the benefits and risks of tamoxifen with their doctor.
Radiation therapy – Women who have had prior radiation treatment in the pelvic area for another cancer are at increased risk for uterine cancer.
Diet – Women who eat a diet high in animal fat are at increased risk for uterine cancer.
Estrogen – Exposure to estrogen and/or an imbalance of estrogen is relevant to many of the following risk factors:
- Women who started having their periods before age 12 and/or go through menopause later in life.
- Women who take hormone replacement therapy after menopause, especially if they are only taking estrogen (estrogen with progesterone poses a lower risk).
- Women who have never had children
Obesity – Fatty tissue in overweight women produces additional estrogen, which can increase the risk of uterine cancer.
Signs & Symptoms
The most likely time for uterine cancer to occur is after menopause. The most common symptom of uterine cancer is abnormal vaginal bleeding, ranging from watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding during menopause is not normal and, therefore, always a sign of some problem.
Unusual vaginal bleeding, spotting or discharge
Difficulty or pain when urinating
Pain during intercourse
Pain in the pelvic area, the lower part of the abdomen between the hip bones
Diagnosis as per modern science
Physical exam and history – An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Pelvic exam – An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
Pap test – A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear. Because uterine sarcoma begins inside the uterus, this cancer may not show up on the Pap test.
Dilatation and curettage – A surgical procedure to remove samples of tissue or the inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped instrument) is inserted into the uterus to remove tissue. Tissue samples may be taken for biopsy. This procedure is also called a D&C.
Endometrial biopsy – The removal of tissue from the endometrium (inner lining of the uterus) by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples. A pathologist views the tissue under a microscope to look for cancer cells.
Staging
Stage I – In stage I, cancer is found in the uterus only.
Stage II – In stage II, cancer has spread from the uterus to the cervix.
Stage III – In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis.
Stage IV – In stage IV, cancer has spread beyond the pelvis. Cancer has spread to the bladder and/or bowel wall, including lymph nodes in the abdomen and/or groin.
