Uterine Cancer

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In cancer of the uterus, also called endometrial cancer, cancer cells are present in the inner lining of the uterus. The inner lining of the uterus is called the endometrium. Normally, the endometrium undergoes a series of changes during a woman’s monthly menstrual cycle, in preparation for a potential pregnancy. The ovaries release hormones that initiate these changes. If pregnancy does not occur, the endometrial lining is shed during menstruation. A very small percentage of cancers grow in the muscular and connective tissues of the uterus. These tumors are called uterine sarcomas.

Causes:

Estrogen is the hormone that stimulates the growth of endometrial cells, especially in the glands. Research has shown that women who develop uterine cancer often have had more exposure to the natural estrogen produced by the ovaries.

These are women who began to menstruate before age 12 or who began menopause later than average. Long-term use of hormone replacement therapy may also increase the risk of uterine cancer. Other conditions of high estrogen exposure include chronic anovulation (condition in which women do not ovulate, such as women with polycystic ovary syndrome) and obesity.

How Is Uterine Cancer Diagnosed?

If a physician suspects that you may have cancer of the uterus, a series of examinations and diagnostic tests will be necessary to confirm the diagnosis. Initially, the physician will obtain a medical history and perform a general physical examination. A series of blood and urine tests will be done.

A pelvic exam or internal examination is done so that the physician can feel the vagina, uterus, ovaries, bladder and rectum. During the exam, the physician is feeling for any lumps, enlargements or changes in the organ size and shape. A special instrument, called a speculum, is inserted into the vagina so that the physician can see the upper part of the vagina and cervix.

A Pap test is performed to obtain a sampling of cells from the cervix. Although this test does not screen for cancer of the uterus, it will tell you if any abnormalities exist in the cervix.(Cervical cancer is a different type of cancer than cancer of the uterus.)

An endometrial biopsy is performed to sample the cells from the lining inside of the uterus. Often times, this biopsy can be obtained in the physician’s office, using a tiny brush to scrape off a tissue sample. At other times, it may be necessary for the physician to perform a dilation and curettage (often called a D&C). This procedure is usually performed in the operating room and requires anesthesia. During a D&C, the cervical opening is widened so that an instrument can be passed into the uterus and tissue samples of the uterine lining can be removed. In all cases where tissue is removed, a pathologist will examine the specimen to look for evidence of cancer. It could take several days to obtain your test results.

If the biopsy report shows evidence of cancer in the lining of the uterus, additional tests will be necessary before treatment is begun. Once a diagnosis of cancer of the uterus is made, the physician will need to determine the stage of the disease. Staging refers to the extent of the disease, finding out whether it has spread from the uterus to other areas of the body.

In most instances, staging for cancer of the uterus will include additional blood work and a chest X-ray. The physician also may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan, a sigmoidoscopy or colonoscopy (examination of the bowel) and an ultrasound.

Once all of the test results have been reviewed, the physician will discuss treatment options with you. Several other factors, like your age, pre-existing health problems, and overall general health will be considered in deciding which treatment plan is best. Physicians who specialize in treating cancers of the female reproductive organs are called gynecological oncologists. Your family physician or gynecologist may refer you to a specialist, or you may decide on your own to seek a second opinion from a specialist before committing to a treatment plan.

Finding out that you have cancer is an overwhelming experience. It may be difficult for you to think straight or make important decisions on your own. Many women find it helpful to have another family member or friend present during discussions about their treatment plan. Don’t be afraid to ask questions; it may help to write them down, since you are less likely to forget to ask them.

Treating Uterine Cancer

Women who are diagnosed with cancer of the uterus typically are treated with one or more of the following methods: surgery, radiation therapy, chemotherapy or hormone therapy.

Surgery

Because the majority of cancers of the uterus are diagnosed before they have spread outside the uterus, surgery is the most common treatment. Surgery to remove the uterus is called a simple hysterectomy. When the cancer has spread beyond the uterus to the cervix and/or to nearby tissue, a radical hysterectomy is performed to remove the uterus, as well as the area of the vagina, which borders on the cervix, and tissues located near the uterus. In most instances, the fallopian tubes and ovaries also will be removed in a procedure called a bilateral salpingo-oophorectomy. Lymph nodes from the pelvic and lower aortic areas often are removed as well to check for the cancer’s spread.

Surgery is performed either vaginally or through an abdominal incision that begins below the navel and extends down to the pubic bone. When samples of lymph nodes are necessary, the procedure can be accomplished through the same incision used for an abdominal hysterectomy. If the patient has had a vaginal hysterectomy, then the lymph nodes can be obtained through laparoscopic lymph node sampling. The advantage to this type of surgery is that the incision is much smaller and the recovery period is quicker.

Surgery alone can cure cancer of the uterus in most women. Additional treatments are necessary in some women.

Radiation therapy

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. At times, radiation therapy is used before surgery to shrink the tumor before removing it. At other times, it is used following surgery to destroy any remaining cancer cells.

Radiation therapy can be delivered both internally and externally to treat cancer of the uterus. When delivered internally, called brachytherapy, a surgeon or a radiation oncologist inserts a small applicator containing a radioactive substance into the patient’s vagina and it is left there for a few days. During this time, the patient is hospitalized and visitors are restricted while the implant is in place.

When radiation therapy is delivered externally, called external beam radiation, it is usually done on an outpatient basis, five days a week, for four to five weeks. The radiation targets a specific body region, and a large machine placed outside of the body delivers the radiation.

Chemotherapy

Chemotherapy involves the administration of medications to kill cancer cells. These drugs can be taken by mouth or given by injection. Common drugs used to treat endometrial cancer often include doxorubicin, cisplatin and paclitaxel. Chemotherapy is used in the treatment of cancer of the uterus to kill cancer cells that have spread from the uterus to other parts of the body.

Hormone therapy

Hormone therapy involves the use of drugs, like progesterone, that can prevent cancer cells from growing. If a woman is not a good candidate for surgery, hormone therapy may be used to help arrest the tumor’s growth.

Hormone therapy also may be used if cancer of the uterus has spread to other parts of the body. Two of the more common hormone drugs used are Provera® and Megace®, both of which are taken by mouth.

Side effects of cancer treatment

All women considering treatment for cancer are concerned about side effects of their therapy. The side effects you may experience depend on many factors and cannot be generalized to all women.

Your physician can explain the possible side effects of each type of cancer treatment. Not everyone experiences the same side effects. If side effects do occur, many things can be done to reduce or relieve the symptoms.

Tips and Cautions:

Risk Assessment Screen for Cancer of the Uterus

Are you at increased risk for developing cancer of the uterus (endometrial cancer)? Take the risk assessment screen to find out. Answer “yes” or “no” to each of the following questions.

  • Are you a woman older than age 50?
  • Are you currently taking or a woman just stopping hormone replacement therapy with estrogen alone, without added progestin to control symptoms associated with menopause, to prevent osteoporosis or to reduce your risk of heart disease or stroke?
  • Are you overweight?
  • Do you have a personal history of colon cancer, rectal cancer or breast cancer?
  • Are you currently taking the drug tamoxifen for the prevention or treatment of breast cancer?
  • Have you ever been diagnosed with endometrial hyperplasia, a benign condition of the lining of the uterus?
  • Are you caucasian?
  • Did you begin menopause at a late age (after age 59)?
  • Do you have diabetes?
  • Do you have hypertension (high blood pressure)?

Before Your Visit

Your doctor will want to know your gynecological history, which establishes your “estrogen exposure,” an important risk factor for endometrial cancer. If your doctor does not already know, come prepared with the following information:

  • Age when your periods began.
  • If you are postmenopausal, age when your periods stopped.
  • Details of birth control pill use.
  • Details of hormone replacement therapy.
  • Your pregnancy history.

When to See the Doctor

  • Abnormal vaginal bleeding
  • Watery, milky discharge
  • Pain in the lower abdomen
  • Painful urination
  • Pain during sexual intercourse

General Medication Safety Tips

When you are prescribed new medicines, make sure you understand the following things:

  • What is the medicine for?
  • How should I take it and for how long?
  • What should I do if I forget a dose?
  • What side effects can this medicine cause?
  • Is this medicine safe to take with the other medicines and supplements that I am already taking?
  • What other safety measures should I follow while using this medicine?
  • What storage conditions are required for this medicine?
  • Ask for written information about the new medicine.

External Sources

American Cancer Society. Endometrial Cancer Resource Center.
Homesley HD, Zaino R. Endometrial Cancer: prognostic factors. Seminars in Oncology. 1994;21(1):71-78.
National Cancer Institute. CancerNet Database. Treatment summaries. Endometrial Cancer. PDQ 9/99.
National Cancer Institute NIH Publication No.98-1562. Revised September 1997.
American Cancer Society. How is Endometrial Cancer Treated? American Cancer Society. Radiation therapy. American Cancer Society. Chemotherapy.
American Cancer Society. Hormone therapy. National Cancer Institute. What You Need to Know About Cancer of the Uterus. 2001. Updated 2002. NIH Publication 01-1562. Accessed: July 30, 2002.
Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone’s Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002.
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