What Is Uterine Cancer? Causes Symptoms, and Treatments

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Having a uterus comes with its own health conditions, and it is important for females to understand this. Menstruation can be painful, cysts can form and need surgery, and, unfortunately, uterine cancers can develop in older adults. Nearly 70,000 people are diagnosed with uterine cancer in the United States every year, and the majority are over 50. How does uterine cancer develop? What are the symptoms, warning signs, risk factors, and treatments? Read on to learn more about uterine cancer.

What Is Uterine Cancer?

Uterine cancers develop in the uterus, a pear-shaped sex organ in females and people born female. There are two different types of cancer that can develop in the uterus. 

  • Endometrial cancer is the most common type of uterine cancer. It begins in the endometrium, which is the lining of the uterus. If detected early enough, endometrial cancer has a high cure rate. 
  • On the other hand, uterine sarcoma is a rare, aggressive type of cancer that develops in the uterus muscles. These sarcomas can progress quickly and metastasize or spread to other parts of the body through tissue, blood, and lymph fluid. Uterine sarcomas are often deadly and have a poor prognosis due to the aggressive nature of the cancer. 

Symptoms of Uterine Cancer

Unfortunately, early symptoms of uterine cancer can mimic symptoms of normal menstruation, menopause, and other conditions. So, what can you be on the lookout for? Unusual spotting or uterine bleeding is the number one symptom of uterine cancer. The bleeding can be light and watery or a heavy flow. Other symptoms include:

  • Pelvic pain
  • Pain or difficulty while urinating
  • Pain during sex
  • An abnormal pap screening

It is crucial to stay up-to-date on pap screening with your obstetrician/gynecologist (OB-GYN) to catch any signs of cancer before they progress. 

Risk Factors

Who is most at risk for uterine cancer, and is it genetic? The most common cause of uterine cancer is age. People over 50 are most likely to develop endometrial cancer. This usually occurs after menopause, though there are some reports in younger people. Other risk factors for endometrial cancer include:

  • Obesity
  • Type II Diabetes
  • Family history of uterine or colorectal cancer
  • The use of an intrauterine device (IUD) increases the overall risk of developing reproductive cancers
  • The use of hormonal birth control like the pill or contraceptive ring increases the risk
  • Number of menstrual cycles throughout your life
  • Diet and exercise
  • If you’ve had ovarian or breast cancer in the past

Risk factors for uterine sarcomas can include:

  • Previous pelvic radiation therapy for a different pelvic cancer- radiation can damage DNA and increase the risk for additional cancers.
  • Race- African American females are nearly twice as likely to develop uterine sarcomas, and doctors do not fully understand why.
  • RB gene- people born with retinoblastoma – a type of eye cancer – are more at risk of developing a uterine sarcoma.

How Does Uterine Cancer Progress?

Endometrial Cancer Stages

There are four stages of endometrial cancer, distinguished by where cancer cells are located. When cancer is only in the surface layer cells of the endometrium, this is “precancerous.”

  1. Stage I: Cancer is in the uterus only. This stage has two substages, A and B. In substage A, cancer is only in the endometrium, or lining, of the uterus. In substage B, cancer has spread to the myometrium (the muscular lining of the uterus).
  2. Stage II: Cancer has spread to the connective tissue inside the cervix but still has not left the uterus.
  3. Stage III: In this stage, the cancer has spread beyond the uterus but has not extended beyond the pelvic region. Stage III has three substages. 1) Cancer has spread to the outer layer of the uterus, fallopian tubes, or ovaries. 2) Cancer has spread to the vagina or the tissues surrounding the uterus called the parametrium. 3) Cancer has spread beyond the uterus into the pelvic lymph nodes or to the aorta.
  4. Stage IV: Stage IV has two substages. These stages involve the spread of cancer to the bladder or bowel wall. The later stage involves the spread of cancer beyond the uterus and pelvis.

Uterine Sarcoma Treatment

Uterine sarcomas are has stages I through IV:

  1. Stage I: In stage I, the tumor is identified, and the cancer is located only in the uterus. Stage I is broken up into two substages depending on the tumor size.
  2. Stage II: Like endometrial cancer, in stage II, the sarcoma has spread beyond the uterus but is confined to the pelvic region.
  3. Stage III: The tumor has spread into the abdomen. There are three substages depending on the involved tissues.
  4. Stage IV: In stage IV, there are two substages in which the tumor either invades the bladder or rectum or spreads to distant parts of the body.

Uterine Cancer Diagnosis

There are a few ways that your doctor can diagnose uterine cancer:

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  • Pelvic exam– this is a screening that people with uteruses should have done regularly. The doctor will feel for any abnormalities in the vagina, cervix, and uterus. 
  • Transvaginal ultrasound– a doctor will take images of the uterus and determine whether a biopsy is necessary. 
  • Biopsy/D&C– if the pelvic exam reveals abnormal results, the doctor will take an endometrial biopsy or dilation and curettage to study the cells in the uterus to check for cancer.
  • MRI/CT– these are scans of the uterus to reveal any tumors or abnormalities.
  • Biomarker Testing– a doctor may order this testing. This involves taking a sample of the tumor to determine if the tumor is cancerous. 

If you display signs of cancer, the OB-GYN will send them to a gynecologic oncologist. This is a specialized doctor who works on reproductive system cancers in females. 

Treatment

Treatment for uterine cancer depends on the type of cancer and the stage the cancer is diagnosed in but may include radiation and chemotherapy, targeted drug therapies, and surgery. As with most cancer treatments, uterine cancer treatment can cause significant side effects such as hair loss, weight loss, decreased appetite, nausea, and vomiting, among others. 

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Endometrial Cancer Treatment

Surgery is the most common treatment for endometrial cancer. This procedure involves removing as much cancerous tissue as possible. This could also mean the doctor removes the uterus and cervix, a procedure called a total hysterectomy. Other treatments include radiation and chemotherapy or targeted therapy using drugs that target and kill cancer cells. This treatment option is generally considered less harmful than traditional chemotherapy and radiation. 

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Endometrial cancer is highly curable, especially if caught in stage 0. Cancer survival rates are calculated on a 5-year survival interval. Endometrial cancer has a very high cure rate (9 of 10 people) if caught in stage 0; an average of 8 out of 10 people survive beyond five years. Even in stage IIIA, the five-year survival rate is nearly 6 out of 10. Treatment interventions seem most effective if the cancer is caught between stages 0 and III. 

Uterine Sarcoma Treatment

The main treatment for uterine sarcomas is surgery to remove the uterus and other affected organs such as the fallopian tubes, ovaries, and cervix. Chemotherapy, radiation, and targeted therapy can also be combined with a total hysterectomy to ensure no cancer cells survive.

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Unfortunately, uterine sarcomas do not have such promising five-year survival rates. About half of all patients survive if the sarcoma is caught in the early stages. If the cancer is caught in an advanced stage, the five-year survival rate is discouraging, with only about 1 out of 10 people surviving. This is why it is crucial to regularly monitor your health, go to your check-up appointments, and get regular pap screenings. 

Next Steps

If you are experiencing concerning symptoms or want to ensure you are perfectly healthy, schedule an appointment with your OB-GYN or primary care doctor to discuss your health and concerns. Support groups are available to you both in-person and online if you have been diagnosed with uterine cancer. Find out more information on support groups here.

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