Uterine cancer is a broad category of cancers that can develop inside a woman’s uterus. Although the terms uterine cancer and endometrial cancer are often used interchangeably, by definition they are distinct categories. These cancers are the fourth most common in women and the numbers are rising. This may be related to the high incidence of obesity in the United States today, since obesity is a risk factor for uterine cancer.
Yale Medicine offers advanced treatments, including brachytherapy, for women with uterine and endometrial cancers, says Shari Damast, MD, a radiation oncologist in the Department of Therapeutic Radiology at Yale Medicine.
What are the symptoms of uterine cancer?
Unlike other cancers that are difficult to detect, uterine cancer often causes very visible symptoms. A woman with uterine cancer might start to notice symptoms that include:
- Unusual discharge or bleeding that is not related to normal menstruation
- Difficulty or pain while urinating
- Pain during sex or pain in the pelvis
Because the symptoms of uterine cancer are fairly obvious and usually lead to a doctor visit, the National Cancer Institute does not recommend regular screenings with ultrasound. There is no evidence showing that regular screenings via biopsy are effective at reducing the number of deaths from uterine cancer.
What are the types of uterine cancer?
The most common type of uterine cancer is endometrial cancer – cancer that occurs in the uterine lining, or endometrium. Endometrial cancers are then divided into categories based on the types of cells of which they’re made.
Adenocarcinomas make up most endometrial cancers, and the most common type of adenocarcinoma is endometrioid cancer. Other types, such as clear-cell carcinoma, mucinous adenocarcinoma and papillary serous adenocarcinoma are less common. They tend to grow more quickly than endometrioid cancer, and are more likely to have spread outside of the uterus by the time the cancer is diagnosed.
Other types of endometrial cancers include carcinosarcoma, squamous cell carcinoma, undifferentiated carcinoma, small cell carcinoma and transitional carcinoma.
Uterine sarcomas comprise up to eight percent of uterine cancers. They form in the muscle or connective tissue of the uterus, rather than the endometrium.
How is uterine cancer diagnosed?
If a woman is experiencing unusual pain, bleeding or vaginal discharge, her gynecologist may perform an ultrasound to get a better look at her uterine tissue.
That may be done as a pelvic ultrasound (in which the ultrasound device is placed on the skin on the lower abdomen) or as a transvaginal ultrasound (in which it is placed inside the vagina). Though the scans may show abnormal growths in the uterus,they can't identify whether or not it is cancer.
Therefore, the doctor may then order an endometrial biopsy, in order to look at some uterine cells under a microscope. For that procedure, a thin tube is inserted into the uterus to remove a small ample of endometrial tissue. This procedure takes about a minute and may cause discomfort similar to menstrual cramps.
If a biopsy is inconclusive, a dilation and curettage (D&C) may also be done. This involves enlarging the opening of the cervix and taking a sample of tissue from inside the uterus. A D&C can be performed under general or local anesthesia.
How is uterine cancer treated?
Almost all cases of uterine cancer are treated first with a hysterectomy.
This procedure involves removing the uterus, fallopian tubes and ovaries; the lymph nodes from the pelvic sidewall are sampled as well. This can be done through traditional means or as a minimally invasive surgery.
Most women diagnosed with uterine cancer also receive other treatments. Uterine cancers are usually given a stage after they’re removed and studied under a microscope. Imaging scans such as computed tomography (CT) or magnetic resonance imaging (MRI) may help determine how aggressively a cancer is growing.
For cancers that are caught early, additional therapy often involves a preventive dose of brachytherapy – a targeted form of radiation that’s given off from a device put inside the body. A radiation oncologist administers brachytherapy for uterine cancer by inserting a small cylinder, shaped much like a tampon, into the vagina. It gives off a cloud of radiation directed at the tip of the vagina, where cancer cells are known to grow back.
The procedure is usually done in three sessions, lasting about 10 minutes each. “It doesn’t burn or hurt," says Dr. Damast. “It doesn’t feel like anything. The patient goes home – and outside of the procedure itself, there’s no exposure to radiation, nothing left inside of her – and she comes back a week later.” Though women treated with brachytherapy need follow up visits every few months for the first few years, in most cases this treatment eliminates early-stage cancer permanently.
More aggressive or advanced cancers often require pelvic radiation (also known as external radiation, in which the patient lies on a table and X-ray beams are focused on the tumor), chemotherapy, hormone therapy or a combination of those treatments.
What is life after uterine cancer like?
Recovery from a hysterectomy can take anywhere from six weeks to six months. “Most patients feel good really quickly,” says Dr. Damast. “But they’re considered healed around six weeks. Then it can take a while after that for them to really feel back to normal – especially if they’re undergoing radiation after their surgery.” Patients will need to initially see their doctors every few months, and then every year, to make sure that their cancer doesn’t come back.
After treatment, women may also experience vaginal dryness, tightness or discomfort during sex. Fatigue, diarrhea and nausea are also common while receiving radiation. Also, says Dr. Damast, “When the cervix is removed, the vagina gets shorter. That means your anatomy is different. Not necessarily bad, just different.” Using moisturizers, lubricants and dilators before and during sex can help.
How is Yale Medicine’s approach to treating uterine cancer unique?
Yale Medicine radiation oncologists treat a large number of uterine cancer patients each year, so every doctor involved in diagnosis and treatment has extensive experience in treating even the most serious forms such as uterine serous carcinoma (USC), a chemotherapy-resistant, very aggressive form of endometrial cancer. The staff also has access to clinical trials and the most cutting-edge technologies, so that every patient can be sure she’s getting the best possible treatment available.
The physicians at Yale Medicine know that uterine cancer is a very personal, sensitive topic. "That’s why they walk each patient through every step of every procedure, and talk with her not only about the treatment but also about what to expect in the future. We open the door for patients to bring up questions about side effects or their sexual health,” says Dr. Damast. “We’re always learning from them about how we can make them more at ease.”