Uterine Cancer

There are two types of Uterine cancer: the more prevalent endometrial cancer and the rarer uterine sarcoma. Key symptoms include bleeding between periods or post-menopausal bleeding and treatment typically involves a hysterectomy to remove the uterus.

What is Uterine Cancer?

Uterine cancer is a term covering cancers in the uterus:

– Endometrial Cancer: Develops in the uterus’s lining (endometrium) and ranks highly among gynecologic cancers.

– Uterine Sarcoma: Originates in the uterus’s muscle wall or myometrium and is very rare.

While “uterine cancer” can refer to either type, it’s often used interchangeably with “endometrial cancer” due to endometrial cancer comprising about 95% of cases.

Uterus Function

The uterus is part of the reproductive system in women and those assigned female at birth. It hosts fetal development during pregnancy. The body or corpus is the top part, while the cervix connects to the vagina. Uterine cancer affects the uterus’s body, distinguishing it from cervical cancer.

Endometrium Function

The endometrium is the uterus’s inner lining, changing with the menstrual cycle. Hormones estrogen and progesterone regulate its thickening in anticipation of pregnancy; if pregnancy does not occur, decreased progesterone leads to the lining shedding, resulting in a period.

Prevalence

Endometrial cancer is the most common reproductive cancer among women and people AFAB in the U.S. It typically develops post-menopause, with around 65,000 diagnoses annually. Approximately 3% will be diagnosed during their lifetimes.

Symptoms and Causes of Uterine Cancer

Symptoms

Uterine cancer symptoms can mimic other reproductive issues. If you experience unusual pain or irregular bleeding, consulting a healthcare provider is crucial for an accurate diagnosis and appropriate treatment. Symptoms include:

– Vaginal bleeding between periods before menopause

– Postmenopausal bleeding or spotting

– Pelvic pain or cramping

– Thin postmenopausal vaginal discharge

– Prolonged or heavy bleeding after age 40

Causes

The exact cause of uterine cancer is unknown, but typically it is linked to cellular changes in the uterus that lead to tumor formation. Various risk factors, involving estrogen and progesterone balance, can increase cancer risk. High-risk individuals should discuss preventive measures with healthcare providers.

Risk Factors

– Age, Lifestyle, and Family History: Increased risk with age (post-50), high-fat diets, genetic disorders like Lynch syndrome.

– Other Conditions: Diabetes, obesity, ovarian diseases contributing to elevated estrogen levels.

– Menstrual/Reproductive History: Early menstruation, late menopause, long menstruation spans, and lack of pregnancy.

– Previous Treatments: Radiation therapy, estrogen replacement therapy (ERT), and tamoxifen use.

Complications

Endometrial cancer can be fatal, but is often treatable if diagnosed early. Possible complications include anemia, metastasis, and resistance to treatment.

Diagnosis and Tests

Diagnostic Process

Contact a healthcare provider if you notice symptoms associated with Uterine cancer. They will evaluate symptoms, risk factors, and conduct a physical and pelvic exam.

Tests

Common diagnostic tests include:

– Blood Tests: CA-125 assay to indicate the presence of cancer.

– Imaging Tests: CT, MRI, and transvaginal ultrasound.

– Other Tests: Endometrial biopsy, hysteroscopy, dilation, and curettage (D&C).

A Pap test cannot diagnose uterine cancer as it screens for cervical cancer.

Diagnosis Details

If endometrial cancer is diagnosed, identifying its type and stage (from I to IV) is critical for treatment planning.

Management and Treatment

Treatment Options

Most patients require surgery, possibly complemented by chemotherapy, radiation, hormone therapy, immunotherapy, or targeted therapy, depending on cancer type and health.

Surgery Types

– Total Abdominal Hysterectomy: Abdomen incision to remove the uterus.

– Vaginal Hysterectomy: Uterus removed via the vagina.

– Radical Hysterectomy: Involves removing the uterus, adjacent tissues, and part of the vagina.

– Minimally Invasive Hysterectomy: Uses small incisions for uterus removal.

Additional procedures may include bilateral salpingo-oophorectomy (BSO) and lymph node dissection.

Post-Surgery Expectations

Effects include infertility and menopause symptoms. Younger, premenopausal patients should discuss ovary preservation with their care team.

Uterine Sarcoma Treatment

Similar to endometrial cancer treatments, often combined with staging and diagnosis in a single procedure.

Prevention

Though preventing uterine cancer isn’t always possible, risk reduction strategies include managing diabetes, maintaining a healthy weight, and considering progesterone-inclusive contraceptives.

Outlook and Prognosis

The five-year survival rate for endometrial cancer rises to 95% from 81% if cancer is detected early and confined. Without treatment, the survival rate drastically drops. Early detection is crucial for a favorable prognosis.