Uncontrolled and unregulated growth of cells in the uterus is referred to as uterine cancer. It could be either malignant or benign. Here is a detailed analysis of uterine cancer.

Uterus: Uterus is a secondary reproductive organ of the female body (ovaries being the primary sex organs), located in the pelvis. Commonly referred to as the womb, the uterus is responsible for carrying and growing a fetus during pregnancy. It is a hollow organ and on its lateral sides, it is connected to the uterine tubes.

Overview 

There are many types of cancers of the uterus comprising of different sarcomas, as well. But the most commonly occurring uterine cancer among women is endometrial cancer.  It is the cancer of the uterus lining called the endometrium. In the USA alone, endometrial cancer comprises nearly 65% of all uterine cancers.

Endometrioid adenocarcinoma: This is the cancer of endometrial glands in the uterus. They vary from being benign to malignant. These are some of the most commonly occurring endometrial cancers.

Sarcomas, on the other hand, tend to be rarer but they are not entirely absent from the list. Sarcomas are further divided into many types depending on their anatomic location and pathophysiology. These include:

1. Uterine Sarcoma: These are potentially an aggressive type of cancer. It involves cancer in the myometrium, which is the muscular wall of the uterus. Up to 10% of all uterine cancers are sarcomas of the myometrium.

2. Uterine papillary serous carcinoma:  These are yet another rare but aggressive kind of cancers occurring in up to 10% of the cases and responsible for nearly 40% of mortality cases. They are also called endometrial serous cell carcinomas.

3. Clear cell carcinoma of the uterus: this type is usually found in the ovaries as opposed to the endometrium of the uterus. They make up to 3% of gynecological cancers and typically occur in postmenopausal women. Heavy vaginal postmenopausal bleeding is one of the main symptoms of such carcinomas.

4. Uterine carcinosarcoma: they are also referred to as malignant mixed Müllerian tumors in some old literature. Epidemiologically, they are closely related to endometrial adenocarcinoma. They most commonly occur in women older than 60.

Signs and Symptoms of Uterine Cancer

Generally speaking, cancer of any sort usually presents itself in a wide range of symptoms but some of the most frequently associated symptoms of cancer include:

• Unexplained and prolonged fever
• Unexplained and rapid weight loss
• Lethargy and tiredness
• Loss of appetite
• A multitude of diseases occurring together

What are the signs and symptoms of uterus  cancer:

In addition to the previously stated common symptoms of cancer, uterine cancers also display some typical array of symptoms. Women over the age of 30 groups should frequently lookout for any or all of these symptoms. These symptoms include:

Difficulty in urination: This involves urgency and a higher frequency in urination. Usually, this symptom is linked to UTI's and kidney infections, as well.

Strange vaginal discharge:  usually white water or yellowish-white vaginal discharge is not uncommon in women. However, in the case of uterine cancers, such discharge varies greatly from the commonly occurring ones.

Pain and discomfort during intercourse: The patient sometimes finds it hard to initiate libido, or the process of intercourse itself is extremely painful and excruciating.

Frequent pelvic pain: feeling pains similar to having periods in the pelvic region at all times is one of the commonly occurring symptoms.

Frequent pain in the lower abdomen: This is in correlation to pelvic pain and usually occurs in the bladder region.

Lump or mass observed in the cervix, vagina, uterus, etc.: this is usually found in the cases when cancer has prolonged to a stage where the mass can be felt by pressing into the skin. This lump could be benign or malignant.

Irregular menstrual cycle: young girls usually have more or less regular menstrual cycles up until their mid-30s. If all of sudden the cycles began to get irregular, then a thorough exam by a gynecologist is recommended.

Postmenopausal vaginal bleeding:  both endometrial carcinoma and other sarcomas have this common symptom and should never be neglected.

Bleeding during or after intercourse: in the case of sexually active women, if there is vaginal discharge or bleeding before or after intercourse, it can be directly related to uterine cancer.

Rapid and unexplained weight loss:  as with all forms of cancers, this symptom is almost always present. Substantial weight loss without any diet or change of lifestyle should never be ignored.

Difficulty getting pregnant:  Although there can be multiple reasons for this symptom, but this could be linked to cancer when any of the other symptoms are also present.

Associated risk factors

There are certain factors that enhance the complexity and severity of the disease. These factors also contribute to the increased chances of getting the disease.

1. Genetic and hereditary history: Family history plays a vital role in the onset and spread of uterus cancer. Less than 10% of cancer cases have a family history of cancer. Lynch syndrome and endometrial cancer are the main risk factors in the genetic line.  Both of these cancer types occur together. The doctor should keep a close eye on one type if the other one is diagnosed.

• When to get genetic testing for cancer?

- When a close relative develops multiple types of cancer

- When a close relative dies of a severe cancer

- When two or more close relatives (e.g. aunts, grandmothers, etc.) develop uterine cancers.

- If one or more relatives is diagnosed with rare uterine and ovarian sarcomas.

2. Age: Women over 50 are at higher risk of any sort of uterine cancer. However, it is not entirely uncommon at a younger age, too.

3. Weight:  weight and obesity have an undeniably strong role in uterine cancers. Fat and adipose tissue tend to cause higher estrogen formation. The higher the estrogen levels; the higher the chances for getting uterine cancers. Women who have a genetic history of cancers in the uterus and ovaries should always maintain weight between the recommended Body Mass Index (BMI) range.

4. Prior exposure to radiation therapy:  exposure to higher intensity of radiation for a prolonged period of time can cause genetic mutation and thus, depression of the tumor suppression gene. In addition to genetic mutation, radiation exposure in the lower abdominal area for pelvic & ovarian cancers can also contribute to cancers of the uterus. 

5. Working in high radiation areas: Women who work in the radiation-emitting environment, e.g. nuclear plants, oil and gas plants, or X - ray operating clinics, etc., are at higher risk for getting uterus, breast, and ovarian cancers.

6. Higher levels of estrogen hormone: Estrogen hormone plays a vital role in endometrial cancers. If the body has a higher estrogen level and lower progesterone level for a significant duration of time then this can cause endometrial cancer. This primarily occurs due to the increase in the thickness of the lining of the uterus wall, or endometrial lining. The uterine lining thus continues to grow and thicken uncontrollably, eventually leading to endometrial sarcomas.

7. Diabetes:  diabetic women tend to be up to 70% more inclined towards endometrial cancer as opposed to non-diabetic women. This is particularly true for non-insulin-dependent diabetic (NIDM) also known as Type-II diabetics. A higher level of freely circulating blood insulin leads to greater chances of endometrial lining thickness.

8. Tamoxifen: This drug belongs to a class of hormone modulators called Selective Estrogen Receptor Modulators (SERM). They are used in the preventive treatment of breast cancers. But overuse of this drug can act as a stimulator for cancers in the uterus.

Prevention and Protection

Although Cancer is predominantly an unpredictable disease in its nature, however, taking all the right steps and care can prevent it from initiating and progressing.  The following factors play an important role in this respect:

Effect of breastfeeding and pregnancy: Endometrial thickening occurs in response to higher estrogen levels in the body. In a pregnant and breastfeeding woman, the level of estrogen greatly reduces. Thus, the chances of endometrial cancer are lower in a woman who has had children.

Monitoring endometrial diseases: Endometrial diseases such as endometrial Hyperplasia are very common among middle-aged women. Such diseases proliferate into the cancerous state over a period of few years if left untreated. It is, therefore, essential to closely monitor and treat such conditions.

Maintaining blood glucose and insulin levels: Diabetic women are strong candidates for uterine sarcomas and endometrial cancers. Therefore, it is essential to maintain diabetes in check.

Family history: Women with a family history of ovarian and uterine cancers should talk to their doctors for testing cancer genes. This can play a vital role in detecting the disease early on.

Contraceptives:  estrogen and progesterone balanced contraceptives should be used as opposed to one single hormone at a time. Using the only estrogen increases uterine thickness therefore, contraceptives with well-balanced hormones should be used.

Treatment therapies for uterine cancers

All forms of cancers have more or less the same course of therapy including chemotherapy, radiation therapy and surgery. In addition, the doctors decide the suitable drugs required to keep the disease in check. Therapy is decided based on the following factors:

• Stage of cancer
• Grade of cancer
• Type of cancer
• If fertility is to be considered or not
• General health and age of the patient

What are the different stages of uterine endometrial cancer:

• Stage I:  this is the initial or the first stage where the cancer is only limited in the uterus and has not spread elsewhere.

Hysterectomy:  Surgical removal of uterus from the body is called a hysterectomy

In this stage, the cancer is localized within the womb or uterus and has not reached the cervix, vagina or lymph nodes. Hysterectomy is the treatment of choice for this stage. However, hysterectomy in young females could lead to infertility and the inability to get pregnant later on in life.

Progestin treatment:  in order to avoid infertility in young females, oncologists sometimes initiate progestin treatment which can lower the disease growth and spread. Thus, this allows them to conceive prior to having the uterus entirely removed.

Radiation therapy:  If the disease is localized but there are chances of remaining cancer fragments after surgery, radiation treatment is also administered.

• Stage II: The cancer is mainly localized within the uterus but has spread to the cervix and adjoining tissues.

Radical hysterectomy: This includes the complete removal of the uterus, Fallopian tubes, and adjoining lymph nodes (para aortic dissection of lymph nodes).

Radiation and chemotherapy: samples obtained from a radical hysterectomy are then sent for biopsies and if found to be cancerous in lymph nodes, then cancer has progressed to stage III.

• Stage III: In this stage, cancer has clearly spread to other parts outside of uterus such as the bladder and the intestines.

Radiation and chemotherapy: usually cancer in this stage has spread so far that hysterectomy is not the first choice of treatment. In fact, usually, radiation and chemotherapy are done to shrink the size of the tumor before surgery is done.

Targeted immune therapy: This is done in cases where hormone imbalance is the initial cause of endometrial thickness leading to cancer.

• Stage IV: This is usually a stage where the adjoining organs and systems are also affected by the tumor and the tumor continues to spread further, too.

The tumor spread at this stage is so severe that multiple organ failure is a high risk for patients. The survival rate is also very low at this stage. Radical hysterectomies and Chemotherapies are usual treatments at this stage. However, doctors usually suggest taking part in clinical trials for the discovery of new treatments. Usually, the spread of the tumor involves:

• Bladder
• Ovaries
• Bowel system
• Non-pelvic lymph nodes
• Lungs
• Liver
• Stomach
• Intestines

Frequently asked questions (FAQ's) about uterine cancer

1.  What is the survival rate and statistics for uterine cancer?

The survival rate for uterine cancer is fairly high. Up to 95% of women survive, if the tumor is caught in an early stage and hysterectomy is performed.

2.  Can uterine cancer be aggressive?

Uterine sarcomas are more aggressive but endometrial cancer is a less vigorous type.

3. Who is at higher risk for endometrial cancer?

Women who have been pregnant are less likely to have endometrial cancer as opposed to women who have not experienced pregnancy.