While a diagnosis of uterine cancer can be scary, it is important to know that its most common form—endometrial cancer—is highly curable. Uterine cancer is a blanket term for a group of cancers that can develop inside a woman’s uterus. Because endometrial cancer occurs the most frequently, with an estimated 60,000 new cases expected in 2016, it is commonly referred to as uterine cancer. It is caused by mutations in the cells that form in the lining (endometrium) of the uterus.
"One in 35 women roughly will develop endometrial cancer, but it is often caught early and it responds well to treatment," says Yale Medicine's Gloria Huang, MD, a gynecologic oncologist. "Once patients are treated, which is usually done very successfully, they worry about uterine cancer returning, but the risk of dying from an obesity-related problem, such as heart disease, is, in fact, much higher for many women."
At Yale Medicine, our team of researchers, including physicians such as Dr. Huang are leaders in the development of innovative treatments for women with uterine and other cancers of the reproductive tract. Our physicians are also skilled in the most up-to-date, minimally invasive forms of surgery.
What are the symptoms of uterine cancer?
- 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 prompt a doctor visit, the National Cancer Institute does not recommend regular screenings with ultrasound for the general population. In addition, there is no evidence that regular screenings via biopsy reduce the death rate from uterine cancer, except in high risk patients.
What are the risk factors for uterine cancer?
It’s more likely that you will develop uterine cancer if you fall into the following risk categories:
- If you are obese, possibly because extra body fat alters your body's hormonal balance
- If you have diabetes or eat a high-fat diet
- If you have a history of endometrial hyperplasia, which is when the endometrium becomes too thick
- If you started your period before the age of 12 or began menopause later, thereby exposing your endometrium to more estrogen over your life
- If you took estrogen replacement therapy for menopause
- If you were unable to become pregnant and have never had children
In addition, other diseases often play a role. Risk is higher in women who have had breast, ovarian or pelvic cancer and polycystic ovary syndrome. Treatments for diseases such as radiation for pelvic cancer or tamoxifen for breast cancer can also increase risk. Uterine cancer is most common in white women; for all women, the risk of developing cancer increases with age.
Why are breast cancer survivors more likely to develop uterine cancer? Women who have undergone treatment for breast cancer have often been prescribed a drug called tamoxifen , which like estrogen can stimulate the endometrium.
These two drugs increase the risk of uterine cancer. However, if estrogen is taken at the same time as another hormone called progesterone, there is no increased risk of uterine cancer. Women who have taken tamoxifen should get an annual pelvic exam and report any symptoms, such as vaginal bleeding, as soon as possible.
How is uterine cancer diagnosed?
If you develop any of the symptoms listed above, such as post-menopausal bleeding or abnormal discharge, visit your gynecologist, Dr. Huang says. Your doctor will ask about your medical history, and conduct a thorough pelvic exam.
In some cases, your doctor may perform a biopsy of the endometrial tissue by inserting a small flexible tube inside your uterus. This procedure can be done in the office and does not require anesthesia.
If an office biopsy is not possible or additional evaluation is needed, your doctor may also perform a minor operation, called dilation and curettage, to collect tissue. A transvaginal ultrasound or CT scan might also be used to detect signs of uterine cancer.
A Pap smear, which is a microscopic look at the cells of the cervix, is primarily used to detect precancerous cells of the cervix, but not necessarily endometrial cancer, which is located higher up inside the uterus, not the cervix. Certain changes seen on a Pap smear can be related to endometrial cancer and may prompt further diagnostic workup as described above.
What are the treatments for uterine cancer?
At Yale Medicine, treatment is always patient-specific and determined by factors like overall health, medical history and the extent of the disease. Most patients will first be treated with surgery, but if the disease has spread beyond the uterus, additional therapy might be required.
Surgical interventions could include removal of the uterus (hysterectomy), fallopian tubes and cervix. The ovaries and nearby lymph nodes may also be removed. In addition to surgery, patients may also undergo radiation, chemotherapy or hormone therapy.
Patients with localized (Stage I) endometrial cancer have a 95% 5-year survival rate with the majority of these patients being cured of the disease, Dr. Huang says. And 3.5 years after diagnosis, the risk of death from cardiovascular disease surpasses the cancer-related risk.
This highlights the importance of exercise and a healthy diet when it comes to life after uterine cancer, Dr. Huang says.
How can uterine cancer be prevented?
While the exact cause of uterine cancer is multifactorial and differs depending on the specific type of uterine cancer, experts do identify a few conditions that may contribute to increased risk. Obese and diabetic women in particular are more likely to develop uterine cancer. Women who use oral contraceptives have a decreased risk.
"There are things women can do that are protective factors, including exercise and maintaining a normal body-mass index," Dr. Huang says. "We also know high insulin levels are a risk factor and we can take medications to lower insulin levels.
What makes Yale Medicine's approach to uterine cancer stand out?
Our researchers are at the forefront of uterine cancer research. In 2013, we made a groundbreaking discovery about the genetics of a dangerous form of uterine cancer called uterine serous carcinoma (USC), which represents a small percentage of uterine cancer cases. These aggressive USC tumors are able to evade traditional chemotherapy and are difficult to treat.
However, by identifying the genetic mutations that are responsible for USC, researchers have paved the way for new treatment options for patients with later-stage, resistant disease. We have extensive experience treating rare forms of uterine cancer, offering multiple clinical trials, should a patient qualify for experimental treatment.
"At Yale, we can draw on our expertise, especially in minimally invasive surgery," Dr. Huang says. "And for the more aggressive types of cancer that don't respond to surgery alone, there is personalized medicine, which looks at testing the tumor and targeting abnormalities of the tumor that might make therapies more effective. There is also access to clinical trials here."