Uterine Cancer

Uterine cancer begins in the uterus, a hollow, pear-shaped organ in the pelvis where a fetus grows during pregnancy. Most uterine cancers begin in the lining of the uterus, called the endometrium. This type is often called endometrial cancer.

Uterine cancer is different from uterine sarcoma, a rare cancer that starts in the muscle wall of the uterus or in the supporting tissues. The type and stage of uterine cancer help guide treatment options.

Types & Stages

Types of uterine cancer include:

• Endometrioid adenocarcinoma forms in the glandular cells of the uterine lining. This is the most common type of uterine cancer and accounts for many endometrial cancer diagnoses.
   
• Serous adenocarcinoma is a less common but more aggressive type of endometrial cancer. It is more likely to spread to lymph nodes and other parts of the body.
   
• Adenosquamous carcinoma is a rare form of uterine cancer that has features of both adenocarcinoma and squamous cell carcinoma.
   
• Carcinosarcoma is a rare and aggressive form of uterine cancer that has features of both carcinoma and sarcoma. It was once thought to be a type of uterine sarcoma, but it is often treated more like a high-risk endometrial cancer.

A rare type of uterine cancer is called uterine sarcoma. Uterine sarcoma develops in the muscle wall of the uterus or in supporting tissues rather than in the endometrium. Types may include:

• Leiomyosarcoma
• Low-grade endometrial stromal sarcoma
• High-grade undifferentiated sarcoma
• Adenosarcoma
• Adenosarcoma with sarcomatous overgrowth
• Perivascular epithelioid cell tumor, also called PEComa

Uterine cancer stages describe how far the cancer has spread:

• Stage I means the cancer is found only in the uterus.
• Stage II means the cancer has spread from the uterus to the cervix but not outside the uterus.
• Stage III means the cancer has spread beyond the uterus to nearby tissues, the vagina, ovaries, fallopian tubes or nearby lymph nodes.
• Stage IV means the cancer has spread to the bladder, rectum or distant parts of the body, such as the lungs, liver or bones.

Your care team will consider the cancer type, stage, grade, tumor features and your overall health when recommending treatment.

Signs & Symptoms

Visit a doctor if you are experiencing symptoms that are new, unusual for you or do not go away.

Symptoms of uterine cancer may include:

• Vaginal bleeding that is not normal for you
• Bleeding after menopause
• Bleeding between periods
• Periods that are heavier or longer than usual
• Vaginal discharge that is not normal for you
• Pelvic pain or pressure
• Pain during sex
• Pain or difficulty urinating
• A lump or feeling of fullness in the lower abdomen
• Unexplained weight loss

Abnormal bleeding is the most common symptom of endometrial cancer. Bleeding after menopause is never considered normal and should be checked by a healthcare provider right away.

Many symptoms of uterine cancer can be caused by conditions that are not cancer. The only way to know the cause is to see a doctor.

Diagnosis

Tests and procedures used to diagnose uterine cancer may include:

• Pelvic exam. During a pelvic exam, your doctor checks the reproductive organs. The doctor carefully inspects the outer genitals, inserts gloved fingers into the vagina and presses on the abdomen to feel the uterus and ovaries. A device called a speculum may also be inserted into the vagina so the doctor can view the vagina and cervix.
   
• Imaging tests. Imaging tests, such as MRI or CT scans, can help your doctor learn more about the cancer’s location, size and whether it may have spread.
   
• Transvaginal ultrasound. During this test, a wand-like device called a transducer is inserted into the vagina. The transducer uses sound waves to create images of the uterus. This test can show the thickness and texture of the endometrium and may help rule out other causes of symptoms.
   
• Hysteroscopy. During a hysteroscopy, your doctor inserts a thin, flexible, lighted tube through the vagina and cervix into the uterus. This tube, called a hysteroscope, allows the doctor to examine the inside of the uterus and the endometrium.
   
• Endometrial biopsy. During an endometrial biopsy, a small sample of tissue is removed from the lining of the uterus. This is often done in a doctor’s office. The tissue is sent to a lab and checked for cancer cells.
   
• Dilation and curettage, also called D and C. If enough tissue cannot be collected during a biopsy or if biopsy results are unclear, your doctor may recommend a D and C. During this procedure, tissue is scraped from the lining of the uterus and examined under a microscope.
   
• Tumor testing. If cancer is found, the tumor may be tested for certain gene or protein changes. This information can help guide treatment options, including targeted therapy or immunotherapy in some cases.
   
• Genetic testing. Your doctor may recommend genetic counseling and testing if your personal or family history suggests an inherited cancer syndrome, such as Lynch syndrome. This can help guide your care and may be important for family members.

Treatment

Treatment for uterine cancer depends on the type and stage of cancer, whether it has spread, tumor features, your overall health and your personal goals.

Treatment may include:

• Hysterectomy is surgery to remove the uterus. In many cases, the fallopian tubes and ovaries are removed at the same time. This is often called a total hysterectomy with bilateral salpingo-oophorectomy, or TH/BSO. Nearby lymph nodes or other tissues may also be removed to help determine the stage of cancer.
   
• Minimally invasive laparoscopy can be used to remove the uterus and other tissues through very small incisions in the abdomen. During this procedure, the surgeon uses a laparoscope, which is a thin, lighted tube with a video camera at the tip. The camera projects images onto a screen, and the surgeon operates through small surgical ports using special instruments.
   
• Robotic-assisted minimally invasive surgery may be used for staging and treatment. Robotic surgery gives the surgeon enhanced vision, depth perception and precise instrument control. Compared with traditional open surgery, minimally invasive surgery may offer benefits such as faster recovery, fewer wound complications and less postoperative pain for some patients.
   
• Pelvic exenteration is a radical surgery that may be used in select advanced or recurrent cases. It removes the reproductive organs and, in some cases, the bladder, urethra, rectum or other nearby tissues. Reconstructive surgery may be done afterward to help restore body functions.
   
• Panniculectomy with hysterectomy and staging may be an option for some patients who have excess abdominal skin and fat. A panniculectomy removes excess skin and underlying fat from the abdominal area and may be combined with cancer surgery in select cases.
   
• Radiation therapy uses high-energy beams or internal radiation to kill cancer cells. It may be used after surgery to lower the risk of cancer coming back, or it may be used as a main treatment when surgery is not an option.
   
• Chemotherapy uses medicines to kill cancer cells or slow their growth. It may be recommended for cancers that are higher risk, advanced, recurrent or more likely to spread.
   
• Hormone therapy uses medicines to block hormones or lower hormone levels that may help some uterine cancers grow. It may be used for certain types of endometrial cancer, especially in select advanced or recurrent cases.
   
• Targeted therapy uses medicines that attack specific features of cancer cells. Tumor testing can help determine whether targeted therapy may be an option.
   
• Immunotherapy helps the immune system recognize and attack cancer cells. It may be used for some advanced or recurrent uterine cancers with certain tumor features.

Clinical trials may also be available. These research studies test new treatments or new ways to use current treatments. Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

The exact cause of uterine cancer is not always known. Uterine cancer begins when cells in the uterus develop changes in their DNA that cause them to grow out of control.

Factors that may increase uterine cancer risk include:

• Age. Uterine cancer can occur at any age, but it is more common after menopause.
   
• Changes in hormone balance. Higher levels of estrogen without enough progesterone can increase the risk of endometrial cancer.
   
• Estrogen-only hormone therapy. Taking estrogen without progesterone after menopause can increase risk in people who still have a uterus.
   
• Obesity. Fat tissue can increase estrogen levels, especially after menopause. This can raise the risk of endometrial cancer.
   
• Never being pregnant. People who have never been pregnant may have a higher risk than those who have had at least one pregnancy.
   
• More years of menstruation. Starting periods at a young age or going through menopause later increases the number of years the endometrium is exposed to estrogen.
   
• Polycystic ovary syndrome, also called PCOS. PCOS can affect hormone levels and may increase risk.
   
• Endometrial hyperplasia. This condition causes thickening of the uterine lining. Some forms, especially atypical hyperplasia, can raise the risk of cancer.
   
• Tamoxifen. Tamoxifen, a medicine used to treat or help prevent breast cancer, can slightly increase the risk of endometrial cancer. For many people, the benefits of tamoxifen outweigh this rare risk.
   
• Diabetes, high blood pressure and metabolic syndrome. These conditions are linked with a higher risk of endometrial cancer, especially when they occur with obesity.
   
• Family history or inherited conditions. Lynch syndrome and some other inherited conditions can increase the risk of uterine cancer. A family history of uterine, colon, ovarian or certain other cancers may also increase risk.
   
• Previous pelvic radiation therapy. Radiation to the pelvis for another cancer may increase the risk of uterine cancer later in life.
   
• Race and ethnicity. Some groups have a higher risk of being diagnosed with more aggressive uterine cancers or later-stage disease.

Some factors may lower risk for some people, including pregnancy, breastfeeding, physical activity, maintaining a healthy weight and certain hormonal contraceptives. These factors do not remove the risk completely. Talk with your healthcare provider about your personal risk.

Screening

There is no recommended routine screening test for uterine cancer for people at average risk who do not have symptoms.

A Pap test screens for cervical cancer, not uterine cancer. HPV testing also helps screen for cervical cancer, but it does not screen for uterine, ovarian, fallopian tube, peritoneal, vaginal or vulvar cancers.

Tests that may be used to evaluate symptoms or higher-risk patients include:

• Pelvic exam. A pelvic exam may help your provider check for changes in the uterus, cervix, ovaries and other pelvic organs, but it is not a reliable screening test for uterine cancer.
   
• Transvaginal ultrasound. This test may be used to look at the thickness of the uterine lining, especially if you have abnormal bleeding.
   
• Endometrial biopsy. This test removes a small sample of tissue from the uterine lining and is commonly used to evaluate abnormal bleeding.

People with Lynch syndrome or a strong family history of uterine or colorectal cancer should talk with a healthcare provider or genetic counselor about their risk and whether any special monitoring is recommended.

If you have abnormal vaginal bleeding or discharge, especially after menopause, do not wait for a screening test. Talk with a healthcare provider right away.