Uterine cancer begins in the uterus (womb), the pear-shaped organ that carries a developing baby during pregnancy.
The most common type of uterine cancer is endometrial cancer. It grows in the lining of the uterus, known as the endometrium. Other types of uterine cancer begin in the supporting connective tissue and muscle cells of the uterus.
In the United States, uterine cancer is the fourth most common cancer in women. Its also the most common cancer of women's gynecologic cancers.
Every year about 52,000 U.S. women are diagnosed with uterine cancer, according to the National Cancer Institute and about 8,500 of these women die of the disease annually.
Like most cancers, the earlier uterine cancer is detected, the better the prognosis. There are more than 600,000 women who are survivors of endometrial cancer, according to the American Cancer Society.
While experts still don't know the exact cause of uterine cancer, they do know that certain women are at higher risk.
Risk factors include:
Even if you have some of these risk factors, it doesnt mean youll get uterine cancer.
However, having these risk factors does mean that you should discuss with your doctor if you need more frequent check-ups, should lose excess weight, or take other measures to reduce your chance of developing uterine cancer.
There are several different types of uterine cancer, and each type progresses differently. Ask about having a specialist review the pathology of your specific cancer, once diagnosed.
Carcinomas: Endometrial cancers, which start in the cells that line the uterus, belong to a group of cancers called carcinomas. The majority of endometrial carcinomas are cancers of the cells that form glands in the endometrium. These are called adenocarcinomas.
The most common types of endometrial cancers are endometrioid adenocarcinomas. Less common are squamous cell, undifferentiated, clear cell, serous carcinoma, and poorly differentiated carcinoma.
Based on features of your cancer, you will learn the grade of an endometrioid cancer. The grade typically ranges from 1 to 3, with grade 3 being the most aggressive type.
Sarcomas: When cancer starts in the connective tissue and muscular cells of the uterus, the cancers are uterine sarcomas. They are much less common than the endometrial cancers and include stromal sarcoma and leiomyosarcomas.
Abnormal vaginal bleeding, such as bleeding after menopause or between periods, is one of the most common early symptoms of uterine cancer. Other symptoms that could indicate uterine cancer (as well as other problems) include:
The earlier you get treatment, the better. If you get a diagnosis of uterine cancer, the Centers for Disease Control and Prevention (CDC) recommend asking your doctor for a referral to a gynecologic oncologist, who has been trained to treat uterine and other gynecologic cancers.
Treatment depends on the exact type of uterine cancer and how extensive it is, and whether it is localized or has spread (metastasized).
Among the options:
Besides a gynecologic oncologist, your treatment team may include surgeons, medical oncologists (who prescribe medication) and radiation oncologists.
If the available treatments do not work for you, your doctor may recommend joining a clinical trial, which tests new treatment options.
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Uterine cancer, also called cancer of the womb, can cause symptoms early in the course of the cancer as well as during more advanced stages.
Perhaps the most significant early warning sign is unusually heavy or prolonged vaginal bleeding. In fact, roughly 90 percent of women diagnosed with this cancer report abnormal vaginal bleeding.
Abnormal bleeding includes bleeding that occurs after menopause, or bleeding that occurs between periods.
If you are still menstruating, it could also be bleeding that is not typical for you, such as very heavy bleeding. In fact, any abnormal bleeding should be reported to your doctor immediately.
Several other symptoms warrant a call to the doctor right away, including:
All of these could be the result of other conditions besides uterine cancer, but nonetheless, it's important to be examined.
When you see your doctor, you will be asked to describe your symptoms. So it may help to write down what they are, when you first noticed them, and other details before your appointment.
Next, after taking a careful history, your doctor may order a range of tests, including:
If cancer is found, the next step is to estimate how advanced it is. At this time, your doctor may order more tests, including scans such as computerized tomography (CT) or positron emission tomography (PET) and blood tests.
In some cases, your doctor will not be able to tell the stage of your cancer meaning how advanced it is until after surgery.
Stages of endometrial cancer include:
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The best treatment for uterine cancer depends on a number of factors, including the type and stage of your cancer, your general health, and your personal treatment preferences.
Cancer of the uterus is classified into several types. Your doctor will discuss your options for treatment, based on the type of uterine cancer you have as well as other factors.
Basically, the choices may include:
The main treatment for endometrial cancer is a hysterectomy, the removal of both the uterus and the cervix (the lower end of the uterus, near the vagina).
In this surgery, the surgeon may also remove the ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
However, if you have not yet gone through menopause, you need to discuss with your doctor whether it would be better to preserve the ovaries. The removal of your ovaries can trigger premature menopause.
Your doctor may also remove lymph nodes from the pelvic area to test for any cancer that may have spread outside of the uterus.
Hysterectomies are done in different ways. In some, the uterus is removed through an abdominal incision (abdominal hysterectomy). Sometimes the uterus is removed through the vagina.
Recovery time depends on the type of surgery and whether there are any complications. In general, however, it can take two to six weeks for recovery. Hospital stays also vary, from about three days to a week.
If your doctor recommends hormone therapy, you will be given hormone medication that decreases the levels of hormones that your body makes, or blocks hormones from working. The goal is to stop the cancer cells from growing.
The goal of chemotherapy is to prescribe medication to shrink or kill the cancer cells. Chemotherapy can be taken orally in pill form, or given to you intravenously or sometimes both ways.
If your doctor recommends radiation therapy, it may be given internally or externally. High-energy rays, somewhat like X-rays, are used to kill the cancer cells.
Internal radiation, also called brachytherapy, is done in the radiology department of a hospital or cancer care center. This involves inserting a cylinder with a source of radiation (pellets) into the vagina.
External beam radiation is typically given for four to six weeks, five days a week. You must be in the same position for each treatment so the radiation gets to the correct spot.
If both types of radiation therapy are required, external beam radiation is often given first.
If you are to undergo radiation after surgery, you will be given time to heal from the surgery first. That typically requires four to six weeks.
When your doctor recommends a treatment plan, its wise to ask about the prognosis, or outlook, for each type of treatment.
You can also inquire about any side effects of treatment. If you dont feel comfortable with the answers, dont hesitate to consult another doctor for a second opinion.
When diagnosed early, women with uterine cancer have a very good prognosis, according to the American Cancer Society.
For endometrial adenocarcinoma, a common type, those diagnosed at stage 1A have an 88 percent survival rate at five years. Those diagnosed with the highest stage, IVB, have a 15 percent survival rate.
For uterine carcinosarcoma, the survival rate at five years is 70 percent, but drops to 15 percent for state IV, the highest stage. For this type of cancer, experts give what is called relative survival.
The rates are based on the assumption that some people will die of other causes besides cancer, and compare the observed survival with that expected for those who don't have cancer.
To give you an idea of your prognosis, your doctor will review the survival statistics gathered for other women who have had the same type of uterine cancer.
Remember that these are averages over the five years after diagnosis, and that some women do much better than average.
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Endometrial hyperplasia describes a condition in which the lining of the uterus, called the endometrium, becomes too thick.
The condition itself is not cancerous; however, it sometimes can lead to uterine cancer.
If your body has too much of the hormone estrogen without the hormone progesterone, you may develop endometrial hyperplasia.
To understand how endometrial hyperplasia develops, it may help to first understand how hormonal changes during a typical menstrual cycle affect your uterine lining.
Estrogen is made by the ovaries during the first part of your cycle. That leads to growth of the lining to prepare your body for pregnancy.
However, after an egg is released (ovulation), progesterone increases with the goal of supporting a fertilized egg.
But if pregnancy does not happen, levels of both hormones decline. That decrease in progesterone is what triggers your period, the shedding of the lining.
If you do not ovulate, progesterone is not made and the lining does not shed. So the lining may keep growing in response to the estrogen and, in time, the cells in the lining can become abnormal.
In some women, the overgrowth, called hyperplasia, can lead to cancer.
While there are many risk factors that increase the chances of developing endometrial hyperplasia, having one or more of these does not mean that you will develop the condition.
Some common risk factors include:
Abnormal uterine bleeding (heavier than usual bleeding between periods) is the most common symptom. If you have it, call your doctor right away and get checked out.
If you have a menstrual cycle shorter than 21 days, check with your doctor. Count from the first day of your period to the first day of your next one.
If you are post-menopausal, report any uterine bleeding to your healthcare provider.
If you have abnormal uterine bleeding, your doctor may order certain tests and exams, including:
Your doctor and other healthcare providers will look to see whether certain cell changes are present before diagnosing the exact type of endometrial hyperplasia. If abnormal changes are found, the diagnosis is called atypical.
If the diagnosis is endometrial hyperplasia, it could be called:
Endometrial hyperplasia can often be treated with progestin. This synthetic hormone is given either orally, topically as a vaginal cream, in an injection, or with an intrauterine device.
If you have simple or mild hyperplasia, which is the most common type, the risk of it becoming cancerous is very small.
If you have atypical hyperplasia, the chances of cancer developing are higher. For simple atypical, the chances of it turning into cancer is about 8 percent if left untreated. Complex atypical turns into cancer in 29 percent of untreated cases.
If the diagnosis is atypical, and you are done bearing children, your doctor may recommend removal of the uterus (hysterectomy), as the risk of uterine cancer rises with atypical hyperplasia.
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