Uterine and Endometrial Cancer | Saint John’s Cancer Institute

Personalized Care

When it comes to diagnosing, evaluating and treating uterine cancer, you want leaders in the field by your side.

At the Saint John’s Cancer Institute, personalized care is first priority and this is based on the risk diagnosis as well as your personal circumstances.

The uterus is a hollow, pear-shaped reproductive organ in the pelvis where a baby grows during pregnancy. There are two types of uterine cancer.

Endometrial cancer

The most common uterine cancer is endometrial cancer, which begins in the layer of cells that form the inner lining (endometrium) of the uterus. Endometrial cancer is mostly found in postmenopausal women and diagnosed at an early stage because it frequently causes early abnormal vaginal bleeding. If endometrial cancer is diagnosed early, surgical removal often cures endometrial cancer.

Uterine sarcoma

Uterine sarcoma is a much rarer type of uterine cancer that forms in the muscles of the uterus. Women who have had pelvic radiation are at higher risk of developing uterine sarcoma. Treatment usually includes surgery, chemotherapy, or radiation, because it is more aggressive in many cases.

The cause of uterine cancer is multifactorial, and these factors can increase your risk of developing this disease. What is known is that something occurs which leads to a genetic mutation within the cells that form the inner lining of the uterus (endometrium) or within the cells that form the uterine muscle. This genetic mutation transforms healthy cells into abnormal cells, which then grow and multiply at an uncontrolled rate and do not die after a normal time span. There can be multiple mutations and some are influenced more by excess estrogen and being overweight than others. The abnormal cancer cells build up into a mass (tumor) and can separate from the uterus to invade other parts of the body (metastasis).

SIGNS & SYMPTOMS

What are the Signs and Symptoms of Uterine Cancer?

Signs and symptoms of uterine cancer may include:

Vaginal bleeding after menopause
Vaginal bleeding or abnormal discharge (watery or blood-tinged) not related to periods
Pelvic pain
Difficult or painful urination

DIAGNOSIS

How is Uterine Cancer Diagnosed?

Uterine cancer cells usually do not show up in the results of a Pap smear, which screens for cervical cancer. In order to diagnose uterine cancer, a sample of endometrial tissue must be removed and checked under a microscope for cancer cells. This can be done using one of the following procedures:

Endometrial biopsy

A thin, flexible tube resembling a straw is inserted through the cervix and into the uterus to obtain tissue from the inner lining (endometrium) of the uterus. A pathologist views the tissue under the microscope to look for cancer cells. The endometrial biopsy can be performed in your doctor’s clinic.

Dilation and curettage (D&C)

This procedure is performed under anesthesia in the operating room. The cervix is dilated and a curette (scraping instrument with a sharp loop) is inserted through the cervix into the uterus to remove tissue. A pathologist views the tissue under the microscope to look for cancer cells. Your doctor may perform dilation and curettage simultaneously with hysteroscopy, which is a procedure that visualizes the inside of the uterus. A hysteroscope (thin, tube-like instrument with a lens and light) is inserted through the cervix into the uterus to look for abnormal areas.

Other tests and procedures to diagnose endometrial cancer include the following:

Pelvic exam: During a pelvic exam, your doctor carefully inspects the outer portion of your genitals and inserts an instrument called a speculum into the vagina in order to inspect the vagina and cervix. Your doctor will also perform a bimanual exam to feel the size, shape, and position of the uterus and ovaries by inserting two fingers of one hand into the vagina and the rectum while using the other hand to press on your lower abdomen.

Transvaginal ultrasound: During a transvaginal ultrasound, a wand (probe or transducer) is inserted into the vagina and generates sound waves that bounce off internal tissues or organs to make echoes. The echoes form an image of the cervix, uterus, fallopian tubes, ovaries, and bladder. Your doctor can use ultrasound images identify tumors or abnormalities in the thickness or texture of the endometrial lining.

PET/CT scan (positron emission tomography/CAT scan): This is an imaging technique for identifying cancer tumors throughout the body. A small amount of radioactive sugar is injected into a vein. The PET scanner rotates around the body and generates images of where the sugar is rapidly taken up and consumed in the body. Cancer cells appear as bright areas in the images because they are usually more active and take up more glucose than normal cells. The CT scanner generates a series of detailed pictures inside the body from different angles.

Uterine and endometrial cancer stages include:

Stage I: The cancer is found in the uterus only.

Stage IA: The cancer is in the endometrium (inner lining) only or less than halfway through the myometrium (muscle layer of the uterus)

Stage IB: The cancer has spread halfway or more through the myometrium.

Stage II: The cancer has spread into the cervix, but has not spread outside the uterus.

Stage III: The cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis.

Stage IIIA: The cancer has spread to the outer layer of the uterus and/or to the fallopian tubes and ovaries.

Stage IIIB: The cancer has spread to the vagina and/or to the connective tissue and fat surrounding the uterus.

Stage IIIC: The cancer has spread to the lymph nodes in the pelvis and/or around the aorta (large blood vessel that carries blood away from the heart).

Stage IV: The cancer has spread beyond the pelvis.

Stage IVA: The cancer has spread to the bladder or intestines, but it has not spread to other parts of the body.

Stage IVB: The cancer has spread to other parts of the body.

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

RISK FACTORS

What are the Risk Factors of Uterine Cancer?

Increased exposure to estrogen made by the body:

The ovaries make two main female hormones: estrogen and progesterone. A disease or condition that increases endometrial exposure to estrogen without a balanced exposure to progesterone can increase your risk of endometrial cancer. Examples include menstruating at an early age (which means more years of menstruation), never being pregnant, starting menopause at a later age, and polycystic ovarian syndrome (which causes irregular ovulation patterns)

Hormone Replacement Therapy (HRT) After Menopause:

Taking estrogen alone can increase the risk of endometrial cancer. This risk may be reduced by combining estrogen with progesterone.

Older Age

Your risk of endometrial cancer increases as your age increases. Endometrial cancer is most commonly diagnosed after menopause.

Obesity

Increased fat tissue increases your body’s production of estrogen, which increases your risk of endometrial cancer.

Type 2 Diabetes and Metabolic Syndrome

Diabetes has been related to an increased risk of endometrial cancer.

Tamoxifen Therapy for Breast Cancer

Women who taken tamoxifen as treatment for breast cancer are at increased risk of developing endometrial cancer. In most cases, the benefits of tamoxifen outweigh the small risk of endometrial cancer.

Prior Radiation to the Pelvis

Radiation therapy to the pelvic area can increase the risk of uterine sarcoma.

Genetic Conditions

Lynch Syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is an inherited syndrome in which a genetic mutation is passed from parents to children. This mutation increases the risk of colon cancer and other cancers, including endometrial cancer. Patients diagnosed with Lynch Syndrome should talk to their doctor about recommended cancer screening tests.

You may receive more than one type of treatment, depending on several factors, including the grade of the tumor (what it looks like under the microscope), where it is located and whether it has spread to other parts of your body. Before we set up a specific treatment plan for your uterine cancer we will take the following into account:

Your age, overall health and medical history
The extent of the disease
Your tolerance of specific medicines, procedures or therapies
Expectations for the course of the disease

Your opinion or preference

We will sit with you and discuss the options available so that you can be as informed as possible when making the decision. Treatment typically included surgery, chemotherapy or radiation or a combination of these depending on the stage. Surgical intervention at the Saint John’s Cancer Institute utilizes cutting-edge robotic-assisted technology. Under special circumstances fertility sparing hormonal therapy is possible.