Uterine Cancer Information

The uterus, also called the womb, is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum.

Uterine cancer (cancer of the endometrium) is the most common gynecologic cancer. It typically afflicts postmenopausal women between ages 50 and 60. It's uncommon between ages 30 and 40 and rare before age 30. Most premenopausal women who develop uterine cancer have a history of anovulatory menstrual cycles or other hormonal imbalance. About 33,000 new cases of uterine cancer are reported annually; of these, roughly 5,500 are fatal.

Causes

The causes uterine cancer and not known. Some factors that seem to put women at more risk are:

• Endometrial hyperplasia
• Menopause, never having children or being infertile
• Being overweight
• High blood pressure and diabetes
• A family history of endometrial, breast or bowel cancer
• Being on oestrogen hormone replacement without progesterone.

Signs and Symptoms

Early uterine cancer usually is asymptomatic (i.e., does not cause symptoms). Abnormal vaginal bleeding, which is the most common symptom, may also result from a condition called dysfunctional uterine bleeding (DUB).

Other symptoms of uterine cancer include the following:

• Abnormal vaginal discharge
• Painful or difficult urination
• Pelvic pain
• Pain during intercourse

Advanced uterine cancer may cause weight loss, loss of appetite, and changes in bladder and bowel habits.

Diagnostic tests 

Endometrial, cervical, or endocervical biopsy confirms cancer cells. Fractional dilatation and curettage is used to identify the problem when the disease is suspected but the endometrial biopsy is negative.

Positive diagnosis requires these tests to provide baseline data and permit staging: multiple cervical biopsies and endocervical curettage to pinpoint cervical involvement; Schiller's test staining of the cervix and vagina with an iodine solution that turns healthy tissues brown (cancerous tissues resist the stain); computed tomography scans or magnetic resonance imaging to detect metastasis to the myometrium, cervix, lymph nodes, and other organs; and excretory urography and, possibly, cystoscopy to evaluate the urinary system.

Proctoscopy or barium enema studies may be performed if bladder and rectal involvement are suspected.

Treatment

Depending on the extent of the disease, the treatment may include one or more of the following:

• Surgery usually involves total abdominal hysterectomy, bilateral salpingooophorectomy or, possibly, omentectomy with or without pelvic or paraaortic lymphadenectomy. Total pelvic exenteration removes all pelvic organs, including the rectum, bladder, and vagina, and is only performed when the disease is sufficiently contained to allow surgical removal of diseased parts. This surgery seldom is curative, especially in nodal involvement.
• Radiation therapy is used when the tumor isn't well differentiated. Intracavitary radiation, external radiation, or both may be given 6 weeks before surgery to inhibit recurrence and lengthen survival time.
• Hormonal therapy, using tamoxifen, shows a response rate of 20% to 40%.
• Chemotherapy, including both cisplatin and doxorubicin, is usually tried when other treatments have failed.

Prevention

All women should have regular pelvic exams and Pap smears beginning at the onset of sexual activity (or at the age of 20 if not sexually active) to help detect signs of any abnormal development.

Since conditions associated with increased risk have been identified, it is important for women with such conditions to be followed more closely by their doctors. Frequent pelvic examinations and screening tests, including a Pap smear and endometrial biopsy, should be done.