While a diagnosis of uterine cancer can be scary, it is important to know that its most common form—endometrial cancer—is curable, especially if it is caught at an early stage. Uterine cancer is a blanket term for cancers that can develop inside a woman’s uterus. There are two main types of uterine cancer: Endometrial cancer begins in the cells that make up the endometrium, which is the lining of the uterus; a second, rare type of uterine cancer known as uterine sarcoma, starts in the muscles or other tissues in the uterus. While uterine sarcomas are often more aggressive than endometrial cancer, they make up only around 5 to 10% of all uterine cancer diagnoses.
According to the National Cancer Institute (NCI), an estimated 66,570 women will be diagnosed with uterine cancer in 2021, accounting for 3.5% of all cancer cases in the U.S. It is the most common type of gynecologic cancer and most frequently occurs in women over the age of 45, though it can affect younger women.
Fortunately, uterine cancer is treatable. Surgery is the most common treatment, but radiation therapy, chemotherapy, and several other therapies may also be used.
"Roughly 1 in 35 women 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."
What are the symptoms of uterine cancer?
- Unusual discharge or bleeding that is not related to normal menstruation
- Difficulty or pain while urinating
- Frequent urination
- Pain during sexual intercourse
- Pelvic pain
- A lump or mass in the vagina
- Pain or bloated feeling in abdomen
- Weight loss without known reason
What are the risk factors for uterine cancer?
Risk factors for uterine cancer include the following:
- Age (older women are at higher risk)
- Hormone replacement therapy that contains only estrogen after menopause
- Tamoxifen (often used to prevent or treat breast cancer)
- Type 2 diabetes
- Previous radiation therapy in the pelvic region
- Increased exposure of endometrium to estrogen (may be due to several factors including starting menstruation at an early age, never giving birth, and/or starting menopause at an older age)
- Polycystic ovarian syndrome (PCOS)
- Family history of endometrial cancer
- Having retinoblastoma in childhood (a cancer of the eye)
- Endometrial hyperplasia (a condition in which the endometrium becomes too thick)
- Certain inherited conditions such as Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer
How is uterine cancer diagnosed?
If you develop any of the symptoms listed above, such as post-menopausal bleeding or abnormal vaginal discharge, visit your gynecologist. Your doctor will ask about your medical history and conduct a thorough pelvic exam that may include a Pap test.
To diagnose uterine cancer, your doctor will need to conduct one or more diagnostic tests. These tests may include:
- Transvaginal ultrasound. This test uses sound waves to produce an image of the tissues of the uterus and pelvic area. In this procedure, an ultrasound probe will be inserted in the vagina.
- Endometrial biopsy. In this procedure, a doctor removes a small piece of tissue from the endometrium. A pathologist then examines the tissue under a microscope to check for the presence of cancer cells.
- Dilation and curettage (D&C). Also known as uterine scraping, in this procedure, a doctor inserts a curette (an instrument with a spoon- or hoop-shaped end) into the vagina and uterus and uses it to scrape part of the endometrium. In a lab, a pathologist examines the tissue sample to see if cancer cells are present.
- Hysteroscopy. This procedure allows a doctor to visually examine the endometrium. A doctor inserts a thin tube called a hysteroscope into the vagina and uterus. The hysteroscope is equipped with a light and camera (or lens), which allow the doctor to view the lining of the uterus. If the doctor detects abnormal tissue, they can also biopsy a small piece of tissue through the hysteroscope.
If uterine cancer is diagnosed, your doctor will order additional tests to learn more about the type of cancer involved and to determine whether the cancer has spread beyond the uterus. This is known as staging, and may involve bloodwork and imaging studies such as a computed tomography (CT) scan, magnetic resonance imaging (MRI) study, positron emission tomography (PET) scan, and/or chest X-ray. The doctor will assign the cancer to a stage numbered from I to IV (using Roman numerals). The lower the stage, the less advanced the cancer is. Staging helps doctors make a prognosis and put together a personalized treatment plan.
What are the treatments for uterine cancer?
Doctors tailor uterine cancer treatment to meet the needs of each patient. Treating uterine cancer may involve:
- Surgery. Surgery is used to remove the cancer from the body. For uterine cancer, hysterectomy, or the surgical removal of the uterus, is the most commonly used treatment. Depending on the type of hysterectomy performed, in addition to the uterus, this procedure may involve the removal of the cervix, ovaries, fallopian tubes, and nearby lymph nodes. Other treatments such as radiation therapy, chemotherapy, or other types of therapy may be necessary after surgery. A surgeon may also perform a lymphadenectomy or a sentinel lymph node biopsy. In these procedures, the surgeon may remove one or several pelvic lymph nodes, which will be analyzed in the lab to determine if cancer has spread to them.
- Radiation therapy. This treatment kills or damages cancer cells by exposing them to radiation. For uterine cancer, radiation therapy can be given using a machine that directs radiation at the cancer (known as external beam radiation) or via brachytherapy. In brachytherapy, a doctor inserts a small, radiation-containing cylinder into the vagina, close to the uterus. While the cylinder remains in place (for ten or twenty minutes to several days), it emits radiation that destroys cancer cells. Multiple doses of brachytherapy may be necessary.
- Chemotherapy. In chemotherapy, drugs are used to destroy or damage cancer cells. These drugs may be administered by mouth or injection.
- Hormone therapy. Certain hormones can help cancer cells grow. Hormone therapy is used to treat these types of cancer. It works by reducing the levels of certain hormones or blocking them.
- Targeted therapy. These drugs are designed to target specific proteins or other components of cancer cells that are not found in noncancerous cells.
Immunotherapy. Immunotherapy uses drugs to stimulate or suppress the patient’s own immune system to help it better fight against the cancer.
What is the outlook for women with uterine cancer?
The outlook for women with uterine cancer depends on several factors, including age and overall health, as well as the timing of diagnosis and the stage of the cancer. In general, younger women and women who have cancers that are detected in their early stages have the best outcomes. Fortunately, most women who have endometrial cancer, the most common type of uterine cancer, receive their diagnosis an early stage of the disease when it can often be cured.
After treatment, while tests may no longer detect cancer cells, there may be a chance that the cancer will return. Because of this, women should continue to see their physician regularly so if the cancer recurs, it can be caught and treated immediately.
What makes Yale Medicine's approach to uterine cancer stand out?
"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."