Uterine Cancer

There are two main types of uterine cancer and each type forms in a different part of the uterus:  endometrial carcinomas and uterine carcinomas. 

• Endometrial carcinomas begin in the lining of the uterus and consist of approximately 90% of uterine cancer cases. That’s why uterine cancer is often referred to as endometrial cancer.
• Uterine sarcomas are a rare form of uterine cancer that begins in the layers of muscles or connective tissues within the uterus.

Cancer that begins in the lower part of the uterus (known as the cervix) is known as cervical cancer.

While there are several risk factors for endometrial cancer, a hormonal imbalance is considered one of the main risk factors. An excess of the hormone estrogen can increase the risk of endometrial cancer. Some risk factors like age and family history are out of your control, but there are many risk factors that you can control through your lifestyle. Some endometrial cancer risk factors include the following. 

Estrogen Replacement Therapy

Women may use menopausal hormone therapy to ease symptoms of menopause; however, if estrogen is not given along with progesterone a hormonal imbalance will occur, increasing a woman's risk of endometrial cancer.

Endometrial Hyperplasia

This condition thickens the endometrial layer of the uterus, and the excess growth can become cancerous.

Breast or Ovarian Cancer

A previous history of breast cancer or ovarian cancer can increase the risk of developing uterine cancer.

Family History

Family history of cancer, especially gynecological cancer or colorectal cancer.

Age

Women over the age of 50 and who have been through menopause are at great risk.

Menstrual Cycles

Having more menstrual cycles during a woman's lifetime raises her risk as well as early menstruation (before age 12) and/or going through menopause later in life.

Pregnancy

Women who have never been pregnant have a higher risk of endometrial cancer than those who have had one or multiple pregnancies.

Obesity

Hormonal balance is disrupted when you’re obese.

Diabetes/Metabolic Syndrome

An imbalanced metabolism can increase the risk of diabetes, as well as cause obesity.

Hypertension

High blood pressure can increase the risk of endometrial cancer.

Early signs of endometrial cancer are abnormal bleeding and discharge. Additional signs and symptoms of uterine cancer may include:

• Feeling a mass in the pelvic area
• Pelvic pain
• Pain during intercourse
• Unexplained weight loss
  
• Unexplained vaginal bleeding, such as bleeding between periods, or non-blood vaginal discharge

There are no uterine cancer screening exams for women with average risk and no symptoms. If you have some of the factors that put you at a higher risk, talk with your doctor about other procedures to help identify endometrial cancer early. You can help lower the risk of endometrial cancer by:

• Maintaining a healthy weight
• Managing diabetes
• Visiting your gynecologist for annual well-woman exams
• Taking oral contraceptives long-term
  
• Discussing hormone replacement therapy with your doctor

Endometrial cancer is most successfully treated when detected at early stages. At Mercy, our oncologists will perform various diagnostic tests and exams to determine the type and stage of uterine cancer. 

If you have any symptoms of uterine cancer, your Mercy doctor will perform a physical exam, a pelvic exam, and ask about your medical and family history. A pelvic exam is performed to detect any lumps which may be cysts or tumors. In addition to pelvic and physical exams, the following tests may be used to diagnose endometrial cancer.

Gynecologic Ultrasound

A gynecologic ultrasound is often one of the first tests performed after a pelvic exam when diagnosing uterine cancer. A transvaginal ultrasound, also known as an endovaginal ultrasound, is a pelvic ultrasound used to examine female reproductive organs. A TVUS is used to see endometrial growths (polyps), measure the endometrium thickness and help doctors determine where they want to biopsy.

Endometrial Tissue Sampling

An endometrial biopsy is the most commonly used tissue sampling procedure for uterine cancer. If the sample from the endometrial biopsy doesn't provide enough tissue or if the results from the biopsy are unclear, dilation & curettage (D&C) will be done. A D&C is a procedure to remove tissue samples from the uterus and is often performed with a hysteroscopy.

Diagnostic Imaging

Imaging exams are not used to diagnose uterine cancer but can help determine if cancer has spread and/or returned after treatment. Types of imaging used to evaluate and determine the extent of uterine cancer are CT scans, MRIs and X-Rays.

Blood Tests

Doctors may recommend blood tests to help detect and stage uterine cancer.

• CA-125 blood test - a CA-125 blood test is commonly used to check levels pre-treatment as well as monitor response to therapy. Although this type of blood test is not typically used for uterine cancer screening.
• CBC test - a complete blood count (CBC) is a test that measures different blood cells. Uterine cancer can cause bleeding which can lead to low levels of red blood cells. 

Surgery (removal of cancer) is usually the first treatment for endometrial cancer. Surgery is performed to remove as much of the tumor as possible, also known as debulking, as well as to determine how far cancer may have spread. Depending on how far cancer has spread in the uterus, different surgical treatments may be used.

Simple or Total Abdominal Hysterectomy 

During a total hysterectomy, the uterus is removed through an incision in the abdomen. This type of hysterectomy is often performed using minimally-invasive robotic-assisted techniques.

Vaginal Hysterectomy

In a vaginal hysterectomy, the uterus is removed through the vagina. This type of hysterectomy may be an option for women who are not healthy enough to undergo other types of surgery.

Radical Hysterectomy

When endometrial cancer has spread to the cervix or the area around the cervix, a radical hysterectomy is performed. During this surgery, the entire uterus, the tissues next to the uterus (parametrium & uterosacral ligaments) and the upper part of the vagina (next to the cervix) are removed. This is most often done through the abdomen but can be done through the vagina as well.

Oophorectomy

An oophorectomy is the removal of the fallopian tubes and both ovaries, using minimally invasive laparoscopic techniques. This procedure can also be done as part of a hysterectomy.

Lymphadenectomy

Lymphadenectomy is the removal of lymph nodes from the pelvic region and lower abdomen to see if cancer has spread beyond the uterus.

Radiation therapy can be given in 2 ways to treat uterine cancer:  internal radiation therapy and external radiation therapy. There are some cases of uterine cancer where both internal and external radiation are used. Depending on the stage and grade of uterine cancer, your Mercy provider will decide what areas need to be treated with radiation therapy and what type of radiation therapy should be used. Both external radiation therapy and brachytherapy may also be used as palliative therapy to relieve symptoms and improve quality of life.

External Beam Radiation Therapy (EBRT)

EBRT focuses a beam of X-ray energy on a specific area of the body to eliminate cancer cells and is delivered from a source outside the body. External beam radiation therapy may be provided in combination with chemotherapy to treat uterine cancer. 

Internal Radiation Therapy

Some patients may receive internal radiation or brachytherapy, a type of radiation therapy where small sources of radiation in the form of capsules, pellets or ribbons are placed inside your body within or near the tumor. There are 2 types of brachytherapy used for endometrial cancer:   low-dose rate (LDR) and high-dose-rate (HDR).

Systemic therapy is the use of medication (drugs) to destroy cancer cells. This type of cancer treatment goes through the bloodstream to reach cancer cells anywhere in the body, unlike local therapies such as surgery and radiation therapy and can be given intravenously by an IV or orally in a pill/capsule form. The types of systemic therapies used for uterine cancer include chemotherapy, hormone therapy, targeted therapy and immunotherapy.

Chemotherapy

Chemotherapy can be part of a treatment plan to attack cancer that has spread from the uterus since it targets all quickly-dividing cells throughout the body.  A combination of chemotherapy medications may be part of a treatment plan for endometrial cancer.

Hormone therapy

Hormone therapy is mostly used in advanced or recurrent endometrial cancer. A few different kinds of hormones are used, but each is intended to slow the growth of cancer. Hormone therapy may be used as part of treatment or post-treatment and is often used alongside chemotherapy.

Targeted Therapy

Targeted therapy is a treatment option for uterine cancer that targets specific genes, proteins or tissues that contribute to the cancer growth and spread.

Immunotherapy

Immunotherapy is designed to stimulate the immune system to boost its natural ability to fight cancer and to make cancer cells easier for the immune system to recognize. Immunotherapy can be used to treat certain types of endometrial cancer that have spread or returned. Oral, topical or intravenous medication may be given as part of immunotherapy treatment.