Uterine & Endometrial Cancer
What is uterine and endometrial cancer?
Uterine cancer is a cancer that grows in the uterus, also known as the ‘womb’. This is the organ in a woman’s pelvis where a baby would grow during a pregnancy. The innermost lining of the womb is known as the endometrium. Endometrial cancer is a cancer that grows in the innermost lining of the uterus and is the most common type of cancer associated with the uterus (95% of uterine cancers).
How would I know that I have endometrial or uterine cancer?
The most common sign of endometrial cancer and uterine cancers is vaginal bleeding. Since most women have normal menstrual cycles (also called a monthly ‘period’) up until menopause, this makes diagnosing these cancers more difficult in women who have not yet reached menopause. Menopause is the time in a woman’s life where the ovaries make less hormone, and the monthly cycle becomes irregular or stops altogether.
So, how would you know what is normal and not normal? For women who have not yet reached menopause a normal period should be an episode of bleeding that happens about every 20-35 days and lasts for 2-7 days. Bleeding or spotting, not related to a normal monthly cycle or bleeding that occurs in between the normal monthly menses is concerning for the possibility of cancer. Menstrual bleeding that becomes heavier than usual in women who have not achieved menopause should also raise suspicion for the possibility of cancer. Menopause is when you have not had a period for a one year period and usually comes with other symptoms such as hot flashes. MOST women have menopause by age 55. ANY vaginal bleeding after menopause or age 55 is also concerning. Unusual vaginal discharge without bleeding or with a foul unusual odor is also not normal. Pain or bleeding with sexual intercourse or vaginal penetration can also be a symptom of this type of cancer. When a woman is transitioning into menopause, periods can become irregular, and any extra bleeding should be brought to the attention of your doctor.
Pelvic cramping, like a period is also a very common symptom of uterine cancer. There are many reasons for a woman to have pelvic cramping, but if you have a change or increase in this that is not typical for you and this lasts for more than a week or two you should discuss this with your doctor, especially if you have already had menopause.
The uterus lies directly behind the bladder. If the uterus grows abnormally, this can place pressure on the bladder and lead to a change in urination. Difficulty urinating, painful urination, or frequent urination may signal abnormal growth in the uterus if the cause of the change is determined not to be coming from an infection of the urine.
Finally, as the womb grows, just like in pregnancy, the pelvis or lower part of the abdomen may begin to enlarge just like with pregnancy. An enlarging abdomen or pelvis, without pregnancy, and with or without pain may be a symptom of a cancer of the uterus or endometrium. Women may notice an unintended change in weight with either weight gain or weight loss. Weight loss can occur because the appetite may change with onset of cancer. The appetite may decrease or you may feel full without eating much at all.
Again, these symptoms may not be caused by cancer since other things can also cause these findings. However, if you are experiencing any of these symptoms, please be sure to let your physician or nurse know right away.
How is uterine or endometrial cancer diagnosed?
Your provider will often begin with your history, your family history, and your symptoms followed by a physical exam. This exam should include a thorough pelvic exam performed by an experienced provider such as a gynecologist, family practitioner, or mid-level provider experienced in performing gynecologic exams.
Next steps may include blood tests, a biopsy, or imaging studies. A biopsy is a collection of tissue and cells used to try to detect abnormal (or cancer) cells. A collection from the uterine lining can be performed in the office during a pelvic exam with a minimum amount of discomfort. This sample must be sent to a pathology lab where it will be examined by a specialist trained to look for different types of cells. It may take several days to get the results.
Imaging studies may also be ordered by your provider and may include tests like an ultrasound (high frequency sound waves), a CT scan (detailed x-ray images combined together to recreate an image of your internal organs, tissues, and bones), or an MRI (using radio frequency images, magnets, and computers to generate an internal image of organs, tissues, and bones without the use of radiation). These imaging tests are not usually painful. They may take several days to schedule and perform, and they will need to be reviewed by a radiologist before final results are available.
When the results of the exam, blood tests, and imaging studies are obtained, you should then meet with your provider to plan the next steps of care. If there is any concern for a possible cancer, your provider should consider referral to a specialist such as a Gynecologic Oncology specialist for the best treatment options, or, next steps in your care.
What is a stage of a uterine cancer?
The stage of a cancer is a way in which doctors describe where the cancer is. Staging defines the size, extent, and location(s) of your cancer. It is a description of how deeply the cancer has invaded into the uterus muscle. It states whether the cancer has spread to other organs near the uterus or more distant. It also describes whether or not local or distant lymph nodes contain cancer cells. Stages are designated by Roman numerals I-IV and refer to the location of the tumor involvement. Subdivisions A, B, and C are used to help define the extent (depth and location) of tumor involvement.
Stage 0– Carcinoma in situ. This is a precancerous growth of abnormal cells which is found only on the innermost surface layer of the endometrium. It has not spread into the uterus, the lymph nodes or to distant sites.
Stage I– This is the first and lowest stage of uterine cancer and is divided into A and B.
Stage IA – The cancer cells have grown into the muscular layer of the uterus but has not grown beyond halfway through the entire depth of the uterus.
Stage IB – The cancer cells have grown beyond halfway into the muscular layer, but has not spread beyond the uterus organ itself.
Stage II– The cancer cells have grown beyond the body of the uterus and into the surrounding supporting tissue of the cervix. The cervix is a tubular shaped section of tissue that connects the vagina and the lowermost portion of the uterus.
Stage III– This stage is divided into Stage IIIA, IIIB, IIIC1, and IIIC2.
Stage IIIA – The cancer has spread to the outside covering of the uterus and/or to the fallopian tubes or ovaries. It has not spread to lymph nodes.
Stage IIIB – The cancer has spread to the vagina or parametria (supporting tissue surrounding the uterus). It has not spread to the lymph nodes.
Stage IIIC1 – Spread of the cancer to pelvic lymph nodes.
Stage IIIC2 – Spread of the cancer to the lymph nodes around the aorta, with or without spread to the pelvic lymph nodes.
Stage IV– This stage is the most advanced stage of uterine cancer.
Stage IVA – The cancer has spread to the bladder or to the bowel directly surrounding the uterus.
Stage IV B – The cancer has spread to more distant sites such as the lymph nodes, peritoneum (lining of the abdomen), lung, liver, or bones.
What does the grade of my tumor mean?
The grade of the cancer is determined by how aggressive (how rapidly tumor cells reproduce) the tumor cells appear to be under microscope evaluation.
Grades range from 1-3. The least aggressive grade is 1 and the most aggressive grade is 3.
What about uterine sarcomas?
Uterine sarcomas are rare, making up about 4% of all uterus cancers. They develop in the muscle wall (rather than the endometrial lining of the uterus) and grow in distinctly different ways depending upon the type. There are essentially three types of sarcomas:
This is the most common type of uterine sarcoma and it develops from the muscle cells of the uterus called the myometrium.
Endometrial stromal sarcoma
This type of tumor grows from cells of the supportive tissue of the uterus called stroma. This is typically the slowest growing type of uterine
This type of tumor grows from cells similar to the stromal sarcoma, but its cells are very aggressive, meaning it grows and spreads more quickly than the other types of uterine sarcomas.
How did I get uterine cancer?
Uterine cancers are the most common gynecologic cancer. The average age of diagnosis is age sixty-two, and the vast majority of women are over the age of fifty years at the time of diagnosis. Women are also at higher risk to develop uterine cancers if they started having periods early in life and have later menopause, or, if they have never had a baby. Taking any hormonal birth control such as the pill, hormonal IUDs or shots lowers the risk of endometrial cancer. Pregnancy and breastfeeding lowers the risk of endometrial cancer.
In general, women are at higher risk to develop uterine cancer if their bodies have been exposed to higher levels of estrogen either because they produce more estrogen, or they have taken medications that increase estrogen without having an opposing rise in the hormone progestin. Being overweight is the most common risk factor in the United states for endometrial cancer. This is because fat cells can make estrogen from other substances in our bodies. Not ovulating regularly from hormonal problems such as polycystic ovarian syndrome also increases the risk of endometrial cancer, unless the woman is taking progesterone or other birth control.
What are treatments for Uterine Cancers?
There are several treatment options for uterine cancers. Your doctor may recommend one or more of the following treatments. Be aware that surgery is not always the first treatment option but it is for most women what is recommended.
1. Surgery– most women with uterine cancer require a surgical procedure called a hysterectomy. This procedure can be performed as an “open” procedure which requires a large incision on the abdomen through which the uterus, tubes and ovaries are removed.
Or, the procedure can be done minimally invasive through several small incisions through which instruments can be introduced to perform the surgery. Minimally invasive surgery can be done laparoscopically or robotically.
A hysterectomy is defined as surgical removal of the uterus, fallopian tubes, cervix, and ovaries.
A radical hysterectomy is defined as the removal of the uterus, fallopian tubes, cervix, ovaries and parametria (supportive tissue surrounding the uterus).
Lymphadenectomy/Lymph node dissection is often performed at the time of surgery if a cancer is suspected or diagnosed.
This is defined as surgical removal of lymph nodes along the chain of lymph drainage where cancer is most likely to spread. This often includes lymph nodes in the pelvis and sometimes around the aorta. If a dye has been injected into the cervix prior to the surgery and the dye traces the lymphatic chain, the nodes that take up the dye are called sentinel lymph nodes. A sentinel lymph node dissection is surgical removal of these nodes.
2. Chemotherapy – Depending upon the stage and type of your cancer (see prior information on stages of cancer), your doctor may recommend chemotherapy to treat your cancer. Sometimes the chemotherapy is done before the surgery and sometimes it is started after the chemotherapy. And, on occasion, chemotherapy is started before surgery and several cycles may be given before and after surgery. These decisions are made based upon your Oncology doctor/surgeon, and national recommendations for Gynecologic Cancer treatment.
3. Radiation– Radiation can be performed from an external beam source or from placement of an internal source. For gynecologic cancers, either type may be recommended and consultation from a Radiation Oncologist is often obtained to help with decision making. External radiation can cover a large area of concern while internal radiation is delivered locally to the area of concern. Internal radiation is often in the from of implanted radiation sources called brachytherapy. This procedure allows a higher concentration of radiation to be delivered closer to the areas of concern for cancer. It is often done together with, or following external beam radiation.
4. Hormone therapy– certain types of endometrial cancers are responsive to hormone therapies. Your tumor may have been tested for hormone receptor status and this may help your doctor decide if this therapy is right for you.
5. Trials– Your facility may have or may know of several trials available for treatment options. Trials are very common in gynecologic cancers because several new drug options have become available in the past few years. Clinical trials are now being held to see if those drugs are effective with other drugs in combination. Please ask your doctor about any potential clinical trials available for your specific cancer.
Source: the information on this page was obtained from two sites: UpToDate medical database, and Cancercenter.com.
Menopause: The time in a woman’s life that marks the end of hormone production and loss of ability to make babies. Periods become irregular or stop altogether. Often occurs naturally as woman enters forties and fifties (average age 51). Or, it may result from surgery with removal of ovaries, chemotherapy, or radiation if ovaries are in the area of radiation.
Menstrual cycle: Natural hormonal process that prepares the womb for possible egg implantation each month. If egg is not fertilized, then the uterus sheds its lining and this results in passage of blood from the uterus lining through the cervix and out the vaginal opening.
Uterus: Also known as the ‘womb’ is the organ that responds to monthly changes in hormone production to prepare for possible fertilization and implantation of a woman’s egg. This is where baby’s grow during pregnancy. In the human, the uterus is connected to the vagina through its lower portion which ends in a cervix at the end of the vagina. The upper most part of the uterus is called the fundus and it connects to the fallopian tubes.
Cervix: The lowest portion of the womb which is visible during your gynecology exam at the end of the vaginal canal.
Fallopian tubes: Structures extending from the upper portion of the uterus towards the ovaries. They act as the conduit, or passageway for eggs from the ovaries to travel to the uterus.
Ovaries: internal portion of the female reproductive system that produce eggs and also make female hormones, estrogen and progesterone. Each month, the ovaries produce and release an egg in the normal menstrual cycle for possible fertilization by a sperm. Women have two ovaries on either side of the womb.
Parametria: Fibrous and fatty supporting tissue that surrounds the uterus
Lymph nodes: Small bean shaped structures that function as part of the body’s immune system to help fight off infection and disease. These structures are connected throughout the body by thin channels called lymphatic vessels.
Source: The information on these pages were obtained from two sites: UpToDate medical data base, and Cancer Center.com.