About uterine cancer
What is uterine cancer?
The uterus is part of a woman's reproductive system. It's a hollow organ in the pelvis.
The uterus has three parts:
- Top: The top (fundus) of your uterus is shaped like a dome. From the top of your uterus, the fallopian tubes extend to the ovaries.
- Middle: The middle part of your uterus is the body (corpus). This is where a baby grows.
- Bottom: The narrow, lower part of your uterus is the cervix. The cervix is a passageway to the vagina.
The wall of the uterus has two layers of tissue:
- Inner layer: The inner layer (lining) of the uterus is the endometrium. In women of childbearing age, the lining grows and thickens each month to prepare for pregnancy. If a woman does not become pregnant, the thick, bloody lining flows out of the body. This flow is a menstrual period.
- Outer layer: The outer layer of muscle tissue is the myometrium.
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the uterus and the other organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Tumors in the uterus can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:
- Benign tumors (such as a fibroid, a polyp, or endometriosis):
- are usually not a threat to life
- can be treated or removed and usually don't grow back
- don't invade the tissues around them
- don't spread to other parts of the body
- Malignant growths:
- may be a threat to life
- usually can be removed but can grow back
- can invade and damage nearby tissues and organs (such as the vagina)
- can spread to other parts of the body
Cancer cells can spread by breaking away from the uterine tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lung, liver, bone, or brain. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about uterine cancer that has spread.
What are the symptoms for uterine cancer?
You might not notice symptoms of cervical cancer until it’s far along. They may include:
- Pain when you have sex
- Unusual vaginal bleeding, such as after sex, between periods, after menopause, or after a pelvic exam
- Unusual vaginal discharge
After it has spread, the cancer can cause:
- Pelvic pain
- Trouble peeing
- Swollen legs
- Kidney failure
- Bone pain
- Weight loss and lack of appetite
What are the causes for uterine cancer?
The most common cause of uterine cancer is the uncontrolled proliferation of abnormal cells in the uterus.
- Genetics: A family history of uterine cancer may increase your risk of developing it yourself.
- Age: The risk for uterine cancer increases with age. Most cases occur in women over 50 years old.
- Diet: Being overweight or obese increases your risk of developing uterine cancer, as well as other cancers. Eating a healthy diet high in fruits and vegetables may help reduce your risk of developing uterine cancer by up to 40%.
What are the treatments for uterine cancer?
Different types of treatment are available for patients with endometrial cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Five types of standard treatment are used:
Surgery (removing cancer in an operation) is the most common treatment for endometrial cancer. The following surgical procedures may be used:
- Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
- Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
- Radical hysterectomy: Surgery to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
- Lymph node dissection: A surgical procedure in which the lymph nodes are removed from the pelvic area and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy.
After the doctor removes all cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or hormone treatment after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that cancer will come back, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward cancer.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near cancer.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy is used to treat endometrial cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies, mTOR inhibitors, and signal transduction inhibitors are three types of targeted therapy used to treat endometrial cancer.
- Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Bevacizumab is used to treat stage III, stage IV, and recurrent endometrial cancer.
- mTOR inhibitors block a protein called mTOR, which helps control cell division. mTOR inhibitors may keep cancer cells from growing and prevent the growth of new blood vessels that tumors need to grow. Everolimus and ridaforalimus are used to treat stage III, stage IV, and recurrent endometrial cancer.
- Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Metformin is being studied to treat stage III, stage IV, and recurrent endometrial cancer.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country.
Follow-up tests may be needed.
Some of the tests that were done to diagnose cancer or to find out the stage of cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment options by stage
Stage I and stage II endometrial cancer
Low-risk endometrial cancer (grade 1 or grade 2)
Treatment of low-risk stage I endometrial cancer and stage II endometrial cancer may include the following:
- Surgery (total hysterectomy and bilateral salpingo-oophorectomy). Lymph nodes in the pelvis and abdomen may also be removed and viewed under a microscope to check for cancer cells.
- Surgery (total hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen) followed by internal radiation therapy. In certain cases, external radiation therapy to the pelvis may be used in place of internal radiation therapy.
- Radiation therapy alone for patients who cannot have surgery.
- A clinical trial of a new chemotherapy regimen.
If cancer has spread to the cervix, a radical hysterectomy with bilateral salpingo-oophorectomy may be done.
High-risk endometrial cancer (grade 3)
Treatment of high-risk stage I endometrial cancer and stage II endometrial cancer may include the following:
- Surgery (radical hysterectomy and bilateral salpingo-oophorectomy). Lymph nodes in the pelvis and abdomen may also be removed and viewed under a microscope to check for cancer cells.
- Surgery (radical hysterectomy and bilateral salpingo-oophorectomy) followed by chemotherapy and sometimes radiation therapy.
- A clinical trial of a new chemotherapy regimen.
Stage III, stage IV, and recurrent endometrial cancer
Treatment of stage III endometrial cancer, stage IV endometrial cancer, and recurrent endometrial cancer may include the following:
- Surgery (radical hysterectomy and removal of lymph nodes in the pelvis so they can be viewed under a microscope to check for cancer cells) followed by adjuvant chemotherapy and/or radiation therapy.
- Chemotherapy and internal and external radiation therapy for patients who cannot have surgery.
- Hormone therapy for patients who cannot have surgery or radiation therapy.
- Targeted therapy with mTOR inhibitors (everolimus or ridaforolimus) or a monoclonal antibody (bevacizumab).
- A clinical trial of a new treatment regimen that may include combination chemotherapy, targeted therapy, such as an mTOR inhibitor (everolimus) or signal transduction inhibitor (metformin), and/or hormone therapy, for patients with advanced or recurrent endometrial cancer.
What are the risk factors for uterine cancer?
Uterine cancer is a type of cancer that affects the uterus. It can either be invasive or non-invasive, and it’s a leading cause of death among women. The risk factors for uterine cancer vary based on type, but they include:
- Age: The most common age range for uterine cancer is between 50 and 55 years old, but it also occurs in younger women and older women alike.
- Menopause: If you were to undergo a hysterectomy at an early age, like before you hit menopause, you might be more likely to develop uterine cancer than if you had your uterus removed later in life. This is because younger women tend to have more estrogen in their bodies than older women do—and estrogen has been linked to uterine cancer development.
- Family history: If someone in your family had had uterine cancer before (especially if it was invasive), then there’s a greater chance that you might develop it as well.
- Personal history of breast or endometrial cancer (uterine cancer) in other family members (heredity).
- Estrogen replacement therapy: Women who take hormones after menopause have an increased risk of developing uterine cancer. The longer they take them, the higher their risk will be.
- Infertility treatments: People who have had infertility treatment such as in vitro fertilization have an increased risk of developing uterine cancer because they are exposed to high levels of estrogen over time.