The uterus, also called the womb, is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum.
- cervix - the narrow, lower portion of the uterus.
- corpus - the broader, upper part of the uterus (also called the body of the uterus).
- myometrium - the outer layer of the corpus; the muscle that expands during pregnancy to hold the growing fetus.
- endometrium - the inner lining of the uterus.
Cancers that occur in each part of the uterus have their own names, such as cervical cancer or endometrial cancer, but are sometimes broadly defined as uterine cancer because the structure is part of the uterus. Cancer of the uterus spreads through the bloodstream or lymphatic system. According to the American Cancer Society (ACS), about 42,160 cases of cancer of the uterine corpus (body of the uterus) will be diagnosed in the US during 2009.
Some conditions in the uterus caused by abnormal, rapid, and uncontrolled division of cells are not cancer. Three of these benign (noncancerous) conditions include:
- fibroid tumors
Fibroid tumors are common benign tumors of the uterine muscle that do not develop into cancer. Fibroid tumors of the uterus occur most often in women of childbearing age. And, although single fibroid tumors do occur, multiple tumors are more common.
Symptoms of fibroid tumors, which depend on size and location, include irregular bleeding, vaginal discharge, and frequent urination. For fibroids that press against nearby organs and cause pain, surgery may be necessary. Many times, however, fibroids do not cause symptoms and do not need to be treated. After menstrual periods cease, fibroid tumors may become smaller and may disappear altogether.
Endometriosis is a benign condition of the uterus that is common among women in their 20s and 30s, especially women who have never been pregnant. Tissue that looks and acts like endometrial tissue begins to grow in unusual places, such as on the surface of the ovaries, on the outside of the uterus, and in other tissues in the abdomen.
Hyperplasia is an increase in the number of normal cells lining the uterus. Although it is not cancer, it may develop into cancer in some women. The most common symptoms are heavy menstrual periods, bleeding between periods, and bleeding after menopause.
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors.
But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.
The following have been suggested as risk factors for uterine cancer:
- age 50 or over
- history of endometrial hyperplasia
- estrogen replacement therapy (ERT)
Women who use estrogen, without progesterone, have an increased risk of developing uterine cancer.
- hypertension (high blood pressure)
- history of an inherited form of colon cancer
The following are known risk factors for uterine cancer:
- history of taking tamoxifen for breast cancer treatment or prevention
African-American women are affected at a rate twice that of Caucasian or Asian women.
- history of radiation therapy to the pelvic area
The following are the most common symptoms of uterine cancer. However, each individual may experience symptoms differently. Symptoms may include:
- unusual vaginal bleeding or discharge
- frequent, difficult, or painful urination
- pain during sexual intercourse
- pain in the pelvic area
- bleeding after menopause
Cancer of the uterus often does not occur before menopause. It usually occurs around the time menopause begins. The occasional reappearance of bleeding should not be considered simply part of menopause. It should always be checked by a physician.
The symptoms of uterine cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
When symptoms suggest uterine cancer, the following may be used to make a positive diagnosis:
- a detailed medical history - family and personal
- a thorough physical examination
- pelvic examination of the uterus, vagina, ovaries, bladder, and rectum
- Pap test (Also called Pap smear.) - a test that involves a microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation.
- endometrial biopsy - a procedure in which an endometrial (uterine lining) tissue sample is obtained using a small, flexible tube that is inserted into the uterus. The tissue sample is examined under a microscope to determine if cancer or other abnormal cells are present. An endometrial biopsy procedure is often performed in a physician's office.
- dilation and curettage (D & C) - a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument)
When cancer cells are found, other tests are used to determine if the disease has spread from the uterus to other parts of the body. This process is called staging. Staging procedures that may be performed include the following:
- blood tests
- chest x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- ultrasound (Also called sonography.) - a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- special examinations of the bladder, colon, and rectum
The National Cancer Institute has defined the following stages of uterine cancer:
||The cancer is only in the body of the uterus and not in the cervix.
||The cancer has spread from the body of the uterus to the cervix.
||The cancer has spread outside the body of the uterus but has not spread outside of the pelvis. However, lymph nodes in the pelvis may contain cancer cells.
||The cancer has spread into the bladder or rectum or has spread beyond the pelvis.
Specific treatment for uterine cancer will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment may include:
- surgery, including:
- hysterectomy - surgery to remove the uterus.
- salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries.
- radiation therapy
The use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
- external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
- internal radiation (brachytherapy, implant radiation) - radiation is given inside the body as close to the cancer as possible. Tiny tubes that contain substances that produce radiation, called radioisotopes, are inserted through the vagina and left in place for a few days. Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Hospitalization is required when an internal implant is in place. In some cases, both internal and external radiation therapies are used.
- hormone therapy
In some cases, hormones can kill cancer cells, slow the growth of cancer cells, or stop cancer cells from growing. Hormone therapy as a cancer treatment involves taking substances to interfere with the activity of hormones or to stop the production of hormones. Hormone therapy may be used to treat endometrial stromal sarcomas and is rarely used for other types of uterine sarcoma.
Progesterone (pill) may be given as hormonal therapy for uterine cancer.
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