Cancer Of The Uterus
(Endometrial Cancer)
The information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.
What is the uterus?
The uterus (womb) is a hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader, upper part is the corpus. The corpus is made up of two layers of tissue. 
In women of childbearing age, the inner layer of the uterus (endometrium) goes through a series of monthly changes known as the menstrual cycle. Each month, endometrial tissue grows and thickens in preparation to receive a fertilized egg. Menstruation occurs when this tissue is not used and passes out through the vagina. The outer layer of the corpus (myometrium) is a muscle that expands during pregnancy to hold the growing fetus. Because most uterine cancer develops in the endometrium, cancer of the uterus also is called endometrial cancer.
What is cancer?
Cancer is a group of more than 100 different diseases. Cancer occurs when cells becomes abnormal and divide without control or order.
The organs of the body are made up of many kinds of cells. Cells normally divide in an orderly way to produce more cells only when they are needed. This process helps keep us healthy.
If cells divide when new cells are not needed, they form too much tissue. The mass of extra tissue, called a tumor, can be benign or malignant.
Benign Tumors
Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Several types of benign tumors occur in the uterus. In some cases, these growths do not need to be treated. Sometimes, however, benign tumors must be removed by surgery. Once removed, these tumors are not likely to return.
Fibroids are benign tumors in the uterus that are found most often in women over 35 years of age. Although single fibroid tumors do occur, multiple tumors are more common. Symptoms of fibroids depend on the size and location of the tumors and may include irregular bleeding, vaginal discharge, and frequent urination. When fibroids press against nearby organs and cause pain, surgery may be recommended. Often, however, fibroids do not cause symptoms and do not need to be treated, although they should be checked often. When a woman stops having menstrual periods ( menopause ), fibroids may becomes smaller, and sometimes they disappear.
Another benign condition of the uterus is endometriosis . In this condition, tissue that looks and acts like endometrial tissue begins to grow in unusual places, such as on the surface of the ovaries, on the outside of the uterus, and in other tissues in the abdomen. Endometriosis is most common in women in their thirties and forties. This condition causes painful menstrual periods and abnormal bleeding. Sometimes, it causes infertility. Some patients with endometriosis are treated with medication, and some are treated with surgery.
Hyperplasia is an increase in the number of normal cells lining the uterus. Although this condition is not cancer, it may develop into cancer in some women. The most common symptoms of hyperplasia are heavy menstrual periods and bleeding between periods. Treatment depends on the extent of the condition (mild, moderate, or severe) and on the age of the patient. Young women usually are treated with female hormones, and the endometrial tissue is checked often. Hyperplasia in women near or after menopause may be treated with hormones if the condition is not severe. Surgery to remove the uterus is the usual treatment for severe cases.
Malignant Tumors
Malignant tumors are cancer. They invade and destroy nearby healthy tissues and organs. Cancer cells also can metastasize, or spread, to other parts of the body and form new tumors. When cancer of the uterus spreads, it may travel through the bloodstream or lymphatic system. Cancer cells can be carried along by blood or lymph, an almost colorless fluid discharged by tissues into the lymphatic system. Lymph nodes scattered along this system filter bacteria and abnormal substances such as cancer cells. For this reason, surgeons often remove pelvic lymph nodes to learn whether they contain cancer cells.
Because uterine cancer can spread, it is important for the doctor to find out as early as possible if a tumor is present and whether it is benign or malignant. As soon as a diagnosis is made, treatment can begin. Each year, more than 32,000 women in the United States find out they have cancer of the uterus.
What causes cancer of the uterus?
Researchers study patterns of cancer in the population to discover which people are more likely to develop certain cancers and what aspects of our surroundings and lifestyles may cause cancer.
Cancer of the uterus occurs most often in women between the ages of 55 and 70. This disease accounts for about 6 percent of all cancers in women. Research shows that some women are more likely than others to develop cancer of the uterus. These women are said to be "at risk." Obese women, women who have few or no children, women who began menstruating at a young age, those who had a late menopause, and women of high socioeconomic status are at increased risk of developing this disease. It appears that most of the risk factors for cancer of the uterus are related to hormones, especially excess estrogen.
Studies have shown that women taking estrogen replacement therapy (ERT) for menopausal symptoms have a two to eight times greater risk of developing uterine cancer than women who do not take estrogens . The risk increases after 2 to 4 years of use and seems to be greatest when large doses are taken for long periods of time. A woman who takes ERT after her uterus has been removed is in no danger of developing uterine cancer. Many doctors now believe that using a combination of estrogen and progestin (another female hormone) for replacement therapy decreases the risk of cancer of the uterus. It is especially important for all women taking replacement therapy to be checked regularly for any signs of cancer. Unusual bleeding should be reported to the doctor at once.
Recent evidence shows that the use of birth control pills may decrease the risk of developing uterine cancer. Women who use a combination pill (containing both estrogen and progestin in each pill) for at least 1 year have only half the risk of endometrial cancer as women who use other types of birth control pills or none. The longer a woman takes the combination pill, the more this protection increases.
What are the symptoms of cancer of the uterus?
Abnormal bleeding after menopause is the most common symptom of cancer of the uterus. Bleeding may begin as a watery, blood-streaked discharge. Later, the discharge may contain more blood.
Cancer of the uterus does not often occur before menopause, but it does occur around the time menopause begins. The reappearance of bleeding should not be considered simply part of menopause; it should always be checked by a doctor.
Abnormal bleeding is not always a sign of cancer. It is important for a woman to see her doctor, however, because that is the only way to find out what the problem is. Any illness should be diagnosed and treated as soon as possible, but early diagnosis is especially important for cancer of the uterus.
How is cancer of the uterus diagnosed?
When symptoms suggest uterine cancer, a medical history is taken and a thorough examination is conducted. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the doctor usually performs one or more of the following exams:
Pelvic exam - The uterus, vagina, ovaries, bladder, and rectum (pelvic exam) are thoroughly examined. The doctor feels these organs for any abnormality in their shape and size. A speculum is used to widen the opening of the vagina so that the doctor can look at the upper portion of the vagina and the cervix.
Biopsy - For a biopsy, the doctor surgically removes a small amount of uterine tissue, which is examined under a microscope by a pathologist.
D and C - In a D and C, the doctor dilates (widens) the cervix and inserts a curette (a small spoon-shaped instrument) to remove pieces of the lining of the uterus. A sample of the uterine lining also can be removed by applying suction through a slender tube (called suction curettage). The tissue is examined for evidence of cancer.
Pap smear - A Pap smear is often used to detect cancer of the cervix. While it is sometimes done for cancer of the uterus, it is not a reliable test for uterine cancer because it cannot always detect abnormal cells from the endometrium.
If cancer cells are found, other tests are conducted to find out whether the disease has spread from the uterus to other parts of the body. These procedures include blood tests and a chest x-ray . For some patients, special x-rays are needed. For example, computed tomography (also called CT or CAT scan ) is used to take a series of x-rays of various sections of the abdomen. Ultrasound may also be used to view organs inside the body. In this procedure, high-frequency sound waves are bounced off internal organs, and the echoes can be seen on a screen that resembles a television. Patients also may have special exams of the bladder, colon, and rectum.
How is cancer of the uterus treated?
A number of factors are considered to determine the best treatment for cancer of the uterus. Among these factors are the stage of the disease, the growth rate of the cancer, and the age and general health of the woman.
Methods of Treating Uterine Cancer
Surgery, radiation therapy , hormone therapy, or chemotherapy may be used to treat uterine cancer. Radiation therapy (also called x-ray therapy, radiotherapy, or irradiation) uses high-energy rays to kill cancer cells. Radiation may be given from a machine located outside the body (external radiation therapy), or radioactive material may be placed inside the body (internal radiation therapy). In hormone therapy, female hormones are used to stop the growth of cancer cells. Chemotherapy is the use of drugs to treat cancer. Often, a combination of these methods is used. In some cases, the patient is referred to specialists in the different kinds of cancer treatment.
In its early stage, cancer of the uterus usually is treated with surgery. The uterus and cervix are removed ( hysterectomy ), as well as the fallopian tubes and ovaries (salpingo-oophorectomy). Some doctors recommend radiation therapy before surgery to shrink the cancer. Others prefer to evaluate the patient carefully during surgery and recommend radiation therapy after surgery for patients whose tumors appear likely to recur. A combination of external and internal radiation therapy often is used. If the cancer has spread extensively or has recurred after treatment, a female hormone (progesterone) or chemotherapy may be recommended.
What are the side effects of treatment for cancer of the uterus?
It is rarely possible to limit the effects of cancer treatment so that only cancer cells are destroyed. Normal, healthy cells may be damaged at the same time. That is why the treatment often causes side effects.
Hysterectomy is major surgery. After the operation, the hospital stay usually lasts about 1 week. For several days after surgery, patients have problems emptying their bladder and having normal bowel movements. The lower abdomen is be sore. Normal activities, including sexual intercourse, usually can be resumed in 4 to 8 weeks.
Women who have their uterus removed no longer have menstrual periods. When the ovaries are not removed, women do not have symptoms of menopause (change of life) because their ovaries still produce hormones. If the ovaries are removed or damaged by radiation therapy, menopause occurs. Hot flashes or other symptoms of menopause caused by treatment may be more severe than those of natural menopause.
Sexual desire and the ability to have intercourse usually are not affected by hysterectomy. However, many women have an emotionally difficult time after a hysterectomy. They may have feelings of deep emotional loss because they are no longer able to become pregnant.
Radiation therapy destroys the ability of cells to grow and divide. Both normal and diseased cells are affected, but most normal cells are able to recover quickly. Patients usually receive external radiation therapy as an outpatient. Treatments are given 5 days a week for several weeks. This schedule helps to protect healthy tissues by spreading out the total dose of radiation.
Internal radiation therapy places the radiation as close as possible to the site of the cancer, while sparing most of the healthy tissues around it. This type of radiation therapy requires a short hospital stay. A radiation implant, a capsule containing radioactive material, is inserted through the vagina into the uterus. The implant usually is left in place 2 or 3 days.
During radiation therapy, patients may notice a number of side effects, which usually disappear when treatment is completed. Patients may have skin reactions (redness or dryness) in the area being treated, and they may be unusually tired. Some have diarrhea and frequent and uncomfortable urination. Treatment can also cause dryness, itching, and burning in the vagina. Intercourse may be painful, and some women are advised not to have intercourse at this time. Most women can resume sexual activity within a few weeks after treatment ends.
Hormones occur naturally in the body. Their purpose is to regulate the growth of specific cells or organs. In cancer treatment, hormones are sometimes used to stop the growth of cancer cells. Hormones travel through the bloodstream to all parts of the body, affecting cancer cells far from the original tumor. Hormone therapy usually causes few side effects.
Anticancer drugs also travel through the bloodstream to almost every area of the body. Drugs used to treat cancer can be given in different ways. Some are given by mouth and others are injected into a muscle, a vein, or an artery. Chemotherapy is most often given in cycles; a treatment period, followed by a recovery period, then another treatment period, and so on.
Depending on the drugs that the doctor orders, the patient may need to stay in the hospital for a few days so that the effects of the drugs can be watched. Often, the patient receives treatment as an outpatient at the hospital, at a clinic, at the doctor's office, or at home.
The side effects of chemotherapy depend on the drugs given and the individual response of the patient. Chemotherapy commonly affects hair cells, blood-forming cells, and cells lining the digestive tract. As a result, patients may have side effects such as hair loss , lowered blood counts, nausea, or vomiting. Most side effects go away during the recovery period or after treatment is over.
Loss of appetite can be a serious problem for patients receiving radiation therapy or chemotherapy. Researchers are learning that patients who eat well are often better able to withstand the side effects of treatment. Therefore, nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles, and organs. Many patients find that eating several small meals throughout the day is easier than eating three large meals.
The side effects that patients have during cancer therapy vary from person to person and may even be different from one treatment to the next in the same patient. Attempts are made to plan treatment to keep problems to a minimum, and fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them.
What happens after treatment for cancer of the uterus?
Regular follow-up exams are very important for any woman who has been treated for cancer of the uterus. The doctor will want to watch the patient closely for several years to be sure that the cancer has not returned. In general, follow-up examinations include a pelvic exam, a chest x-ray, and laboratory tests.
When people have cancer, life can change for them and for the people who care about them. These changes in daily life can be difficult to handle. When a woman finds out she has uterine cancer, a number of different and sometimes confusing emotions may appear.
At times, patients and family members may feel depressed, angry, or frightened. At other times, feelings may vary from hope to despair or from courage to fear. Patients usually are better able to cope with their emotions if they can talk openly about their illness and their feelings with family members and friends.
Concerns about the future, as well as about medical tests, treatments, hospital stays, and medical bills, often arise. Talking to doctors, nurses, or other members of the health care team may help to ease fear and confusion. Patients can ask questions about their disease and its treatment and can take an active part in decisions about their medical care. Patients and family members often find it helpful to write down questions for the doctor as they think of them. Taking notes during visits to the doctor also can help patients remember what was said. Patients should ask the doctor to repeat or explain more fully anything that is not clear.
Patients have many important questions to ask about cancer, and their doctor is the best person to provide answers. Most people ask what kind of cancer they have, how it is treated, and how successful the treatment is likely to be.
Many women become concerned, especially after surgery and radiation therapy, that the changes to their bodies will affect how other people feel about them. They may worry about working, caring for their family, or about how cancer and its treatment will affect their sex life. Usually, as the patient recovers, the changes to her body become more accepted. With love and support, patients gradually feel reassured that they are just as appreciated as before.
The patient's doctor is the best person to give advice about working or other activities, but it may be hard to talk to the doctor about feelings and other very personal matters. Many patients find it helpful to talk with others who are facing similar problems. This kind of help is available through cancer- related support groups, such as those described in the next section. If the emotional problems of the patient or family become too hard to handle, a mental health counselor may be able to help.
What does the future hold for patients with cancer of the uterus?
There are more than 8 million Americans living today who have had some type of cancer. Many are women who have had cancer of the uterus. The outlook for women with very early cancer of the uterus is excellent; nearly all patients with this condition can be cured. The chances of controlling advanced disease are improving as researchers continue to look for better ways to treat this disease.
Doctors often talk about "surviving" cancer, or they may use the word "remission" rather than "cure." Even though many patients recover completely, doctors use these terms because cancer of the uterus may show up again at a later time. Patients are naturally concerned about their future and often try to use statistics they have read or heard about to figure out their own chances of being cured. It is important to remember that statistics describe an average of large numbers of people, and no two cancer patients are alike. The outlook for a particular patient depends on the type and stage of her disease, her age and general health, her response to treatment, and other variables.
Scientists continue to study new treatments for cancer of the uterus, including new drugs, drug combinations, and combinations of radiation therapy and chemotherapy. Scientists are studying these methods closely to learn whether they can be of value in future treatment.
What resources are available to patients with cancer of the uterus?
General information about cancer is widely available. Some helpful resources and publications are listed below.
Cancer Information Service (CIS)
1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients, their families and friends, the public, and health care professionals. The staff can answer questions in English and Spanish and can send booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4-CANCER (1-800-422-6237), connects callers with the office that serves their area.
American Cancer Society (ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office and local units all over the country. It supports research, conducts educational programs, and offers many services to patients and their families. To obtain free booklets about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under "American Cancer Society" in the white pages of the telephone book. Cancer of the Uterus At A Glance - Cancer of the uterus occurs most often in women between the ages of 55 and 70 years.
- Risk factors (factors that increase chances of developing the disease) have been identified.
- Abnormal bleeding after menopause is the most common symptom of cancer of the uterus.
- Cancer of the uterus is diagnosed based on the results of the pelvic examination, pap smear, biopsy of the uterus, and D and C procedure.
- Treatment of cancer of the uterus depends on the stage of the disease, the growth rate of the cancer, as well as the age and health of the woman.
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