What You Need To Know About Uterine Cancer

Uterine cancer is the fourth most common women’s cancer in the United States. Around 3% of women will develop uterine cancer during their lifetime.¹

Endometrial cancer is significantly more common than uterine sarcoma, accounting for more than 90% of all uterine cancers.² The information in this article is specific to endometrial cancer, although some of it can be applied to both.

Prevalence

Each year, approximately 66,000 women in the United States are diagnosed with uterine cancer.² Most are between the ages of 45 and 74. First-world countries have higher rates of endometrial cancer, and the United States has the eighth highest rate in the world.

Of this number, about 13,000 women will die from their cancer.

Since the mid-2000s, the prevalence of uterine cancer has increased by approximately 1% every year and it is speculated that this is due to increasing rates of obesity.

Survival rates

The earlier uterine cancer is detected, the higher the survival rate.

Five-year survival rates are based on the following stages:²

• Local: 95%

• Regional: 69%

• Distant: 17%

Fortunately, endometrial cancer is usually diagnosed at an early stage. This means patients have a high chance of survival and recovery.

However, it should be noted that there are some disparities across different ethnicities. White women have slightly higher rates of uterine cancer, but Black women are more likely to be diagnosed at a later stage and so have lower rates of survival.¹

The most common symptom of uterine cancer is abnormal vaginal bleeding or spotting.

It can be hard to tell the difference between abnormal vaginal bleeding and normal menstruation, so it is important to seek advice from your doctor. Some examples of instances where bleeding may be abnormal include:

• Bleeding between your monthly period

• Experiencing long, heavy, and/or frequent bleeding, especially if you are approaching menopause

• Having already been through menopause

Other less common symptoms:

• Cramping pain in your pelvis

• Pain during sexual intercourse 

• Vaginal discharge, which may be bloody, pink, or watery

What are the first or early warning signs of uterine cancer?

In a post-menopausal woman, any vaginal bleeding is considered abnormal and this is usually the first warning sign of uterine cancer.

What are the stages of uterine cancer?

Cancer can be categorized into one of four stages, defined by how much it has spread from where it originated. The stages of uterine cancer relate to how far it has spread from the uterus.¹

The four stages, defined by the International Federation of Gynecology and Obstetrics, are: 

Stage I

• IA: The cancer is only in the uterus, or in less than half of the myometrium

• IB: The cancer has spread more than halfway through the myometrium

Stage II

The cancer has spread to the cervical stroma

Stage III

• IIIA: The cancer has spread to the outermost uterine layer (serosa), fallopian tubes, or ovaries

• IIIB: The cancer has spread to the vagina or tissues around the uterus (parametrium)

• IIIC1: The cancer has spread to lymph nodes in the pelvis

• IIIC2: The cancer has spread to lymph nodes around the aorta

Stage IV

• IVA: The cancer has spread into the intestines or bladder lining

• IVB: The cancer has spread to groin lymph nodes, upper abdomen, omentum, or to distant organs such as the lungs or bone

Sometimes, the stage of cancer is more simply defined as:

• Local: Cancer is confined to the primary site in the uterus

• Regional: Cancer has spread to pelvic lymph nodes

• Distant: Cancer has spread to other organs

Unlike other cancers, scientists have not yet determined any direct causes of uterine cancer. However, we know that increased exposure to the female sex hormone estrogen, particularly when not balanced by an appropriate production of progesterone, greatly increases the likelihood of developing uterine cancer.

The ovaries produce and secrete two main hormones – estrogen and progesterone – which regulate a woman’s menstrual cycle, amongst many other functions. Estrogen causes the lining of the uterus (the endometrium) to grow and thicken through a process called ‘proliferation,’ when cells grow and divide.

After estrogen causes the endometrium to proliferate, the levels of progesterone will normally rise. Progesterone puts a ‘break’ in the endometrial proliferation caused by estrogen and prepares the uterus for a possible pregnancy.

When estrogen is produced without enough progesterone to balance it out, too much proliferation of the endometrial tissue can occur. This increases the chances that normal cells will get mutations that cause them to become cancerous and divide uncontrollably. 

The risk factors for developing uterine cancer

Several factors increase your chances of getting uterine cancer.¹ These include:

Age

Women over 50 and/or being post-menopausal.

Irregular ovulation patterns

An imbalance of estrogen and progesterone or prolonged exposure to estrogen, which can occur due to irregular ovulation patterns, beginning menstruation from an early age (younger than 12), reaching menopause after the age of 55, never having been pregnant, and estrogen-only hormone replacement therapy (HRT).

Obesity

Women who are obese are three times more likely to develop uterine cancer than women who are not.² This is because estrogen is produced in your fat cells. In fact, out of all cancers, obesity has the clearest link to endometrial cancer.

Genetics

Having a family history of uterine cancer.

Personal history

Previously having breast or ovarian cancer.

Lynch syndrome

A genetic condition that predisposes people to several cancers, including uterine cancer. A woman with this condition has a 40%–60% lifetime cumulative risk of developing endometrial cancer.³

Endometrial hyperplasia

A condition where your endometrium is thicker than normal.

How uterine cancer is diagnosed

You should see your doctor if you are experiencing any of the symptoms outlined above. Your doctor will carry out tests or refer you to a gynecologist.

The types of tests that can be used to diagnose uterine cancer include:

Pelvic exam

In a pelvic exam, your doctor physically checks your genitals for abnormalities. They may insert a ‘speculum’ into your vagina, a device that opens the vaginal walls to make it easier for them to see. They may also need to feel your uterus and ovaries to check their size, shape, position, and to see if there are any lumps. They will place two fingers from one hand inside your vagina and their other hand on your abdomen.

Transvaginal ultrasound

This is useful for analyzing the thickness and texture of the endometrium. The doctor will insert a transducer into your vagina. This device uses sound waves to generate a video image of your endometrium. If the results are abnormal, your doctor may then carry out an endometrial biopsy.

Endometrial biopsy (also known as ‘pipelle biopsy’)

This is a medical procedure where a small part of the endometrial tissue is removed. A narrow plastic tube is inserted into the uterus and used to remove a small sample of endometrial cells using suction. The tissue will be analyzed to see if the cells are cancerous.

Hysteroscopy

A thin, flexible tube called a ‘hysteroscope’ is inserted into your vagina and cervix. At the other end of the tube, there is a light and a camera that sends images to a monitor so that your doctor can see inside the uterus. It is common for a biopsy to be performed at the same time.

Imaging tests

A CT scan uses x-rays to take pictures of the inside of the body, which can be viewed on a computer. An MRI scan uses magnetic fields and has a similar purpose to a CT scan. However, these are usually done after a diagnosis has been made because they are useful for detecting spread and determining the stage of cancer. 

Many of these procedures are invasive and may make you feel uncomfortable. Your doctor will talk you through all the steps before they proceed and will fully inform you of the risks and benefits of the test.

Make sure you understand everything that they will be doing. You can request to have someone sit in the room with you if it makes you feel more comfortable. You may also be given anesthesia so you don’t feel any pain.

There are various types of treatments for uterine cancer.¹

Your treatment will be decided based on the stage and type of uterine cancer, and your medical team’s collective opinion on what would be best for you. All treatments have risks and benefits so it is important to make sure that you are fully informed before you make any decisions.

Your possible treatments may involve one or more of the following:

Surgery

The surgery generally used for uterine cancer patients is called a ‘hysterectomy.’ This involves removing the uterus, and possibly the ovaries, fallopian tubes, and lymph nodes if cancer has spread. 

A hysterectomy is usually the primary treatment for women with uterine cancer, and it may be the only treatment needed if the cancer is in an early stage.

Hormone therapy

Synthetic progesterone has been shown to slow the spread of cancer and control symptoms. This treatment is mainly used for recurring cancer or stage III and IV patients whose cancer has spread and who may be too unwell for other treatments. It can also be a possible treatment for women with an early stage of uterine cancer who do not want to lose their ability to become pregnant due to a hysterectomy.

Chemotherapy

Chemotherapy uses anti-cancer pills or drugs injected into the veins to kill the cancer cells and/or prevent them from dividing and growing. Chemotherapy may be used after initial cancer treatment (known as adjuvant therapy) for patients with high-risk endometrial carcinoma or when cancer can’t be operated on.

Radiation

High-energy x-rays or other types of radiation can kill cancer cells or stop them from growing. 

With external radiation, a machine outside the body sends the radiation to the uterus. Internal radiation then delivers radioactive materials directly into or near cancer, usually sealed inside seeds, capsules, wires, or other materials. Precautions will be taken to make sure the x-rays do not harm your normal cells.

Surgery is usually enough for patients with less severe uterine cancer. But for those with medium or high severity, radiation is usually offered.

Targeted therapy

This treatment uses drugs that can target specific parts of cancer cells. Since it is targeted, it usually causes less damage to normal cells than radiation or chemotherapy treatments do.

Targeted therapy may be used for more invasive (high-risk) endometrial cancers that have a high likelihood of recurring. The drugs may, for example, target proteins responsible for cancer cell growth and division, or stop the creation of blood vessels that cancer cells use to grow and spread.

Clinical trials

There is a lot of research going into new cancer treatments. Your doctor may talk to you about clinical trials you can join to access new and potentially life-saving treatments. Some people think that patients only join clinical trials as a last resort and if their cancer is in a late stage, but this isn’t the case. Clinical trials can be suitable for many different cancer types and stages.

A hysterectomy (surgery to remove the uterus) can prevent uterine cancer and it may be done in women with a high risk of developing uterine cancer, such as those with Lynch syndrome. However, this is not an easy decision to make, especially for women who have not been through menopause and want to have children.

Even though there is no guaranteed way to prevent uterine cancer, it is important to know the risk factors and what you can do to reduce your likelihood of developing it. 

What can you do to help lower your risk of developing uterine cancer?

Take birth control pills

This includes pills with a combination of estrogen and progesterone or progesterone-only oral contraceptives. The progesterone-only pill may provide even greater protection against developing endometrial carcinoma. This pill helps to ensure a hormonal balance so that the endometrial lining does not become too thick due to the presence of unopposed estrogen. 

Use a progestin-secreting intrauterine device

Progestin is a synthetic form of progesterone and provides the same benefits of preventing excessive spread of the uterine lining.

Keep active and maintain a healthy weight

Losing weight if you are overweight or obese will prevent the excess build-up of estrogen in fat tissue. 

Being pregnant

Pregnancy lowers your risk of uterine cancer because it shifts the hormonal balance towards more progesterone instead of estrogen.

Screening guidelines

There isn’t currently a specific screening test for uterine cancer, but clinical trials are underway and may deliver one soon.

The American Cancer Society recommends the following for uterine cancer screening:¹

• High-risk: Women who are at high risk of developing uterine cancer (such as those with Lynch syndrome or endometrial hyperplasia) should have yearly endometrial biopsy tests and/or transvaginal ultrasounds from the age of 35

• Low-risk: Women who are not at risk do not need to undertake regular screening, because the benefits don’t outweigh the risks of bleeding, infection, and a false-positive result which can bring a lot of anxiety

• All women should be aware of the signs and symptoms of uterine cancer and see a doctor if they have any concerns about their health

In the United States, there is a lack of organizations and charities that are specifically focused on uterine cancer. However, many groups spread awareness for either gynecological cancers or women's cancers in general, which include uterine cancer. 

Some examples are: 

Foundation for Women’s Cancer (FWC) spreads awareness for all gynecological cancers. They have recognized September as Gynecological Cancer Awareness Month. 

Inside Knowledge About Gynecologic Cancer is run by the Centers for Disease Control and Prevention (CDC) and the National Comprehensive Cancer Control Program. Like the FWC, they also raise awareness for all gynecological cancers. They are involved in educating women and health providers about gynecological cancer.

Share Cancer Support is an organization that spreads awareness about the signs and symptoms of all women's cancers (uterine, breast, ovarian, or cervical cancer). They also support, educate, and empower patients who have been diagnosed with one of these cancers.

Some organizations based in other countries are Womb Cancer Support UK, The Eve Appeal (UK), and WomenCan (Australia and New Zealand).

Raising awareness for uterine cancer is very important. This is because: 

• By reaching out to the general public, it can help all women better understand the symptoms of uterine cancer so that they can seek medical advice and be diagnosed earlier

• It attracts donations from the public, which can help fund research, treatments, and clinical trials for uterine cancer

How can someone get involved and help spread awareness?

There are lots of ways you can get involved in your community to help spread awareness about uterine cancer, no matter your age or background. 

You could:

• Organize and/or participate in fundraising events such as fun-runs, bake sales, raffles, and tournaments

• Make sure you have a good knowledge of the risk factors and symptoms of uterine cancer so that you can educate people on what signs to look out for and when to seek medical attention

• Advocate and talk about it on social media, and encourage open conversations

• Donate to organizations and charities such as the FWC

• Speak up for people you may know who have had uterine cancer and share stories

Your family doctor is always your first point of contact if you are concerned about uterine cancer. They will likely refer you to a specialist for testing and diagnosis, and this could be a gynecologist or gynecological oncologist. A gynecologist is a doctor who specializes in the female reproductive system, and an oncologist is a cancer specialist. 

When someone has cancer, they typically have a team of doctors and other healthcare professionals working with them to provide treatment and support during their cancer journey. 

This includes a: 

• Gynecologist and gynecological oncologist

• Gynecologic surgeon: A surgeon who specializes in performing surgery on female reproductive organs

• Radiation oncologist: A cancer doctor who specializes in the use of radiation as a cancer treatment

• Medical oncologist: A cancer doctor who specializes in the use of chemotherapy and medicines as a cancer treatment

• Oncology nurses: They take care of you before, during, and after treatment, and treat your side effects

• Other healthcare professionals may not directly treat your cancer, but can help you cope with cancer treatment, maintain your health and wellbeing, and aid you in overcoming the mental and emotional challenges that cancer brings. These include social workers, psychologists, dieticians, physiotherapists, and more.