Cancer of the Uterus

Endometrial cancer is more common in high-income countries where obesity rates are high.

Risk factors for endometrial cancer are

Conditions that result in a high level of estrogen and a low level of progesterone include the following:

Estrogen promotes the growth of tissue and rapid cell division in the lining of the uterus (endometrium). Progesterone (or progestin medications) causes thinning of the endometrium, which balances the effects of estrogen. Levels of estrogen are high during part of the menstrual cycle. Thus, having more menstrual periods during a lifetime may increase the risk of endometrial cancer. Taking oral contraceptives Oral Contraceptives Contraceptive hormones can be Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings) Applied to the skin (patch) Implanted under the skin read more that contain both estrogen and a progestin appears to reduce the risk of endometrial cancer.

Drugs or herbal products that contain estrogen or substances similar to estrogen can cause endometrial cancer if they are not taken with a progestin.

Tamoxifen, a drug used to treat breast cancer, blocks the effects of estrogen in the breast, but it has the same effects as estrogen in the uterus. People with breast cancer are not usually given progestins (to balance the effects of estrogen). Thus, this drug may increase the risk of endometrial cancer, mostly in postmenopausal women. Women taking this drug should contact a health care practitioner if they have abnormal vaginal bleeding.

In about 5% of women with endometrial cancer, heredity plays a role. About half of endometrial cancers that involve heredity occur in women who have a hereditary syndrome called Lynch syndrome Lynch syndrome (hereditary nonpolyposis colorectal carcinoma [HNPCC]) Family history and some dietary factors (low fiber, high fat) increase a person’s risk of colorectal cancer. Typical symptoms include bleeding during a bowel movement, fatigue, and weakness... read more . People with this syndrome have a high risk of developing colon and other cancers.

Abnormal vaginal bleeding Vaginal Bleeding Abnormal vaginal bleeding includes any vaginal bleeding that occurs Before puberty Between menstrual periods During pregnancy After menopause (12 months or more after the last menstrual period) read more is the most common early symptom of endometrial cancer. Abnormal bleeding includes

About 1 to 14% of women with vaginal bleeding after menopause has endometrial cancer. Postmenopausal women who have vaginal bleeding should see a doctor promptly, even if there only a small amount of blood or pink, red, or brown staining.

Women with sarcoma usually have abnormal vaginal bleeding. Less commonly, sarcomas cause pain or pressure in the pelvis or abdomen.

Doctors may suspect endometrial cancer if one of the following is present:

If cancer is suspected, doctors take a sample of tissue from the endometrium (endometrial biopsy Uterus Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more ) and send it to a laboratory for analysis. An endometrial biopsy accurately detects endometrial cancer more than 90% of the time. Alternatively, an ultrasound device may be inserted through the vagina into the uterus (called transvaginal ultrasonography) to evaluate abnormalities. However, a biopsy is still necessary to make the final diagnosis.

If the diagnosis is still uncertain or suggests cancer, doctors scrape tissue from the uterine lining for analysis—a procedure called dilation and curettage Dilation and Curettage Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more (D and C). At the same time, doctors usually view the interior of the uterus using a thin, flexible viewing tube inserted through the vagina and cervix into the uterus in a procedure called hysteroscopy.

If endometrial cancer is diagnosed, some or all of the following procedures may be done to determine whether it has spread:

If results of the physical examination or other tests suggest that the cancer has spread beyond the uterus, computed tomography (CT) or magnetic resonance imaging (MRI) is done.

Prognosis depends on the stage of the endometrial cancer.

Overall, 63% of women are cancer-free 5 years after treatment.

Generally, the prognosis is better if

Prognosis is generally worse with sarcomas than with endometrial carcinoma. Sarcomas develop from muscle or connective tissue. Endometrial carcinoma begin in the lining of the uterus.

No measure can prevent endometrial cancer from developing. However, the risk of getting endometrial cancer can be decreased by minimizing or avoiding conditions and activities thought to increase the risk. For example, obesity increases the risk of endometrial cancer. Thus, losing weight, exercising regularly, and eating a healthful diet may be helpful. Also, medications or herbal products that contain estrogen should not be taken alone. They should be taken with a progestin.

Hysterectomy Treatment The most common type of cancer of the uterus develops in the lining of the uterus (endometrium) and is called endometrial cancer. Endometrial cancer usually affects women after menopause. It... read more (surgical removal of the uterus) is the mainstay of treatment for women who have endometrial cancer.

Doctors can remove the uterus, fallopian tubes, and ovaries using one of the following methods:

These methods usually take about 1 to 2 hours and require a general anesthetic. Afterward, vaginal bleeding and pain may occur. Recovery may take up to 6 weeks.

For laparoscopic surgery, thin instruments and a small video camera are inserted through tiny incisions near the navel. The camera sends an image of the abdomen's interior to a monitor. While looking at the monitor, surgeons hold the instruments in their hands and use them to cut and sew tissue.

For robotic-assisted laparoscopic surgery, laparoscopy is done in the usual way. But robotic arms, rather than surgeons, hold the instruments. Surgeons use hand controls to manipulate the arms of the robot. The camera used provides a 3-dimensional, highly detailed (high-definition) image of the interior that is displayed on a console. Surgeons sit at the console to view this image and use a computer that translates their hand movements into precise movements of the instruments.

After laparoscopic or vaginal surgery, hospital stays are shorter than after open surgery (which involves a larger incision). Also, women usually have less pain and fewer complications and can return more quickly to normal activities.

There are several types of hysterectomy. The type used depends on the disorder being treated.

For uterine cancer or ovarian cancer Ovarian Cancer, Fallopian Tube Cancer, and Peritoneal Cancer Ovarian cancer is cancer of the ovaries. It is related to fallopian tube cancer, which develops in the tubes that lead from the ovaries to the uterus, and peritoneal cancer, which is cancer... read more , total hysterectomy is usually done. For cervical cancer Treatment Cervical cancer develops in the cervix (the lower part of the uterus). Most cervical cancers are caused by human papillomavirus (HPV) infection. Cervical cancer usually results from infection... read more or vaginal cancer Treatment Cancer of the vagina, an uncommon cancer, usually develops in the cells lining the vagina, typically in women over 60. Vaginal cancer may cause abnormal vaginal bleeding, particularly after... read more , treatment may include radical hysterectomy.

For uterine cancer, nearby lymph nodes Overview of the Lymphatic System The lymphatic system is a vital part of the immune system. It includes organs such as the thymus, bone marrow, spleen, tonsils, appendix, and Peyer patches in the small intestine that produce... read more are usually removed at the same time as hysterectomy. These tissues are examined by a pathologist to determine whether the cancer has spread and, if so, how far it has spread. With this information, doctors can determine whether additional treatment (chemotherapy, radiation therapy, or a progestin) is needed after surgery.

When the cancer appears to be only in the uterus, doctors may do sentinel lymph node dissection instead of removing all the lymph nodes. A sentinel lymph node What Is a Sentinel Lymph Node? is the first lymph node that cancer cells are likely to spread to. There may be more than one sentinel lymph node. These nodes are called sentinel lymph nodes because they are the first to warn that cancer has spread.

A sentinel lymph node dissection involves

To identify sentinel lymph nodes, doctors inject a blue or green dye and/or a radioactive substance, usually into the cervix. These substances travel to the lymph nodes near the uterus and map the pathway from the uterus to the lymph node (or nodes) nearest the uterus. During surgery, doctors check for lymph nodes that look blue or green or that give off a radioactive signal (detected by a handheld device). Doctors remove this node (or nodes) and send it to a laboratory to be checked for cancer. If the sentinel lymph node or nodes do not contain cancer cells, no other lymph nodes are removed (unless they look abnormal).

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