What is uterine cancer?
Uterine cancer is the most common type of cancer of the female reproductive system. It is a malignant tumor that starts in the cells of the uterus. A malignant tumor means it can invade and destroy surrounding tissue. It can also spread (metastasize) to other parts of the body.
The uterus, sometimes also called the womb, is part of the female reproductive system. It is a hollow, pear-shaped muscular organ where the fetus develops during pregnancy. The lining of the uterus, called the endometrium, is made up of tissue rich in glands. The lower part of the uterus, or cervix, is connected to the vagina.
Sometimes cells in the uterus go through changes that make the way they grow or behave abnormally. These changes can lead to non-cancerous, or benign, conditions such as endometriosis. They can also lead to the formation of non-cancerous tumors, including uterine fibroids.
Changes in the cells of the uterus can also cause precancerous conditions. This means that the abnormal cells are not yet cancerous, but they could be if left untreated. Atypical endometrial hyperplasia is the most common precancerous condition of the uterus.
In some cases, the altered cells in the uterus can become cancerous. There are 2 main types of uterine cancer. Most cancers of the uterus are endometrial carcinomas, which start in cells in the lining of the uterus (called the endometrium). Uterine sarcoma, on the other hand, begins in the supporting tissues of the uterus such as muscle, fat, bone and fibrous tissue (fibrous tissues are those that make up ligaments and tendons). Carcinosarcoma is a third type of cancer that sometimes affects the uterus. It has characteristics of carcinoma and sarcoma.
Rare types of uterine cancer can also occur. Gestational trophoblastic disease is one example.
The uterus, sometimes also called the womb, is the part of the female reproductive system in which the baby develops. It is located above the vagina, between the bladder and the rectum. It measures approximately 7cm in length and 5cm in width (in its widest dimension). The uterus is held in place in the pelvis by several ligaments.
The female reproductive system is made up of internal organs, including the vagina, uterus, ovaries and fallopian tubes. It also has external genitalia (the parts that make up the vulva). All of the internal organs are located in the pelvis, which is located under the abdomen between the hip bones.
The uterus receives a fertilized egg and protects the fetus (baby) as it grows and develops. The uterus contracts to push the baby out of the body during delivery.
Every month, unless the woman is pregnant or going through menopause, the lining of the uterus grows and thickens in preparation for pregnancy. If the woman does not become pregnant, the lining is released from the body through the cervix and then the vagina. This is called menstruation. These occur until menopause.
Malignant tumors of the uterus
A cancerous tumor of the uterus can invade and destroy surrounding tissue. It can also spread (metastasize) to other parts of the body. Cancerous tumors are also called malignant tumors.
Endometrial carcinoma starts in the lining of the uterus (called the endometrium). Over 95% of uterine cancers are endometrial carcinomas.
Endometrioid carcinoma accounts for 75 to 80% of all endometrial carcinomas. It manifests in the glands of the endometrium.
There are different types, or variants, of endometrioid carcinoma. One of these variants is squamous-cell differentiating endometrioid carcinoma. When this tumor is made up of glandular cancer cells and non-cancerous squamous cells, it is called adenoacanthoma. When it is made up of glandular cancer cells and squamous cells that are also cancerous, it is called adenosquamous or mixed cell carcinoma.
Other variants include endometrioid carcinoma:
Other types of endometrial carcinoma
Endometrial carcinoma can also be of the following types:
serous adenocarcinoma (serous papillary adenocarcinoma)
clear cell adenocarcinoma
squamous cell carcinoma
transitional cell carcinoma
small cell carcinoma
Carcinosarcoma is also called a malignant mesodermal mixed tumor or a malignant Müllerian mixed tumor (MMMM). This is another type of cancer that starts in the endometrium. It has both carcinoma and sarcoma characteristics.
Carcinosarcoma used to be classified as sarcoma of the uterus, but doctors now consider it a poorly differentiated type of endometrial carcinoma.
Sarcoma of the uterus
Uterine sarcoma starts in muscle tissue or connective tissue in the uterus. About 2% to 5% of uterine cancers are sarcomas of the uterus.
Leiomyosarcoma of the uterus occurs in the muscular layer of the lining of the uterus (called the myometrium). This is the most common type of uterine sarcoma.
Endometrial stromal sarcoma is a rare type of uterine sarcoma. It occurs in the connective tissue that supports the endometrium. Low-grade endometrial stromal sarcoma most commonly affects premenopausal women. High-grade endometrial stromal sarcoma most often develops after menopause.
Undifferentiated sarcoma is a rare and aggressive type of endometrial stromal sarcoma.
Gestational trophoblastic disease
Gestational trophoblastic disease (MTG) is a number of rare tumors that start in tissue that would normally develop in the placenta after conception (the union of a sperm and an egg). It can occur in pregnant women or those who have recently been pregnant.
Precancerous conditions of the uterus
Atypical endometrial hyperplasia is a precancerous condition that occurs in the lining of the uterus (called the endometrium). It consists of an excessive proliferation of abnormal cells. It can also be caused by endometrial hyperplasia, which is an excessive proliferation of normal cells. Polyps that can appear in the uterus sometimes have atypical endometrial hyperplasia.
Atypical endometrial hyperplasia is not yet cancerous, but this abnormal change can develop into cancer of the uterus if left untreated.
Atypical endometrial hyperplasia usually occurs in older women. Young women who do not ovulate or who are obese can also get it.
Atypical endometrial hyperplasia occurs when there is an imbalance of female hormones (called estrogen and progesterone) and the endometrium is exposed to relatively more estrogen than progesterone. Estrogen is then said to be either uncompensated or unopposed. Several factors can cause this imbalance, including:
hormonal changes during menopause
hormone replacement therapy (HRT)
tamoxifen (Nolvadex, Tamofen) used to treat breast cancer
The most common symptom of atypical endometrial hyperplasia is abnormal vaginal bleeding. Some women may have an abnormal vaginal discharge or abnormal Pap test results, but this is less common.
If you have any symptoms or if your doctor thinks you may have atypical endometrial hyperplasia, you will have tests. The following tests may be used to diagnose atypical endometrial hyperplasia.
An endometrial biopsy is a procedure in which small pieces of the lining of the uterus (called the endometrium) are removed and examined under a microscope. It is usually performed in the doctor’s office.
Dilation and curettage (DC) is a procedure in which the cervix (the lower, narrow part of the uterus) is widened, or dilated, so that a curette (a curette-shaped instrument) can be inserted into it. sharp-edged spoon) into the uterus for the purpose of removing cells, tissue or masses from the endometrium (inner lining of the uterus).
The treatment of atypical endometrial hyperplasia depends on the following factors:
the degree of difference between abnormal cells and normal cells
the amount of bleeding
the desire of the woman with perhaps one day to bear children
Treatment options for atypical endometrial hyperplasia may include:
hysterectomy (in postmenopausal women)
taking progesterone (in women who may eventually want to bear children)
Benign tumors of the uterus
Uterine fibroids are common benign tumors of the uterus. These are lumps that appear in the connective tissue of the uterus. These masses do not spread to other parts of the body (they do not metastasize) and are usually not life threatening.
Uterine fibroids can affect different parts of the uterus, but they most often occur in the uterine wall. They tend to get bigger when the affected woman is of childbearing age and to shrink after menopause. Uterine fibroids can increase the risk of infertility.
About half of women have uterine fibroids by the age of 50. They are rare in women under the age of 20. It is not known what causes uterine fibroids. Doctors believe they are hormonal because high levels of estrogen and progesterone seem to accelerate their growth. They could also be hereditary.
In many women, fibroids do not cause any symptoms. The presence and nature of symptoms depend on the number of fibroids, their size and their location in the uterus. When they do occur, symptoms can include:
abnormal vaginal bleeding
need to urinate often (frequent urination)
pain, pressure, or cramps in the lower abdomen
problems during pregnancy, including premature contractions and spontaneous abortion
If you have symptoms of uterine fibroids, or if the doctor thinks you may have one, you will be checked for tests. Tests done to diagnose uterine fibroids include:
transvaginal or pelvic ultrasound
magnetic resonance imaging (MRI)
biopsy of the lining of the uterus (called endometrium)
Uterine fibroids usually do not require treatment unless they are causing symptoms. Treatment options include:
drugs that lower estrogen levels and slow the growth of fibroids
surgery to remove fibroids without removing the uterus (called myomectomy)
surgery to remove the uterus (called a hysterectomy)
Non-cancerous conditions of the uterus
Endometriosis is a common non-cancerous condition of the uterus and reproductive system that occurs when tissue in the lining of the uterus (called the endometrium) grows outside the uterus. In endometriosis, endometrial tissue usually grows outside of organs in the pelvis such as the uterus, vagina, cervix, fallopian tubes, ovaries, bladder, or the colon. Endometrial tissue sometimes reaches the abdominal cavity. In rare cases, it can develop in other parts of the body, such as the lungs. Endometriosis can increase the risk of infertility.
Doctors don’t know exactly what causes endometriosis. The following factors can increase your risk of getting endometriosis:
first-degree relative with endometriosis
childbirth at an advanced age
menstrual cycles lasting less than 27 days and periods lasting more than 8 days
certain types of uterine abnormalities
Endometriosis may not cause any symptoms. When symptoms do occur, they depend on where the endometrial tissue is growing. They can include:
pain in the pelvis, abdomen, lower back, or legs
nausea and vomiting
inability to get pregnant
After menopause, symptoms usually go away as hormone levels drop.
If you have symptoms of endometriosis, or if your doctor thinks you may have it, you will be checked for tests. Tests done to diagnose endometriosis include:
transvaginal or pelvic ultrasound
computed tomography (CT)
magnetic resonance imaging (MRI)
biopsy during laparoscopy, sigmoidoscopy or cystoscopy
Learn more about these tests and procedures.
Treatment options for endometriosis include:
- medicines to lower estrogen levels and control pain
- surgery to remove endometrial tissue that has grown outside the uterus
- surgery to remove the uterus (called a hysterectomy), fallopian tubes and ovaries
Risk factors for uterine cancer
A risk factor is something, like a behavior, substance, or condition that increases your risk for developing cancer. Most cancers are caused by many risk factors, but uterine cancer can develop in women who do not have any of the risk factors described below.
Atypical endometrial hyperplasia is a precancerous condition of the uterus. It’s not cancer, but it can turn into cancer of the uterus if left untreated. Some of the risk factors for uterine cancer can also cause atypical endometrial hyperplasia.
Risk factors are usually ranked from most important to least important. But in most cases, it is impossible to rank them with absolute certainty.
- Estrogen hormone replacement therapy
- Number of periods
- No childbirth
- Overweight and obesity
- Polycystic ovary syndrome
- Radiotherapy to the pelvis
- Estrogen-secreting tumors of the ovary
- Little physical activity
- Lynch Syndrome
- Cowden Syndrome
There is convincing evidence that the following factors increase your risk of uterine cancer.
Estrogen hormone replacement therapy
Hormone replacement therapy (HRT) uses female sex hormones (estrogen, progesterone, or both) to control symptoms of menopause, such as hot flashes, vaginal dryness, and mood swings. Research shows that taking estrogen-only HRT (no progesterone) increases the risk of uterine cancer. Combining estrogen with progesterone (combined HRT) does not increase the risk of uterine cancer.
Number of periods
Women who have a greater number of periods in their lifetime are at greater risk of developing uterine cancer. We are talking about women who started menstruating before the age of 12 (early menstruation, or early menarche) or whose periods stopped after 55 (late menopause). Early periods like late menopause mean that the body makes estrogen longer, which increases the risk of uterine cancer.
Women who never give birth to a child are twice as likely to develop uterine cancer than women who give birth at least once. During pregnancy, the level of estrogen in the body drops. The more a woman gives birth, the less estrogen her body makes and the lower her risk of developing uterine cancer.
Overweight and obesity
A woman who is overweight or obese has a higher risk of developing uterine cancer. A woman who has a lot of body fat may be up to 10 times more likely to have it.
Researchers are not sure why being overweight and obese increases the risk of uterine cancer. This may be because having too much fatty tissue increases the level of estrogen in the body, and too much estrogen increases the risk of uterine cancer. In obese people, the blood levels of insulin and insulin-like growth factor 1 are often high, which can help some tumors to grow. The risk of developing uterine cancer is even higher in women who are overweight or obese and have high blood pressure or diabetes.
Tamoxifen (Nolvadex, Tamofen) is a hormonal medicine given to treat certain cancers, most often breast cancer. Women who take tamoxifen for 2 years or more have a higher risk of developing uterine cancer.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is caused by changes in the normal hormonal cycle and the normal ovulation process. Many women with polycystic ovary syndrome don’t get their period often, or don’t at all, and may have difficulty getting pregnant. These women are also at higher risk of developing uterine cancer.
Diabetes, also called diabetes mellitus, is a chronic disease that increases the rate of blood sugar. Women with diabetes are about twice as likely to get uterine cancer as women who don’t have diabetes. Women with diabetes who are also obese or have high blood pressure are at an even greater risk of developing uterine cancer.
Radiotherapy to the pelvis
Radiation therapy is used to treat certain cancers or uterine bleeding caused by a non-cancerous (benign) condition. Women who receive large doses of radiation therapy to the pelvis are at greater risk of developing uterine cancer.
Estrogen-secreting tumors of the ovary
A woman with an ovarian tumor that makes estrogen is more likely to get cancer of the uterus because her estrogen levels are high.
Little physical activity
Women who do little physical activity are more likely to get cancer of the uterus. Being active seems to protect against uterine cancer.
Lynch syndrome (also called hereditary nonpolyposis colorectal cancer or HNPCC) is an inherited disease caused by a change (mutation) that has occurred in one of DNA’s mismatched repair genes. These genes usually correct mistakes made when copying DNA during cell division. In the case of Lynch syndrome, the mismatched repair genes do not work properly and the cells that carry the errors are not repaired. These abnormal cells eventually build up and can become cancerous.
Women with Lynch syndrome have a higher risk of developing uterine cancer during their lifetime. These women tend to get cancer of the uterus at a younger age than women in general.
Cowden syndrome is an inherited disease that can cause many non-cancerous masses called hamartomas to form in the skin, breast, thyroid gland, colon, small intestine and mouth. Cowden syndrome is caused by a mutation in the PTEN gene. It increases the risk of uterine cancer.
Possible risk factors
The following factors have been linked to uterine cancer, but there is insufficient evidence to suggest that they are risk factors. More research is needed to clarify the role of these factors in the development of uterine cancer:
physical inactivity (sedentary habits)
family history of uterine cancer
high blood pressure (hypertension)
exposure to diethylstilbestrol (DES), a form of estrogen made in the laboratory
high glycemic load (the glycemic load is a measure of how quickly certain amounts of food raise blood sugar levels)
No link to uterine cancer
Important research indicates that there is no link between intrauterine devices (a type of birth control) and the increased risk of uterine cancer.
Reduce the risk of uterine cancer
You can reduce your risk of uterine cancer by doing the following.
Maintain a healthy weight
Research shows that you can lower your risk of uterine cancer by being at a healthy weight. Eating well and being physically active can help you achieve a healthy weight.
Move more and spend less time sitting
Studies show that physical activity can help protect you from uterine cancer.
Learn about protective factors
Certain medications and lifestyle choices can help protect you against cancer of the uterus.
Estrogen and progesterone birth control pills can help protect women against cancer of the uterus. Doctors may also consider giving this type of oral contraceptive to women with polycystic ovary syndrome who are not ovulating to help prevent cancer of the uterus.
Carrying children can help reduce the risk of uterine cancer.
Research suggests that drinking coffee can help protect against cancer of the uterus, whether or not it is decaffeinated.
Find out if your risk of uterine cancer is high
Some women may have a higher than average risk of developing uterine cancer. Discuss your risk with your doctor. If it is above average, you may need to see your doctor more often to check for uterine cancer. Your doctor will tell you which tests to take and how often.
A woman with atypical endometrial hyperplasia usually receives treatment that helps prevent the abnormal cells from turning into cancer of the uterus.
Women with polycystic ovary syndrome should be treated with progesterone to control hormone levels and reduce the risk of uterine cancer.
Prophylactic hysterectomy may be an option for women at very high risk of uterine cancer, some of whom have Lynch syndrome. This surgery removes the uterus before the cancer starts. The decision to have a prophylactic hysterectomy should be carefully considered. Talk to your doctor about the risks and benefits of this surgery and whether it is the best option for you.
Finding uterine cancer early
Finding and treating uterine cancer at an early stage increases the chances of successful treatment. Have a regular check-up and see your doctor if you experience any symptoms, such as abnormal vaginal bleeding, or if you are concerned about your health.
Most women should have a regular Pap test for cervical cancer. This test can sometimes detect uterine cancer. It is not used as a routine screening test for uterine cancer because it is designed to find abnormal cervical cells rather than abnormal uterine cells. The Pap test does not reach the inside of the uterus, so it will not detect all uterine cancers.
If your risk is above average, you may need to see your doctor more often to check for uterine cancer. Talk to your doctor about tests that can help find early stage uterine cancer, including the following:
- pelvic exam
- transvaginal ultrasound
- biopsy of the lining of the uterus, the endometrium
Symptoms of uterine cancer
Cancer of the uterus can cause various signs and symptoms as the cancer grows. Other medical conditions can cause the same symptoms as uterine cancer.
The most common symptom of uterine cancer is abnormal vaginal bleeding. This includes changes in your periods (heavier, longer, or more frequent periods than normal), bleeding between periods, bleeding after menopause, and light vaginal bleeding.
Other signs and symptoms of uterine cancer include:
- unusual vaginal discharge, which may be foul-smelling, look like pus, or be tinged with blood
pain during sex
- pain or pressure in the pelvis, lower abdomen, back, or legs
- pain during urination, difficulty passing urine, or blood in the urine
- pain during bowel movements, difficulty in defecating, or blood in the stool
- bleeding from the bladder or rectum
- accumulation of fluid in the abdomen (called ascites) or legs (called lymphedema)
- loss of appetite
- difficulty in breathing
Diagnosis of uterine cancer
The diagnostic process for uterine cancer usually begins with a visit to your family doctor. Your doctor will ask you about your symptoms and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for uterine cancer or other health problems.
The diagnostic process can seem long and overwhelming. It’s okay to worry, but try to remember that other medical conditions can cause uterine cancer-like symptoms. It is important that the healthcare team rule out any other possible cause of the condition before making a diagnosis of uterine cancer.
The following tests are commonly used to rule out or confirm a diagnosis of uterine cancer. Many tests that can diagnose cancer are also used to determine the stage, that is, the extent of progression of the disease. Your doctor may also order other tests to assess your general health and to help plan your treatment.
Medical history and physical examination
A medical history is a history of symptoms, risk factors, and any medical events and conditions a person has had in the past. When checking your medical history, your doctor will ask you questions about your personal history of:
symptoms that may indicate the presence of uterine cancer
use of hormone replacement therapy
use of tamoxifen (Nolvadex, Tamofen) to treat or prevent breast cancer
polycystic ovary syndrome or ovarian tumors
radiotherapy to the pelvis
overweight or obese
Your doctor may also ask you about your family history of:
cancer of the uterus, ovary, breast or colon
other hereditary cancer syndromes
The physical exam allows the doctor to look for any signs of uterine cancer. During the physical examination, the doctor may:
measure your weight and blood pressure
auscultate your chest
perform a pelvic exam and digital rectal exam
feel your abdomen to check if your liver is swollen, there are lumps, or if there is a buildup of fluid (called ascites)
feel the lymph nodes in the groin and those above the collarbone for swelling
Complete blood count (CBC)
The complete blood count (CBC) is used to assess the quantity and quality of white blood cells, red blood cells and platelets. It is used to check for anemia caused by vaginal bleeding. The CBC also allows doctors to obtain benchmarks against which to compare the results of future blood tests performed during and after treatment.
In an ultrasound, high-frequency sound waves are used to produce images of body structures. In transvaginal ultrasound, sound waves are produced by a small ultrasound probe that is gently inserted into the opening of the vagina.
Transvaginal ultrasound can be used for:
determine the thickness of the endometrium
check for lumps in the uterus
check to see if cancer has invaded the muscular layer of the lining of the uterus (called the myometrium)
check to see if the cancer has spread to other areas of the pelvis
During a biopsy, the doctor removes tissues or cells from the body for analysis by a pathology laboratory. The laboratory report confirms the presence or absence of cancer cells in the sample.
An endometrial biopsy is a procedure that removes small pieces of the lining of the uterus (called the endometrium). It is usually performed in the doctor’s office. Sometimes a hysteroscopy (a type of endoscopy) is done at the same time.
Dilation and curettage (DC) is a procedure in which the cervix (the lower, narrow part of the uterus) is widened, or dilated, so that a curette (a curette-shaped instrument) can be inserted into it. sharp-edged spoon) into the uterus for the purpose of removing endometrial cells, tissue or masses. It may be used if the sample taken from an endometrial biopsy was too small to make a diagnosis, if the results were inconclusive, or if endometrial hyperplasia was detected.
This procedure is performed in an operating room.
Endoscopy allows the doctor to observe the inside of a body cavity using a rigid or flexible tube, at the end of which are attached a lumen and a lens. This instrument is called an endoscope.
A hysteroscopy is often done when there is abnormal vaginal bleeding. This helps doctors detect and diagnose abnormal changes in the uterus. Sometimes a biopsy is done during a hysteroscopy. The tissue samples taken are then examined to determine whether the changes are non-cancerous (benign), precancerous, or cancerous (malignant).
Sometimes a cystoscopy is done when the person has difficulty passing urine or notices blood in their urine. Doctors use it to find out if the cancer has spread to the bladder or urethra.
Sometimes a proctoscopy is done when bowel movements change. Doctors use it to find out if the cancer has spread to the rectum.
Blood biochemical analyzes
In blood chemistry tests, the level of certain chemicals in the blood is measured. They make it possible to evaluate the functioning of certain organs and to detect abnormalities. To determine the stage of uterine cancer, the following blood chemistry tests can be done.
Blood urea nitrogen and creatinine levels can be measured to check kidney function. Higher than normal levels could mean that the cancer has spread to the ureters or kidneys.
Alanine aminotransferase (ALT), aspartate transaminase (AST), and alkaline phosphatase can be measured to check liver function. Higher than normal levels could mean that the cancer has spread to the liver.
Determination of tumor markers
Tumor markers are substances found in the blood, tissues and fluids taken from the body. An abnormal level of a tumor marker can mean that a woman has cancer of the uterus.
Tumor marker assay is usually done to assess response to cancer treatment. It can also be used to diagnose cancer of the uterus.
Tumor antigen 125 (CA 125) can be measured. A higher than normal rate could indicate the presence of advanced or metastatic uterine cancer.
A barium enema is an imaging test that uses a contrast medium (barium sulfate) and X-rays to produce images of the colon. It can be used to find out if the cancer has spread to the rectum. A barium enema may be done if a woman experiences symptoms that suggest the cancer may have spread to the rectum.
In an x-ray, low doses of radiation are used to produce images of the body’s structures on film. It is used to find out if uterine cancer has spread to the lungs.
Computed tomography (CT)
A computed tomography (CT) scan uses special x-ray machines to produce 3-dimensional and cross-sectional images of the body’s organs, tissues, bones and blood vessels. A computer assembles the photos into detailed images.
CT is used to determine if the cancer has spread to other organs or if it has come back after treatment.
Magnetic resonance imaging (MRI)
In magnetic resonance imaging (MRI), powerful magnetic forces and radio waves are used to produce cross-sectional images of the body’s organs, tissues, bones and blood vessels. A computer assembles the photos into 3-dimensional images.
MRIs are used to find out how much cancer has invaded the muscle layer of the lining of the uterus (called the myometrium). It can also help doctors determine if the cancer has spread to other organs or if it has come back after treatment.
Histological classification of uterine cancer (grade)
To determine the grade of uterine cancer, the pathologist examines a sample of tissue taken from the uterus under a microscope. The pathologist assigns a grade of 1 to 3 to cancer of the uterus. The lower this number, the lower the rank.
The grade describes how cancer cells look and behave compared to normal cells. The term differentiation is used to refer to how different cancer cells are.
Low-grade cancer cells are well differentiated. They almost look like normal cells. They tend to grow slowly and are less likely to spread.
High-grade cancer cells are poorly differentiated or undifferentiated. Their appearance is less normal, or more abnormal. They tend to grow faster and are more likely to spread than low-grade cancer cells.
Knowing the grade gives your healthcare team an idea of how quickly cancer can grow and how likely it is to spread. It helps him plan your treatment. The grade can also help the healthcare team make your prognosis and predict how the cancer might respond to treatment.
The International Federation of Gynecology and Obstetrics (FIGO) has developed a histological classification system for endometrial carcinoma. This system is based on the percentage of cells in the tumor that grow into lamellae (these are called solid components in the tumor) rather than forming glands. It can also take into account how abnormal the cells look.
The International Federation of Gynecology and Obstetrics (FIGO) developed a grading system for endometrial carcinoma. It is based on the percentage of cells in the tumour that grow in sheets (called solid tumour growth) rather than form glands. It may also take into account how abnormal the cells appear.
|1||5% or less of tumour tissue is solid tumour growth.|
The cancer cells are well-differentiated.
|2||6%–50% of tissue is solid tumour growth.|
The cancer cells are moderately differentiated.
|3||More than 50% of tissue is solid tumour growth.|
The cancer cells are poorly differentiated.
Uterine sarcoma is a soft tissue sarcoma that begins in the muscle or connective tissue cells of the uterus. There are several grading systems used for soft tissue sarcomas. The French Federation of Comprehensive Cancer Centers (FNCLCC) system is most commonly used. In this system, the grade is based on the following 3 factors.
Differentiation: The cells are given a score of 1–3 based on how they look. A score of 1 means the cancer cells look very similar to normal cells. A score of 3 means the cells look very abnormal.
Mitotic count: The cancer cells are given a score of 1–3 based on how they are dividing. A score of 1 means the pathologist saw only a few cells dividing. A score of 3 means many cells were dividing.
Tumor necrosis: The tumour is given a score of 0–2 based on how much of it is made up of dying tissue. A score of 0 means very little tissue is dying. A score of 2 means there is a large amount of dying tissue.
The scores for each factor are added up to determine the grade of the cancer. A higher score means a higher grade.
|GX||Grade cannot be assessed|
|G1||Total score of 2 or 3|
|G2||Total score of 4 or 5|
|G3||Total score of 6 or higher|
Stages of uterine cancer
Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).
The most common staging system for uterine cancer is the FIGO system. The FIGO system is used to stage endometrial carcinoma, uterine carcinosarcoma and uterine sarcoma. For these types of uterine cancer, there are 4 stages. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.
When describing the stage, doctors may use the words local, regional or distant. Local means that the cancer is only in the uterus and has not spread to other parts of the body. Regional means close to the uterus or around it, including lymph nodes in the pelvis and lymph nodes around the aorta (a large artery that carries blood away from the heart). Distant means in a part of the body farther from the uterus.
Endometrial carcinoma and uterine carcinosarcoma
Doctors use the following FIGO stages for endometrial carcinoma and uterine carcinosarcoma. The FIGO system does not include stage 0 (carcinoma in situ).
The tumour is only in the inner lining of the uterus (called the endometrium) or it has grown less than halfway through the muscle layer of the uterus wall (called the myometrium).
The tumour has grown halfway or more than halfway into the myometrium.
The tumour has grown into the cervix.
The tumour has grown into the outer surface of the uterus (called the uterine serosa) or the fallopian tubes, ovaries or their supporting ligaments.
The tumour has grown into or spread to the vagina or tissues next to the cervix and uterus (called the parametria).
The cancer has spread to lymph nodes in the pelvis (called pelvic lymph nodes) or to lymph nodes around the aorta (called para-aortic lymph nodes).
The tumour has grown into the lining of the bladder or intestines.
The cancer has spread to other parts of the body (called distant metastasis), such as to the lungs, liver or bone. This is also called metastatic cancer.
Doctors use the following FIGO stages for uterine leiomyosarcoma and endometrial stromal sarcoma.
The tumour is only in the uterus and is not larger than 5 cm.
The tumour is only in the uterus and is larger than 5 cm.
The tumour has grown into the fallopian tubes, ovaries or their ligaments.
The tumour has grown into other tissues in the pelvis.
The tumour has grown into 1 area of the abdomen.
The tumour has grown into 2 or more areas of the abdomen.
The cancer has spread to lymph nodes in the pelvis or to lymph nodes around the aorta.
The tumour has grown into the bladder or rectum.
The cancer has spread to other parts of the body (called distant metastasis), such as to the lungs, liver or bone. This is also called metastatic cancer.
Recurrent uterine cancer
Recurrent uterine cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.
If uterine cancer spreads
Cancer cells can spread from the uterus to other parts of the body. This spread is called metastasis.
Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If uterine cancer spreads, it can spread to the following:
- middle layer of the wall of the uterus (called the myometrium)
- outer layer of the uterus (called the perimetrium)
- tissues around the uterus
- fallopian tubes
- lymph nodes in the pelvis
- lymph nodes around the aorta (called para-arotic lymph nodes)
- lymph nodes above the collarbone
- abdominal cavity
- peritoneal cavity
Prognosis and survival for uterine cancer
If you have uterine cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for uterine cancer.
Grade is one of the more important prognostic factors. Grade 1 or 2 tumours have a better prognosis and are less likely to recur than Grade 3 tumours.
Myometrial invasion is how far the tumour has grown into, or invaded, the middle layer of the uterus wall (called the myometrium). Doctors can use the degree of myometrial invasion to predict if the cancer will come back, or recur, and to predict survival. The deeper the tumour has grown into the myometrium, the poorer the prognosis.
Doctors often classify the degree of myometrial invasion as:
none – the tumour hasn’t grown into the myometrium
superficial – the tumour has grown less than halfway through the myometrium
deep – the tumour has grown more than halfway through the myometrium
Myometrial invasion is closely linked to the grade of the tumour. A higher grade tumour has a greater chance of growing into the myometrium.
Stage 1 cancers have the most favourable prognosis. Cancers have a less favourable prognosis if they have spread outside of the uterus, including to the following:
structures in the pelvis and abdomen (also known as extra-uterine disease)
Type of tumour
Endometrial carcinomas have a more favourable prognosis than uterine sarcomas. Some types of tumours within these groups have more favourable prognoses than others. For example, endometrioid carcinomas have a more favourable prognosis than serous adenocarcinomas. Also, endometrial stromal sarcomas have a more favourable prognosis than uterine leiomyosarcomas.
Cancer cells in the peritoneal fluid
When cancer cells are in the fluid in the abdominal cavity (called peritoneal fluid), it often means that the cancer has spread outside the uterus. This prognostic factor is often linked with other factors, such as how deep the tumour has grown into the myometrium and if the cancer has spread to lymph nodes. Cancer cells in the peritoneal fluid (called positive peritoneal cytology) often means the cancer is more aggressive and it has a less favourable prognosis.
The presence of progesterone receptors on the cancer cells may be linked with a less aggressive cancer. Cancer cells that have progesterone receptors have a better response to hormonal therapy and a more favourable prognosis.
Younger women tend to have a better prognosis than post-menopausal women. This is true even though younger women may not be diagnosed with uterine cancer based on their symptoms as quickly as older women. Younger women often have lower grade tumours that are found at an earlier stage and haven’t grown very deep into the myometrium. Older women often have a more aggressive type of tumour and more advanced disease. As a result, older women tend to have a less favourable prognosis.
Obesity, especially when the woman also has diabetes and high blood pressure, has been linked with a less favourable prognosis.
Treatments for uterine cancer
If you have uterine cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for uterine cancer, your healthcare team will consider:
the type of tumour
your overall health
your personal preferences
You may be offered one or more of the following treatments for uterine cancer.
Staging is done during surgery. The surgeon does a pelvic exam while you are under general anesthetic. Then the surgeon makes an incision, or cut, in the abdomen to examine the organs and see if the cancer has spread to them. This is called abdominal exploration (laparotomy). The surgeon may remove abnormal tissue samples and lymph nodes during surgery. The surgeon may also rinse the abdomen with saline and collect a sample (called pelvic washings). Tissue samples, lymph nodes and pelvic washings are sent to the lab and examined under a microscope to check for the presence of cancer cells. The same surgery can also be done using less invasive methods with laparoscopy or robotic surgery.
Depending on the type of the tumour and whether or not you have other health problems, you may have one of the following types of surgery:
Total hysterectomy removes the cervix and uterus. The surgeon may also remove nearby lymph nodes.
Radical hysterectomy removes the cervix, the uterus, some of the structures and tissues near the cervix and upper vagina and nearby lymph nodes.
Bilateral salpingo-oophorectomy removes both ovaries and fallopian tubes. It is usually done at the same time as a hysterectomy.
Lymph node dissectionremoves lymph nodes in the pelvis, abdomen or both. It is commonly done during surgery to remove uterine cancer. The lymph nodes are then examined to see if they contain cancer. This helps doctors predict prognosis and decide if a woman needs other treatment.
Omentectomy removes the omentum to check for cancer cells.
Pelvic exenteration removes the cervix, uterus, vagina, ovaries, fallopian tubes and lymph nodes. The rectum, bladder or both may also be removed. Pelvic exenteration is sometimes done when uterine cancer recurs, or comes back, in the pelvis after it has been treated with radiation therapy.
Tumour debulking is surgery to remove as much of the tumour as possible. It may be used for advanced uterine cancer.
Radiation therapy may be used to treat any stage of uterine cancer. Women often receive external beam radiation therapy or brachytherapy.
Hormonal therapy may be given after surgery for some stages of uterine cancer. It may also be used as the main treatment for advanced or recurrent uterine cancer.
Chemotherapy may be given after surgery for some stages of uterine cancer. It may also be used as the main treatment for advanced or recurrent uterine cancer.
Chemotherapy is sometimes given during the same time period as radiation therapy to make the cells more sensitive to radiation. This is called chemoradiation. It may be used to treat some types of uterine cancer.
Find out more about chemotherapy.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first few years after treatment has finished. These visits allow your healthcare team to monitor your progress, detect early recurrences and help with recovery from previous treatment.
Some clinical trials in some countries are open to women with uterine cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Follow-up after treatment for uterine cancer
Follow-up after treatment is an important part of cancer care. Follow-up for uterine cancer is often shared among the cancer specialists (gynecologist, radiation oncologist, medical oncologist and surgeon) and your family doctor. Your healthcare team will work with you to decide on follow-up care to meet your needs.
Don’t wait until your next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:
- pain in the lower abdomen, pelvis, back or legs
- vaginal bleeding or discharge
- change in bladder habits
- change in bowel habits
- weight loss
- chronic cough
The chance of uterine cancer coming back, or recurring, is greatest within the first few years after treatment, so close follow-up is needed during this time.
Schedule for follow-up visits
Follow-up visits for uterine cancer are usually scheduled:
- every 3–4 months for the first 2–3 years after initial treatment
- every 6 months for the next 2–3 years
- yearly from then on
During follow-up visits
During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping. Your doctor may do a physical exam, including:
doing a pelvic exam
feeling the lymph nodes in the neck and groin area
Tests are often part of follow-up care. You may have:
a chest x-ray if you have a chronic cough
a CT scan if you have symptoms or your doctor finds something during the physical exam
blood tests to check cancer antigen 125 (CA125) levels if they were higher than normal before surgery for advanced stage cancer
If a recurrence is found, your healthcare team will assess you to determine the best treatment options.
Supportive care for uterine cancer
Supportive care helps women meet the physical, practical, emotional and spiritual challenges of uterine cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.
Recovering from uterine cancer and adjusting to life after treatment is different for each person, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for uterine cancer may have concerns about the following.
Self-esteem and body image
How a person feels about or sees themselves is called self-esteem. Body image is a person’s perception of their own body. Uterine cancer and its treatments can affect a woman’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:
- hair loss
- skin problems
- changes in body weight
- sexual problems
- an ostomy
- urinary or bowel problems
Some of these changes can be temporary, others will last for a long time and some will be permanent. For many women, body image and their perception of how others see them are closely linked to self-esteem. Loss of self-esteem may be a real concern for them and can cause considerable distress. Even though the effects of treatment may not always be visible to other people, body changes can still be troubling. Some women may be afraid to go out or that others will reject them. They may feel angry or upset.
A woman may feel differently about her body and herself as a woman, especially after a hysterectomy or pelvic exenteration. She may feel less like a woman or less feminine because she no longer has a uterus or has had vaginal reconstruction. A woman may also feel self-conscious because the way she urinates or has a bowel movement is different after a pelvic exenteration.
Some cancer treatments can cause sexual problems for women that make sex painful or difficult. For example, radiation therapy to the pelvis can cause vaginal dryness. Scarring after radiation therapy to the pelvic area or some surgeries for uterine cancer can also cause vaginal narrowing (also called vaginal stenosis). Some treatments can cause women to enter menopause early (called treatment-induced menopause).
Some women may have other sexuality problems, such as a loss of interest in sex. It is common to have a lower sex drive around the time of diagnosis and treatment.
There are ways to manage most sexual problems that develop because of treatments for uterine cancer. When a woman first starts having sex after treatment, she may be afraid that it will be painful or that she will not have an orgasm. It may take time for partners to feel comfortable with each other again, and the first attempts at being intimate with a partner may be disappointing. Some women and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.
Fertility problems can occur after treatment with radiation therapy or chemotherapy for uterine cancer. Women who have had a hysterectomy will not be able to become pregnant.
Before you start any treatment for uterine cancer, talk to your healthcare team about possible side effects that may affect your ability to have children after treatment. You can work with your healthcare team to discuss and plan fertility options before cancer treatment begins.
Lymphedema is a chronic form of swelling that occurs when lymph fluid builds up in soft tissues. It usually occurs in parts of the body where large numbers of lymph nodes have been removed.
You may have lymphedema in your legs if lymph nodes were removed from your pelvis during surgery to treat uterine cancer. Lymphedema is more likely to occur if you were also given radiation therapy to the pelvis.
If lymphedema develops, your healthcare team can suggest ways to help prevent further fluid buildup and reduce swelling as much as possible. This may include elevating the limb, exercise, physical therapy and pain management. You can also ask for a referral to a healthcare professional who specializes in managing lymphedema.
Many women who are treated for uterine cancer worry that the cancer will come back, or recur. It is important to learn how to deal with these fears to maintain a good quality of life.
In addition to the support offered by the treatment team, a mental health professional, such as a social worker or counsellor, can help you learn how to cope and live with a diagnosis of uterine cancer.
Although uncommon, a different (second) cancer may develop after treatment for uterine cancer. While the possibility of developing a second cancer is frightening, the benefit of treating uterine cancer with chemotherapy or radiation therapy usually far outweighs the risk of developing another cancer. Whether or not a second cancer develops depends on the type and dose of chemotherapy drugs given and if radiation therapy was also given. The combination of chemotherapy and radiation therapy increases the risk of second cancers.
Women who have radiation therapy to the pelvis have a small risk of developing a second cancer in the area treated with radiation. This area can include the colon, rectum, anus or bladder.
Women who have chemotherapy for uterine cancer can develop a second cancer at any time, but it usually occurs up to 10 years after treatment. The most common cancer that develops in women treated with chemotherapy for uterine cancer is acute myelogenous leukemia (AML).
Living a healthy lifestyle and working with your healthcare professional to develop a wellness plan for staying healthy may help lower the risk of second cancers. Routine screening to find a second cancer early, being aware of changes in your health and reporting problems to your doctor are also important parts of follow-up care after cancer treatment.
An ostomy connects an internal cavity to an opening (stoma) on the abdomen. Women who have a pelvic exenteration will have the bladder, rectum or both removed. A urostomy allows urine to pass out of the body and a colostomy allows stool to pass out of the body. Women who have the bladder and rectum removed will have 2 ostomies.
Many women can adapt to and live normally with an ostomy, although they have to learn new skills and how to care for it. Specially trained healthcare professionals (called enterostomal therapists) teach people how to care for their ostomies.
The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.
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