Alternative Names uterine cancer, endometrial cancer, cancer of the endometrium
Definition Cancer of the uterus occurs in the lining of the uterus, called the endometrium. It is sometimes called endometrial cancer. Cancer of the uterus is the most frequent and most curable type of cancer that affects a woman's reproductive system. Among women, it is the fourth most common site for cancer after the breast, lung, and bowel.
What is going on in the body? The cells that line the uterus respond to signals sent by oestrogen and progesterone, two hormones made in the ovaries. In the first 2 weeks of a woman's monthly cycle, oestrogen makes these cells divide and grow as the uterus prepares for pregnancy. During the second 2 weeks, progesterone prepares the lining of the uterus for an embryo to implant. If pregnancy does not occur, the levels of both hormones fall sharply. This causes the lining of the uterus to slough off. This is known as menstrual flow. The monthly menstrual cycle keeps the endometrium from growing too much.
Some women do not make progesterone. Others make high levels of oestrogen. In both cases, the cells lining the uterus grow continuously and are not sloughed off regularly. This makes it more likely that pre-cancerous changes of the endometrium will occur. If a woman is not treated for this, cancer of the uterus may develop.
Cancer of the uterus is most common in women between the ages of 50 to 65. But it can also happen in younger women.
What are the signs and symptoms of the disease? The most common symptom of this disease is abnormal vaginal bleeding, including:
heavy periods
bleeding or spotting between periods
bleeding after intercourse
bleeding or spotting after 6 months of not having any periods if a woman is not taking hormone replacement therapy
unusual pain and cramping in the lower belly not related to menstruation
What are the causes and risks of the disease? No one knows exactly what causes this disease. Certain factors increase a woman's risk of getting cancer of the uterus. For example, some women make high levels of oestrogen that are not balanced by progesterone. This is called unopposed oestrogen. It is more likely in women who:
are obese, since fat cells can make extra oestrogen
few or no children. The more children a woman has, the lower her risk for uterine cancer.
taken tamoxifen to prevent breast cancer from coming back
family history of uterine cancer
What can be done to prevent the disease? No one knows exactly what causes cancer of the uterus. However, a woman may be able to lessen her risk of getting it by:
eating a low-fat diet
maintaining a healthy weight
lowering her blood pressure
reporting any pattern of abnormal bleeding to her doctor
having yearly pelvic examinations and Pap smears
Also, a woman should talk with her doctor about the risks of taking oestrogen without progesterone after menopause if she has not had her uterus removed. The risk for cancer of the uterus may last as long as 10 years after adding progesterone or stopping oestrogen therapy completely.
How is the disease diagnosed? A Pap smear is not intended to diagnose uterine cancer. This test is used to diagnose cancer of the cervix. However, Pap smears occasionally show changes in endometrial cells. If this occurs, a biopsy or dilatation and curettage, or D&C, will be done. This involves scraping the uterine wall to gather more cells from the lining of the uterus.
If advanced cancer is suspected, other tests may be done, such as:
bone scan to be sure that the cancer has not spread to the bones
What are the long-term effects of the disease? When uterine cancer is diagnosed early and treated, more than 80% of women will survive more than 5 years. Most are completely cured when the cancer is diagnosed and treated early.
What are the risks to others? Uterine cancer is not contagious, so there are no risks to others.
What are the treatments for the disease? The disease is treated by removing the uterus in a procedure called a hysterectomy. Doing this surgery through the abdomen rather than the vagina is recommended. It allows the surgeon to see the entire pelvis and abdomen and to note any spread of the cancer. He or she can also take samples of cells from the abdominal cavity to check for any tiny floating cancer cells. The surgeon will also remove lymph nodes from the pelvic area to be sure that the cancer has not spread.
Sometimes a surgeon will remove the uterus through the vagina and then remove the lymph nodes through a small cut in the abdomen. This avoids a large scar on the abdomen and shortens the hospital stay. Not all women are candidates for this procedure.
Because tumour cells may have spread to the ovaries and fallopian tubes, these organs are usually taken out, too.
For women with advanced disease, the preferred treatment is surgery. If the surgeon finds that the cancer has not spread, there may be no further treatment. Women who are at a higher risk of the cancer coming back may have radiation treatments to the pelvis. Or they may have chemotherapy. Because this cancer comes from a tissue that is sensitive to hormones, treatment with hormones may also be effective.
What are the side effects of the treatments? After having a hysterectomy, combined with removal of glands in the pelvis, a woman may experience:
stress
chronic swelling in the abdomen and legs
swelling in the veins of the lower legs that may lead to blood clots
surgical problems, such as a hole connecting the vagina and the rectum
bleeding that requires a blood transfusion
The side effects of chemotherapy depend on the drug used.
What happens after treatment for the disease? A woman who has been treated for cancer of the uterus should try to:
eat a balanced diet
get plenty of rest
drink plenty of fluids to avoid dehydration
cut down on stress
rely on family members and friends for help with daily activities she feels too tired to do alone
If a woman tries herbal products or alternative medicines for her symptoms, she should tell her doctor. Sometimes toxic reactions can occur when certain therapies are combined.
How is the disease monitored? At least every 3 to 4 months after treatment, a woman should have follow-up that includes:
A woman should report any symptoms that might suggest the cancer is coming back. She can then be treated quickly, if necessary.
Signs of recurrent endometrial cancer include:
vaginal bleeding
abdominal bloating
changes in bowel or bladder habits
swelling of the lower legs
persistent cough
loss of appetite
weight loss
fatigue
Author: Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
