What Is Uterine Cancer?

• Endometrial Cancer This type of uterine cancer develops in the lining of the uterus, which is also known as the endometrium. Most uterine cancers are endometrial.
• Uterine Sarcoma This type of uterine cancer originates in the muscle wall of the uterus. It is relatively rare.

Uterine cancer can cause symptoms in both the early and more advanced stages. Roughly 90 percent of patients diagnosed with uterine cancer report postmenopausal vaginal bleeding, bleeding between periods, or very heavy bleeding during their menstrual cycle.

• Abnormal vaginal discharge (even with no traces of blood)
• Pelvic pain
• Pain during intercourse
• Difficulty urinating
• A mass in the pelvic area
• Unexpected weight loss

• Age (older than 50)
• Obesity
• Estrogen-only hormone replacement therapy after menopause
• A history of irregular menstrual periods
• Difficulty getting pregnant
• Use of tamoxifen (Nolvadex) to treat breast cancer
• A family history of uterine cancer, colon cancer, or ovarian cancer
• Beginning menstruation before age 12 and menopause later than average
• History of infertility or never having been pregnant
• Endometrial hyperplasia, an abnormal overgrowth of cells in the lining of the uterus
• Radiation therapy to the pelvic region
• Diabetes
• BRCA mutations or a PTEN mutation

• Pelvic Exam During a pelvic exam, your doctor will insert two fingers into the vagina while pressing the other hand down on the abdomen to feel for abnormalities in the uterus and the ovaries. A speculum is inserted into the vagina to visually inspect the area.
• Transvaginal Ultrasound In this exam, a wandlike device known as a transducer is inserted into the vagina to create an ultrasound video image of the thickness of the uterine lining and determine if there are irregularities.
• Hysteroscopy During this test, a lighted tube, or hysteroscope, is inserted into the vagina and through the cervix to gain access to and examine the uterus and uterine lining.
• Endometrial Biopsy Thin suction tubing is used to remove tissue from the uterine lining to be examined and analyzed by a laboratory.
• Dilation and Curettage If an endometrial biopsy is inconclusive, it may be necessary to do a more extensive procedure called dilation and curettage, or D&C. The cervix is dilated for better access to the uterus and the endometrial lining is scraped to get additional tissue for testing.

Stages of Uterine Cancer

• Stage 1 The cancer has not spread beyond the uterus.
• Stage 2 The cancer has spread from the uterus to the cervix.
• Stage 3 The cancer has spread from the uterus to the vagina, ovaries, and lymph nodes.
• Stage 4 The cancer has spread to the bladder, rectum, lungs, or bones.

Uterine cancer is treated by one or a combination of treatments. Ultimately, treatment for uterine cancer depends on the type of cancer and how extensive it is, as well as whether it is localized or has spread (metastasized). Other factors include overall health, age, and personal preferences, such as whether it is important to preserve fertility.

Surgery

Hormone Therapy

Hormone therapy blocks or changes the effects of hormones that contribute to cancer growth. It’s sometimes used in patients who want to preserve the uterus and their fertility. It’s also often used to treat stage 3 or 4 cancer or cancer that has recurred after treatment.

• Progestins, which are the primary hormone treatment prescribed
• Aromatase inhibitors (AIs)
• Tamoxifen
• Fulvestrant
• CDK 4/6 inhibitors

Chemotherapy

Chemotherapy is a type of cancer treatment that uses powerful drugs to kill cancer cells. It’s an effective way to treat cancer, but it also can cause unpleasant side effects such as nausea, fatigue, hair loss, nerve damage, and a loss of appetite. It can be used alone or in combination with other treatments, like surgery and radiation, to improve the patient’s chance for survival.

• bevacizumab (Avastin)
• carboplatin
• cisplatin
• docetaxel (Taxotere)
• doxorubicin (Adriamycin) or liposomal doxorubicin (Doxil)
• gemcitabine
• paclitaxel (Taxol)

Radiation Therapy

• Internal radiation therapy, which is when radioactive materials are placed inside the body. It’s also known as brachytherapy.
• External beam radiation therapy, which is performed with a machine that focuses radiation beams at the tumor.

Targeted Therapy

Targeted drugs include:

• bevacizumab (Avastin) Trastuzamab (Herceptin)
• cabozantinib (Cabometx)
• entrectinib (Rozlytrek)
• everolimus (Afinitor)
• fam-trastuzumab deruxtecan-nxki (Enhertu)
• larotrectinib (Vitrakyi)
• lenvatinib (Lenvima)
• temsirolimus (Torisel)

Immunotherapy

• Maintain a healthy weight. Women who are overweight are more likely to get endometrial cancer.
• Exercise regularly. Higher levels of physical activity have been linked to a lower risk of endometrial cancer. Regular exercise can also help you maintain a healthy weight and lower the risk of high blood pressure and diabetes, both of which are risk factors for endometrial cancer.
• Use hormonal contraceptives. Birth control pills, patches, rings, implants, or an IUD may reduce your endometrial cancer risk.

Every patient with uterine cancer is different, and so are their health outcomes. When diagnosed early, patients with uterine cancer have a very good prognosis.

• Anemia due to blood loss before diagnosis
• Perforation (hole) of the uterus, which may occur during a dilation and curettage (D&C) or endometrial biopsy
• Nausea or vomiting from chemotherapy
• Increased risk of infection from surgery, radiation, and chemotherapy

One reason for the shorter survival time is late diagnosis. Approximately 69 percent of white women are diagnosed when the cancer is local compared with 54 percent of Black women. Because Black women are less likely to be diagnosed in the early stage of the disease, their survival rate is lower at every stage.

• Uterine cancer, also called endometrial cancer, is the most common gynecological cancer in the United States. It is diagnosed most frequently in postmenopausal women.
• Early diagnosis and treatment of uterine cancer can lead to a very good prognosis. Surgery is the main treatment option, but others include hormone therapy, chemotherapy, radiation, targeted drugs, and immunotherapy.
• If you experience postmenopausal bleeding, difficulty urinating, or pelvic pain, seek medical attention right away, as these can be symptoms of uterine cancer.