Uterine Cancer

Uterine cancer is a type of cancer that begins in the uterus. The uterus is an important female reproductive organ. It is a hollow, muscular organ where a fetus grows. Uterine cancer can start in different parts of the uterus. Most uterine cancers start in the endometrium (the inner lining of the uterus). This is called endometrial cancer. Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make mucus and other fluids). Uterine sarcoma is an uncommon form of uterine cancer that forms in the muscle and tissue that support the uterus.

Uterine cancer usually occurs after menopause. Obesity, certain inherited conditions, and taking estrogen alone (without progesterone) can increase the risk of endometrial cancer. Radiation therapy to the pelvis can increase the risk of uterine sarcoma. Taking tamoxifen for breast cancer can increase the risk of both endometrial cancer and uterine sarcoma.

Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer. Uterine sarcoma is harder to cure.

Signs and symptoms of uterine cancer may include:

• vaginal bleeding after menopause
• bleeding between periods
• an abnormal, watery or blood-tinged discharge from your vagina
• pelvic pain
• pain during intercourse
• troubling urinating

The cause of most uterine cancers is unknown. In general, something prompts cells in the uterus to mutate or change. The genetic mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they do not die at a set time. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).

Tests and procedures used to diagnose endometrial cancer include:

• pelvic examination
• ultrasound to create a picture of your uterus
• hysteroscope to examine your endometrium
• removing a sample of tissue for testing (biospy)
• performing surgery to remove tissue for testing

If you have or have had uterine cancer, you can take steps to manage the stress that accompanies the diagnosis.

• Learn about uterine cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.

The treatments for uterine cancer are based on the type and stage of the cancer, your overall health, and your preferences. Four types of standard treatment are used, alone or in combination: surgery, radiation therapy, chemotherapy, and hormone therapy.

Surgery. Surgery is the main treatment for most women with endometrial cancer. The surgery will remove the uterus (hysterectomy), as well as the ovaries and fallopian tubes (salpingo-oophorectomy). A hysterectomy can cure early-stage endometrial cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant.

Radiation. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink a tumor or after surgery to kill any remaining cancer cells. Radiation therapy can be given externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy), or internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes.

Chemotherapy. Chemotherapy uses medications, usually injected into a vein, to kill cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable.

Drugs approved to treat uterine cancer include:

• paclitaxel (Taxol)
• carboplatin
• doxorubicin (Adriamycin) or liposomal doxorubicin (Doxil)
• cisplatin
• ifosfamide (Ifex)

Hormone therapy. This type of treatment uses hormones or hormone-blocking drugs to fight cancer. Hormone treatment for endometrial cancer can include:

• progestins such as medroxyprogesterone acetate (Provera) and megestrol acetate (Megace)
• lutenizing hormone releasing hormone agonists such as goserelin (Zoladex) and leuprolide (Lupron)
• aromatase inhibitors such as letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin)