Uterine cancer is the most common cancer of the female reproductive tract and accounts for 6% of all cancers in women. There are two main types of uterine cancer.

• Endometrial cancer — This is the most common type of uterine cancer. It occurs in the inner lining of the uterus, called the endometrium. Its cause is not fully understood. Most endometrial cancers are cancers of glandular cells, or adenocarcinomas. Women between the ages of 50 and 65 are most affected. Women are more likely to develop endometrial cancer when they have high levels of the hormone estrogen that are not offset by the hormone progesterone. Since progesterone levels decrease after menopause, postmenopausal women are particularly at risk of developing this cancer. Other women likely to have high levels of estrogen without enough progesterone include those who are obese, who have a history of infertility, and who take long-term estrogen therapy (for example, in the treatment of osteoporosis). Women who also may be at high risk of endometrial cancer include women with high blood pressure and diabetes, and women who take tamoxifen (Nolvadex) for the treatment of breast cancer.



• Uterine sarcoma — The uterine wall consists of connective tissues, such as muscle and fibrous tissue. Cancers beginning in this type of tissue are called sarcomas. Uterine sarcoma is rare, accounting for only 2% to 4% of all cancers of the uterus. While its cause is unknown, it occurs most often in middle-aged and elderly women. Those who have undergone pelvic radiation in treatment of other cancers may be more likely to develop this cancer. African-American women appear to be at a particular risk for one type of uterine sarcoma, leiomyosarcoma. The reason for this is unknown.

The main symptom of all uterine cancers is abnormal bleeding from the vagina. It's the primary complaint of an estimated 90% of women diagnosed with endometrial cancer and 85% of postmenopausal women diagnosed with uterine sarcoma. For younger women, abnormal bleeding may include heavier than usual periods, spotting (bleeding between periods) and bleeding after intercourse. For older women, any bleeding that happens six months after menopause begins may be a concern. Abnormal bleeding at the time menopause starts also should be reported to your doctor.

Only about 10% of women with uterine sarcoma feel pain before they are diagnosed. Some women also are able to feel a mass.

If you have signs and symptoms of uterine cancer, you should be evaluated by a gynecologist. This specialist will ask you about your medical history and will examine you, with special focus on the pelvic area. The Pap test, an examination of sample cells from the cervix and upper vagina, is often done at this time. However, it usually can identify uterine cancer only if it has spread outside the uterus.

Your doctor may take a sample of endometrial tissue for testing. An endometrial biopsy can be performed in the doctor's office. During this procedure, the doctor suctions a small amount of tissue through a very thin tube inserted through the cervix into the uterus. You may feel some cramps during this procedure. A pathologist will examine the sample for cancerous cells.

If a clear diagnosis is not possible from the biopsy, the doctor may do an outpatient procedure called dilation and curettage (D & C). In this procedure, the cervix is dilated (widened) and tissue is scraped from inside the uterus. You will be given general anesthesia or conscious sedation for this procedure. It's common to have bleeding for a few days after the procedure. However, few women complain of serious discomfort. During the D & C , the doctor also may use an instrument called a hysteroscope to view the inside of the uterus.

Radiographic (X-ray) tests also may be used to look for cancer in the uterus. In a procedure called a transvaginal sonogram, a probe is inserted into the vagina. The probe emits sound waves that bounce off uterine tissue, and creates images that help to locate cancerous cells. During a specific type of transvaginal sonogram, called a sonohysterogram, saline is put into the uterus through a catheter (tube) to help outline any problems.

If cancer is confirmed, your doctor probably will refer you to a gynecologic oncologist, a physician specializing in cancers of the female reproductive system. The next step is to determine if, and how far, it has spread outside the uterus. Blood tests usually are ordered along with routine imaging tests, such as a computed tomography (CT) scan and a chest X-ray.

The extent of the cancer determines its stage. Higher survival rates are associated with earlier stages. The following applies to uterine cancer:

• Stage I — The cancer is limited to the uterus.
• Stage II — The cancer has spread from the uterus to the cervix.
• Stage III — The cancer, spread beyond the uterus, is still confined to the pelvic region.
• Stage IV — The cancer has spread to the inner surface of the urinary bladder or rectum. This stage may also indicate that the cancer has moved into the lymph nodes in the groin, or into organs distant from the uterus, such as the lungs.

Since experts don't understand the causes of uterine cancer, there are no clear guidelines for preventing it. Doctors recommend a healthy diet and exercise to help control weight and blood pressure.

For women undergoing estrogen replacement therapy, ask your doctor about taking estrogen in combination with progesterone, and the need for regular examinations.

Types of treatment for uterine cancer include surgery, radiation therapy, chemotherapy and hormone therapy.

• Surgery — If you have uterine cancer, you will most likely have some form of surgery. Which procedure is used depends largely on the stage, type and grade of the cancer. Your general state of health may also be a factor. The most common surgery involves removal of the uterus (hysterectomy) and the ovaries (bilateral oophorectomy). Complications are rare, but both of these procedures cause infertility.



• Radiation therapy — Radiation therapy also depends on the stage, type and grade of cancer. If you need treatment over a larger area because the cancer has spread, you will be exposed to radiation from an outside source, known as external beam radiation. In other cases, a form of internal radiation called brachytherapy will be used. In this procedure, a pellet of radioactive material is inserted near the tumor. There are side effects with both types of radiation, such as fatigue, skin irritation and diarrhea, but most soon disappear after treatment has been completed.



• Chemotherapy — Chemotherapy, the use of drugs to kill cancer cells, is generally only used with uterine cancer when it has spread beyond the uterus.



• Hormone therapy — The aim of hormone therapy is to block cancer cells from getting the hormones they need to grow. With uterine cancer, it involves progesterone pills and sometimes, in cases of advanced or recurring disease, tamoxifen (Nolvadex).

Call a doctor immediately if you have abnormal vaginal bleeding. You also should consult a doctor whenever pain occurs during urination, intercourse, or in the pelvic area in general, although uterine cancer usually is not the cause of these symptoms.

The earlier the cancer is discovered and treated, the better the outlook. In general, 80% of women with uterine cancer survive five years or more. However, it is important to know that, even in the best of cases, there is a possibility of the cancer returning. Follow-up care is important.

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