About uterine cancer

Uterine cancer is the most common gynecologic cancer in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). It develops in the uterus, or womb, which is the pear-shaped organ in a woman’s pelvis where babies grow during pregnancy.

The average age for a uterine cancer patient is 60 years old, and the disease is uncommon in women under 45, the American Cancer Society (ACS) says. One of the most common symptoms is abnormal vaginal bleeding, which may include a change in periods, bleeding between periods or bleeding after menopause.

While uterine cancer may form in different areas of the uterus, the most common type starts in the inner uterine lining, the endometrium. Endometrial cancer is often diagnosed early and treated with surgery alone. Cancer that forms in the cervix of the uterus is not considered a uterine cancer; instead, it’s called cervical cancer.

At Cancer Treatment Centers of America^® (CTCA), our gynecologic oncology team uses evidence-based medicine to develop individualized treatment plans for each uterine cancer patient. Treatment plans may include surgery, chemotherapy or targeted therapy. Each patient’s treatment plan is tailored to her individual needs, including fertility-sparing surgery, which may be a potential option for women of child-bearing years. Your cancer care team may also include a dietitian, naturopathic provider and care manager. Our Survivorship Support program assists women who experience sexual side effects resulting from their treatment.

As in so many areas of cancer research, the exact cause of uterine cancer isn’t known.

Many of the risk factors connected to endometrial cancer affect the balance between estrogen and progesterone hormones in the body, the ACS says. Scientists have found either estrogen or progesterone receptors—or both—on endometrial cancer cells. They suspect that some interaction between these receptors and the hormones may cause increased endometrium growth, with the abnormal cell growth eventually significant enough to lead to cancer.

Many factors may increase the risk of endometrial cancer or uterine sarcoma, according to the American Society of Clinical Oncology (ASCO) and other groups. They include:

• Obesity, which is linked to about 70 percent of uterine cancer cases
• Elevated estrogen levels, which in some cases may be attributable to estrogen supplements in post-menopausal women or hormonal drugs being taken for other conditions>
• Diabetes
• Metabolic syndrome, such as some combination of high blood sugars, high blood pressure, high triglyceride levels and low levels of high-density lipoproteins in the blood
• Previous cancer diagnosis, particularly women who have had breast cancer colon cancer or ovarian cancer
• Genetics, including women whose families have a history of colon cancer, endometrial cancer or Lynch syndrome (a hereditary non-polyposis colorectal cancer)
• Increased menstrual cycles, either with periods starting before age 12 or menopause starting after age 55
• Tamoxifen, a drug used for treating breast cancer that acts as anti-estrogen in breast tissue but has the opposite effect in uterine tissue
• Endometrial hyperplasia, such as a thickening in the lining of the uterus
• Ovarian tumors
• Polycystic ovarian syndrome
• Pelvic radiation therapy
• No prior pregnancies

There is no known way to prevent uterine cancer, the CDC says, but some things may reduce your chance of getting the disease. One is having decreased estrogen levels, such as during pregnancy. Factors that may lower a woman’s risk of uterine cancer also include:

• Using birth control pills
• Maintaining a healthy weight and being physically active
• Taking progesterone if you’re also taking an estrogen supplement

Uterine cancer is most common in women over the age of 50, usually during or after menopause. While white women are more likely to be diagnosed with the disease, African-American women are more likely to have advanced uterine cancer and—along with Hispanic women—more aggressive tumors. Obese women also are at significantly higher risk of uterine cancer.

About 3.1 percent of women will be diagnosed with uterine cancer at some point during their lifetime, the National Cancer Institute (NCI) says. The ACS estimates that around 66,570 new cases of the cancer will be diagnosed in the United States in 2021.

The types of uterine cancer fall into two main categories:

• Adenocarcinoma, or endometrial cancer, which makes up more than 90 percent of uterine cancers. It develops in cells in the endometrium, the inner lining of the uterus. A common subtype of this cancer is endometrioid carcinoma. Other less common subtypes include serous adenocarcinoma, adenosquamous carcinoma, uterine clear-cell carcinoma and uterine carcinosarcoma (a mix of adenocarcinoma and sarcoma).

• Uterine sarcoma, which develops in the myometrium—the uterine muscle or wall—or in the supporting tissues of the uterine glands. Endometrial sarcoma subtypes include uterine leiomyosarcoma, endometrial stromal sarcoma and undifferentiated sarcoma.

Uterine cancer is often detected early because of abnormal vaginal bleeding, which occurs in about 90 percent of women with endometrial cancer.

Other symptoms of endometrial cancer may include:

• Difficult or painful urination
• Pain during intercourse
• Unusual vaginal discharge that does not have signs of blood
• Pain and/or a mass in the pelvic area
• Unintentional weight loss

Other symptoms for a uterine tumor may include:

• Frequent urination
• Abdominal pain
• A lump or growth in the vagina
• Feeling full at all times

The following procedures or tests may be used to diagnose uterine cancer:

• Pelvic exam
• Endometrial biopsy
• Sentinel lymph-node biopsy
• Dilation & curettage (D&C) with hysteroscopy
• Imaging tests, including ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI)
• Lab tests, including advanced genomic testing and CA-125 blood test

The first line of treatment for uterine cancer is often surgery, although it may be combined with other treatments depending on the disease’s stage and type. Types of surgery include:

• Simple hysterectomy, which removes the uterus and the cervix
• Radical hysterectomy, which removes the uterus, cervix, ovaries, fallopian tubes, surrounding parametria tissue and the upper part of the vagina
• Lymphadenectomy, which removes lymph nodes in the pelvis and is typically performed with a hysterectomy

Other treatment options may include:

• Chemotherapy
• Immunotherapy
• Radiation therapy
• Targeted therapy
• Hormone therapy