Endometrial Cancer Cancer Of The Uterus

Overview, Causes, & Risk Factors

Cancer of the uterus occurs in the lining of the uterus, calledthe endometrium. It is sometimes called endometrial cancer. Cancer of theuterus is the most frequent and most curable type of cancer that affects awoman’s reproductive system. Among women, it is the fourth most common cancerafter breast cancer,lung cancer, andcolorectal cancer.

What is going on in the body?

The cells that line the uterus respond to signals sent by estrogen andprogesterone, 2 hormones made in the ovaries. In the first 2 weeks of awoman’s monthly cycle, estrogen makes these cells divide and grow as the uterusprepares for pregnancy. During the second 2 weeks, progesterone prepares thelining of the uterus for an embryo to implant.

If pregnancy does not occur, the levels of both hormonesfall sharply. This causes the lining of the uterus to slough off. This processis known as menstruation. The monthly menstrual cycle keeps the endometrium from growing too much.

Some women’s bodies do not make progesterone. Others make highlevels of estrogen. In both cases, the cells lining the uterus growcontinuously and are not sloughed off regularly. This makes it more likely thatprecancerous changes of the endometrium will occur. If a woman is not treatedfor this, cancer of the uterus may develop.

Cancer of the uterus is most common in women between theages of 50 to 65. But it can also occur in younger women.

What are the causes and risks of the disease?

No one knows exactly what causes cancer of the uterus, but certain factorsincrease a woman’s risk. For example, some women’s bodies make high levels of estrogenthat are not balanced by progesterone. This is called unopposed estrogen.Cancer of the uterus is also more likely in women who have the following conditions:

  • obesity, because fat cells can make extra estrogen
  • a history of infertility
  • late menopause, meaning after age 55
  • polycystic ovarysyndrome, a condition in which fluid-filled sacs form on theovaries
  • estrogen therapy for more than 1 year without takingprogesterone as well
  • estrogen combined with less than 7 days of progesterone amonth
  • A woman may also have a higher risk for thistype of cancer if she has one of the following conditions:

  • high blood pressure
  • diabetes
  • cancer of the breast, ovaries, or colorectal cancer
  • few or no children. The more children a woman has delivered, the lowerher risk for uterine cancer.
  • past use of tamoxifen, a medication used to prevent breast cancer from coming back
  • a family history of cancer of the uterus
  • Symptoms & Signs

    What are the signs and symptoms of the disease?

    The most common symptom of this disease is abnormal vaginalbleeding. Other symptoms include the following:

  • heavy periods
  • spotting or vaginal bleedingbetween periods
  • bleeding after intercourse
  • bleeding or spotting after 6 months of not having any periods, in awoman who is not taking hormone replacementtherapy
  • a feeling of pelvic heaviness
  • unusual pain and cramping in the lower belly that is not related to menstruation
  • Diagnosis & Tests

    How is the disease diagnosed?

    A Pap smear is not intended to diagnose uterine cancer. This test isused to diagnose cancer of the cervix. However, Pap smears occasionally showchanges in endometrial cells. If this occurs, a biopsy or dilatationand curettage, or D&C, will be done. This involves scraping theuterine wall to gather more cells from the lining of the uterus.

    If advanced cancer is suspected, other tests may bedone, such as the following:

  • a complete blood count to rule out anemia, which is a low red blood cellcount
  • a test to make sure that cancer has not spread to the kidneys
  • ultrasound of the vagina
  • a chest X-ray to make sure that the cancer has not spread to thelungs
  • liver function tests to make sure that the cancer has not spread tothe liver
  • bonescan to be sure that the cancer has not spread to the bones
  • Prevention & Expectations

    What can be done to prevent the disease?

    No one knows exactly what causes cancer of the uterus. However, a woman may beable to lessen her risk of getting it by taking the following steps:

  • eating a diet low in fat
  • maintaining a healthy weight
  • maintaining a normal bloodpressure level
  • reporting any pattern of abnormal vaginal bleeding to the healthcareprovider
  • having yearly pelvicexams and Papsmears
  • Also, a woman should talk with her healthcare provider about the risks oftaking estrogen without progesterone after menopause if she has not had her uterus removed. The risk forcancer of the uterus may last as long as 10 years after adding progesterone orstopping estrogen therapy completely.

    What are the long-term effects of the disease?

    When cancer of the uterus is diagnosed early and treated, morethan 80% of women will survive more than 5 years. Most are completely curedwhen the cancer is diagnosed and treated early.

    What are the risks to others?

    Uterine cancer is not contagious, so there are no risks to others.

    Treatment & Monitoring

    What are the treatments for the disease?

    Cancer of the uterus is treated by removing the uterus in aprocedure called an abdominal hysterectomy. Doing this surgery throughthe abdomen rather than the vagina is recommended. It allows the surgeon to seethe entire pelvis and abdomen and to note any spread of the cancer. He or shecan also take samples of cells from the abdominal cavity to check for any tinyfloating cancer cells. The surgeon will also remove lymph nodes from the pelvicarea to be sure that the cancer has not spread.

    Sometimes a surgeon will remove the uterus through thevagina and then remove the lymph nodes through a small cut in the abdomen. Thisavoids leaving a large scar on the abdomen and shortens the hospital stay. Not allwomen are candidates for this procedure.

    Because tumor cells may have spread to the ovaries andfallopian tubes, these organs are usually removed also. For women with advanced disease, the preferred treatmentis surgery. If the surgeon finds that the cancer has not spread, there may beno further treatment. Women who are at a higher risk of the cancer coming backmay have radiation treatments to the pelvis. Or they may havechemotherapy. Becausethis cancer comes from a tissue that is sensitive to hormones, treatment withhormones may also be effective.

    What are the side effects of the treatments?

    After having a hysterectomy, a woman may experience the following:

  • inability to control urine
  • sexual problems
  • stress
  • swelling in the legs
  • ascites, which is anaccumulation of fluid in the abdomen
  • swelling in the veins of the lower legs that may lead to blood clots
  • surgical problems, such as a hole connecting the vagina and therectum
  • bleeding that requires a blood transfusion
  • Radiation therapy will usually produce some hair loss. Chemotherapy is often associated with nausea, vomiting, and anemia, or a low red blood cellcount.

    What happens after treatment for the disease?

    A woman who has been treated for cancer of the uterus should try to take these steps:

  • Eat a balanced diet following the food guide pyramid.
  • Get plenty of rest.
  • Drink plenty of fluids to avoid dehydration.
  • Decrease stress.
  • Rely on family members and friends for help with daily activities whenfeeling too tired to do them alone.
  • If a woman triesherbal remedies oralternative medicines for her symptoms, she should tell her healthcareprovider. Sometimes toxic reactions can occur when certain therapies arecombined.

    How is the disease monitored?

    At least every 3 to 4 months after treatment, a woman should have a follow-up,including:

  • apelvicexam
  • a physical exam
  • blood tests
  • Depending on the stage of the cancer, other tests made be used, such as the following:

  • pelvic ultrasound
  • CTscan
  • magnetic resonance imaging, or MRI
  • A woman should report any new or worsening symptoms that mightsuggest that the cancer is coming back. She can then be treated quickly, ifnecessary.

    Following are some of the signs of recurrent endometrial cancer:

  • vaginal bleeding
  • abdominal bloating
  • changes in bowel or bladder habits
  • swelling of the lowerlegs
  • persistent cough
  • loss of appetite
  • weight loss
  • fatigue
  • Article type: xmedgeneral