Uterine cancer occurs in the uterus, a hollow organ located between a woman’s bladder and rectum. Uterine cancer is the most common gynecologic cancer.
During pregnancy, the uterus is where the baby grows. There are three sections of the uterus:
- The cervix (the narrow lower portion that connects to the vagina)
- The fundus (the top section)
- The isthmus (the wide middle section)
The uterus also has three layers:
- The endometrium (the innermost layer)
- The myometrium (the thickest layer made up of mostly muscle)
- The serosa (the thin outer lining)
In addition to uterine cancer, there are also non-cancerous (benign) uterine conditions that can cause abdominal pain and abnormal uterine bleeding:
- Benign polyps
- Endometrial hyperplasia
There are two main types of uterine cancer:
- Adenocarcinoma: This type is responsible for more than 80% of uterine cancers. It forms in the endometrial cells.
- Sarcoma: This form of uterine cancer causes about 2 to 4% of cases and develops in the uterine muscle (myometrium) or supporting tissues of the uterine glands.
Uterine cancer that develops in the endometrium (the inner lining of the uterus) is also called endometrial cancer. When cancer occurs only in the cervix, it is called cervical cancer.
The following factors may increase your risk of uterine cancer:
- Being 50 or older (it is not common in women under age 45)
- Being white (however, Black women are more likely to be diagnosed with advanced uterine cancer and Black and Hispanic women are more likely to have aggressive tumors)
- Eating foods high in animal fat
- A personal or family history of uterine, ovarian or colorectal cancer
- A family history of Lynch syndrome
- Having fewer than five periods a year before menopause
- Obesity (about 70% of cases of uterine cancer are linked to obesity)
- Trouble getting pregnant
- Taking estrogen by itself as a hormone replacement
- Taking tamoxifen for breast cancer treatment
- Undergoing previous radiation therapy to the pelvic area
There are currently no proven ways to reduce your risk of uterine cancer. However, the following factors are associated with a lower risk:
- Taking birth control pills
- Using a progestin-secreting intrauterine device (IUD) for birth control
- Maintaining a healthy body weight
- Being physically active
- Taking progesterone if you take estrogen
- Managing your diabetes well
Some women with uterine cancer experience no symptoms. Others experience symptoms like:
- Abnormal vaginal bleeding, discharge or spotting (vaginal bleeding after menopause is a common sign that something is wrong)
- Abnormal Pap test results
- Pain the pelvic region
If your primary care provider or gynecologist thinks you may have uterine cancer, they may refer you to a gynecologic oncologist. The following tests may be used to diagnose uterine cancer:
- Pelvic exam: Your doctor will check your ovaries, uterus, vagina, bladder and rectum for abnormalities, such as a growth. A Pap test may also be done at this time.
- Endometrial biopsy: During a biopsy, a small sample of tissue is removed from the affected area of the body. This tissue is examined under a microscope for signs of cancer. A biopsy is the only way to make an official uterine cancer diagnosis.
- Dilation and curettage (D&C): This procedure is used to remove uterine tissue samples. It is often done along with a hysteroscopy, a procedure in which a physician inserts a thin, flexible tube with a light at its end to better see into the uterus.
- Transvaginal ultrasound: During this procedure, an ultrasound probe is inserted into the vagina and creates a picture of the uterus and surrounding tissues using sound waves.
- Computed tomography (CT) scan: A CT scan takes X-rays of the body from different angles to create a three-dimensional image that shows tumors or abnormalities.
- Magnetic resonance imaging (MRI): This test uses magnetic fields instead of X-rays to create images of the inside of the body. An MRI can also help your doctor measure the size of the tumor.
- Molecular testing: Your oncologist may recommend that your tumor be tested to identify its proteins, genes and other factors.
Staging is based on where your cancer started, if or where it has spread, and if or how it’s affecting other areas of the body. Here are the stages of uterine cancer:
- Stage I: The cancer is only located in the uterus and hasn’t spread elsewhere.
- Stage IA: The cancer is only found in the endometrium or in less than half of the myometrium.
- Stage IB: The tumor has spread to more than half of the myometrium.
- Stage II: The cancer has spread to the cervical stroma, but not elsewhere in the body.
- Stage III: The cancer has spread beyond the uterus to other organs in the pelvis.
- Stage IIIA: The tumor has spread to the serosa of the uterus and/or to the ovaries or fallopian tubes.
- Stage IIIB: The cancer has spread to the vagina or near the uterus.
- Stage IIIC1: The tumor has spread to the regional pelvic lymph nodes.
- Stage IIIC2: The cancer has spread to the para-aortic lymph nodes.
- Stage IV: The cancer has spread to the bladder, rectum or distant organs.
- Stage IVA: The tumor has spread to the mucosa of the bladder or rectum.
- Stage IVB: The cancer has spread to the lymph nodes in the groin and/or to distant organs like the lungs or bones.
In addition to staging the cancer, your doctor will also grade it to determine how much it looks like healthy cells under a microscope. The grades include:
- Grade X: The grade cannot be determined.
- Grade 1: The tumor tissue is well-differentiated and may grow slowly.
- Grade 2: The tissue is moderately differentiated (this is a less common grade).
- Grade 3: The tissue is poorly differentiated or undifferentiated, meaning that most or all cells in the tumor look abnormal. Grade 3 tumors often grow and spread quickly.
Your doctor will use staging and grading to determine what type of treatment is right for you.
Uterine cancer may come back after treatment and affect the uterus, abdominal lymph nodes, pelvic region or elsewhere in the body. If it recurs, it is usually within three years of the first diagnosis.
During uterine cancer treatment, you’ll be cared for by a multidisciplinary team. This team may include:
- A gynecologic oncologist
- A radiation oncologist
- A nurse navigator
- Nurse practitioners
- Physician assistants
- Oncology nurses
- Social workers
The treatment will depend on the type and the stage of the disease and may include:
- Surgery: You may need surgery to remove the tumor and surrounding tissue. Surgery is most often
the first treatment for uterine cancer. Common surgical procedures include:
- Hysterectomy: This includes a simple hysterectomy (removing the uterus and cervix) or a radical hysterectomy (removing the uterus, cervix, upper portion of the vagina and some surrounding tissues). If you’ve been through menopause, the surgeon may also perform a bilateral salpingo-oophorectomy to remove the ovaries and fallopian tubes.
- Lymph node removal: During the hysterectomy, the surgeon may also remove lymph nodes near the tumor to see if the cancer has spread.
- Radiation therapy: Radiation therapy may be used before surgery to help shrink the tumor, after surgery to kill any remaining cancer cells or instead of surgery if you aren’t eligible for surgery. Radiation therapy can be administered either as external radiation therapy (from outside the body) or internal radiation therapy (a radioactive substance is placed in or near the tumor). Radiation therapy may also help prevent cancer recurrence.
- Chemotherapy: Chemotherapy uses specific drugs to slow or kill cancer cells. With systemic chemotherapy, the medication is injected into a vein or given orally for specific types of uterine cancer. The goal of chemotherapy is to shrink the tumor and slow its growth.
- Targeted therapy: Targeted therapy is designed to identify and attack specific cancer cells without harming normal cells. Targeted therapies can also be used to activate cells to carry drugs, toxins or radioactive material directly to cancer cells.
- Hormone therapy: Hormone therapy may be used to slow the growth of certain types of uterine cancer cells. Hormone therapy may be given orally as a pill or through intrauterine devices (IUDs) and aromatase inhibitors (AIs).
- Immunotherapy: Immunotherapy can help your body’s natural defenses fight cancer.
Robotic Surgery for Uterine Cancer Treatment
Your gynecologic oncologist may recommend robotic surgery, a type of minimally invasive surgery. Robotic surgery gives your doctor more control, a better view and high-definition 3D vision during the procedure. Because this type of surgery requires just a few small incisions, you may experience:
- Quicker recovery
- Less blood loss and transfusions
- Reduced pain
- Less scarring
- Lower risk of infection
Ask your doctor if you’re eligible for robotic surgery.
If you have uterine cancer, you may be wondering if you’ll still be able to have children after treatment. If you’re pre-menopausal, talk with your physician about possible ways to preserve your fertility. You may be referred to a fertility specialist called a reproductive endocrinologist before you begin cancer treatment. Be sure to ask which fertility treatments (if any) your insurance will cover.
See Sarah Cannon’s blog on fertility preservation for more information.