Definition and Overview
Uterine cancer, as the name implies, is the cancer of the uterus, which is a hollow, muscular organ that belongs to the female reproductive system. It is where a fetus grows during pregnancy.
Uterine cancer is also often referred to as endometrial cancer, as it is in the endometrium where cancer usually starts. The endometrium is a prime spot for adenocarcinomas because its lining thickens each month in anticipation of pregnancy, creating a regular predominance of cells in the area making it more prone to mutation, which causes cancer.
Another form of uterine cancer, though rare, is called uterine sarcoma, which occurs in the muscles or other tissues in the uterus. The most common risk factor for uterine sarcoma is when a patient has had previous radiation therapy to the pelvic area. Breast cancer treatment (past and present) with Tamoxifen also raises the risk of getting uterine sarcoma.
Cause of Condition
Just like any other cancer that affects different body parts, the exact cause of uterine cancer remains unknown. However, there are certain risk factors that have been associated with the incidence of uterine cancer although they don’t necessarily mean that women who have them will automatically develop the disease. There are women who exhibit none of these risk factors but have gotten uterine cancer. There are also women who have most or all risk factors but have not gotten uterine cancer.
Below is the list of risk factors for uterine cancer:
Endometrial hyperplasia – This is a condition where there is a rampant increase in cell activity in the endometrium that results in an abnormal growth in the area. Mild hyperplasia is treatable with hormone therapy and normally doesn’t lead to uterine cancer. However, severe hyperplasia that presents with bleeding in between periods and after menopause has a higher chance of turning into uterine cancer.
Using estrogen-only hormone therapy – Women undergoing menopause resort to hormone therapy to alleviate various symptoms such as hot flashes and vaginal dryness. However, hormone therapy that uses estrogen alone, especially in women with their uterus intact, can result in a higher chance of getting uterine cancer.
A long history of menstrual cycles – This involves women who have had their first menstrual cycle at an early age and have had their menopause later in life. Those who started early but had menopause early are less at risk as well as those who had their periods late and their menopause late too.
Infertility – Women who are pregnant are naturally infused with a huge dose of progesterone that offsets the estrogen level in the body. Those who cannot get pregnant and have never been pregnant are in danger of getting uterine cancer because the body does not produce as much progesterone as needed.
Tamoxifen medication – The drug Tamoxifen may be effective against breast cancer, but it may cause endometrial cancer. When taken, the drug negates the estrogen in the breast tissue but not in the uterus. It can also cause the endometrium to thicken, increasing the risk of uterine cancer in the process.
Ovarian tumors – The presence of ovarian tumors causes the unrestricted release of estrogen into the body, which can stimulate the thickening and growth of the endometrium, raising the risk of uterine cancer.
Pelvic radiation therapy – Radiation therapy in the pelvic area may cause the damage and mutation of the cells. Uterine cancer is one of the side effects of such damage.
Uterine cancer is usually indicated by the following key symptoms:
- Abnormal or unusual vaginal bleeding – Any vaginal bleeding that doesn’t occur within the normal menstrual cycle and especially after menopause is something to be concerned about. It may start as spotting or simple discharge and later gravitates toward a more serious blood flow problem.
- Pain with urination
- Pain in the pelvic region
- Pain during sexual intercourse
Who to See and Types of Treatments Available
The key symptoms mentioned above may be caused by uterine cancer but they can also be symptoms of other medical conditions. The best way to be sure is to visit a doctor, like an obstetric-gynecologist, for confirmation.
Depending on the results of the initial assessment, the doctor may recommend diagnostic procedures, such as pelvic exam that involves the palpation of the uterus and vagina for any abnormalities in shape or size to determine what is causing the symptoms. An ultrasound may also be recommended to get a better view of the uterus. If necessary, the doctor may also call for a biopsy, which removes a sample of tissue from the uterus to be examined by a pathologist, who can determine for sure if cancer is present.
When uterine cancer is diagnosed, the doctor (or a team of doctors) may devise a multi-treatment plan consisting of:
Hormone therapy – This may be used as the first step in preventing uterine cancer when the cause of the thickening of the endometrium is hormonal imbalance.
Surgery – A hysterectomy (removal of the uterus) may be the next logical step in preventing or curing uterine cancer. This is usually advised when the cancer is confined to the uterus and has not spread to other muscles or tissues.
Chemotherapy – This involves a holistic approach to killing cancer cells that may have potentially spread beyond the uterus.
Radiation therapy – This is necessary to clear the affected area from cancer cells to prevent other nearby muscles and tissues from getting infected in the future.
El-Khalfaoui K, du Bois A, Heitz F, Kurzeder C, Sehouli J, Harter P. Current and future options in the management and treatment of uterine sarcoma. Ther Adv Med Oncol. 2014 Jan;6(1):21-8. PMID: 24381658 www.ncbi.nlm.nih.gov/pubmed/24381658.
Gadducci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol. 2008 Feb;65(2):129-42. PMID: 17706430 www.ncbi.nlm.nih.gov/pubmed/17706430.