Uterine Cancer

Recent estimates from the American Cancer Society show that each year in the United States, over 45,000 women will be diagnosed with some form cancer of the uterus, the most common of which is cancer of the endometrium (the lining of the inside of the uterus). Over 8,000 of these women will die from the disease. It is the third most common gynecologic cancer behind cervical and ovarian cancers.

Endometrial cancers are usually carcinomas that originate from the endometrial cells that line the inside of the uterus, the function of which is to provide the optimal environment of a fertilized egg to implant in the uterus after conception. During a woman’s menstrual cycle, this layer of endometrial cells is expelled from the uterus during menstruation.

Most endometrial cancers occur in post-menopausal women between the ages of 60 to 70, although there are certain types that can occur in younger women around age 40. The most common type is associated with increased estrogen exposure over a woman’s lifetime as well as endometrial hyperplasia (an overgrowth of the endometrium which can occur with obesity, polycystic ovarian syndrome (PCOS), and some forms of hormone replacement therapy).

While there is no known single cause of endometrial cancer, several risk factors have been identified, including estrogen replacement therapy without progesterone, a history of endometrial polyps (benign growths), diabetes, infertility as well as never being pregnant, obesity, PCOS, a late start to menopause (after age 50) and an early menarche (first menstrual period before age 12), and exposure to the anti-breast cancer drug Tamoxifen. Additional risk factors are believed to be a high intake of animal fats in the diet, hypertension, and heavy daily intake of alcohol. Women who have had breast or ovarian cancer are also at an increased risk.

Symptoms of endometrial cancer usually begin with abnormal vaginal bleeding in women who have already gone through menopause, and abnormal or heavy menstrual bleeding in pre-menopausal women, usually between menstrual periods. Postmenopausal women may also experience a clear, thin white vaginal discharge as well. Lower abdominal pain and pelvic cramping are also common.

Usually, women are not routinely screened specifically for endometrial cancer, as the disease is highly curable in the early stages. As the disease advances, some women may notice a change in the size or shape of her uterus, along with the above mentioned symptoms. Diagnosis is typically started with endometrial curettage, which provides a sample of the endometrium for pathologic diagnosis. Visualization of the inside of the uterus can be done through hysteroscopy, which can aid in biopsy and identifying lesions. A newer method called TruTest can sample the entire lining of the uterus and is less painful than biopsy.

Treatment is usually started with a total abdominal hysterectomy, where the surgeon will remove the entire uterus, the ovaries and fallopian tubes, and take a look inside the abdomen to take samples of abdominal fluid and inspect the lymph nodes for signs of metastasis. Radiation therapy is usually given to women whose disease has a high likelihood of returning or has spread into the abdomen. Chemotherapy is usually not given unless a woman has very advanced disease.

For women whose disease has not spread beyond the uterus, the survival rate is very high, up to 95% in some instances. Unfortunately the survival rate drops considerably as the disease moves to other organs. The best way to reduce the risk of endometrial cancer is to live a healthy lifestyle (avoid obesity, heavy alcohol intake, high fat diets) and to have regular Pap smears and pelvic examinations as recommended by a gynecologist.