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 percent 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 percent may occur before menopause. The survival rate for all stages of uterine cancer is approximately 84 percent, but if diagnosed at its earliest stage, survival increases to 90-95 percent.
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:
- Premenopausal or perimenopausal bleeding
- Abnormal vaginal discharge
- Pelvic pain or pressure, usually occurring in later stages of the disease
- Weight loss
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 percent:
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 percent:
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 percent:
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 percent
Stage IVA: Tumor invades the bladder and/or bowel wall
Stage IVB: Spreads beyond the pelvis, including lymph nodes in the abdomen or groin
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 or can be done as an outpatient where the seeds remain in place for a shorter time. 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.
New treatments are always being tested in clinical trials and some patients with cancer may want to consider participating in one of these research studies.
These studies are meant to help improve current cancer treatments or obtain information on new treatments. Talk to your doctor about the clinical trials that may be right for you.