Uterine cancer is the most common gynecological cancer in the United States, and it most commonly occurs after menopause. (1) It is one of six cancers classified as a gynecological cancer. These are the other five: (2)
- Cervical cancer
- Ovarian cancer
- Vaginal cancer
- Vulvar cancer
- Fallopian tube cancer
Uterine cancer forms in the uterus, the hollow, pear-shaped organ located in a woman’s pelvis that is designed to carry a developing fetus. There are two main types of uterine cancer, beginning in different types of tissue, though there many subtypes within those categories. These are the two main types of uterine cancer: (3)
- Endometrial Cancer This type of uterine cancer develops in the lining of the uterus, which is also known as the endometrium. Most uterine cancers are endometrial.
- Uterine Sarcoma This type of uterine cancer originates in the muscle wall of the uterus. It is relatively rare.
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Signs and Symptoms of Uterine Cancer
Uterine cancer can cause symptoms in both the early and more advanced stages. Roughly 90 percent of women diagnosed with uterine cancer report postmenopausal vaginal bleeding, bleeding between periods, or very heavy bleeding during their menstrual cycle.
Other symptoms of uterine cancer: (4)
- Abnormal vaginal discharge (even with no traces of blood)
- Pelvic pain
- Pain during intercourse
- Difficulty urinating
- A mass in the pelvic area
- Unexpected weight loss
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How Is Uterine Cancer Diagnosed?
Uterine cancer is generally diagnosed through several types of examinations.
Pelvic Exam During a pelvic exam, your doctor will insert two fingers into the vagina while pressing the other hand down on the abdomen to feel for abnormalities in the uterus and the ovaries. A speculum is inserted into the vagina to visually inspect the area.
Transvaginal Ultrasound In this exam, a wandlike device known as a transducer is inserted into the vagina to create a video image of the thickness of the uterine lining and determine if there are irregularities.
Hysteroscopy During this test, a lighted tube, or hysteroscope, is inserted into the vagina to examine the uterus and uterine lining.
Endometrial Biopsy This procedure is performed to remove tissue from the uterine lining to be examined and analyzed by a laboratory.
Dilation and Curettage This test may be performed if questions remain after the uterine lining is biopsied. Tissue removed from the lining of the uterus is analyzed for cancer cells.
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Stages and Prognosis of Uterine Cancer
Like most cancers, the degree to which uterine cancer has advanced is classified by stages. All cancers are more curable the earlier they are discovered. Uterine cancer has four stages: (6)
Stage 1 The cancer has not spread beyond the uterus
Stage 2 The cancer has spread from the uterus to the cervix
Stage 3 The cancer has spread from the uterus to the vagina, ovaries, or lymph nodes
Stage 4 The cancer has spread to the bladder, rectum, or other organs.
When diagnosed early, women with uterine cancer have a very good prognosis, according to the American Cancer Society. For endometrial adenocarcinoma, the most common type of uterine cancer, for example, those diagnosed at stage 1A, the earliest stage, have a five-year survival rate of 88 percent. Those diagnosed with the latest stage, 4B, have a 15 percent survival rate.
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Treatment for Uterine Cancer
Ultimately, treatment for uterine cancer depends on the type of cancer and how extensive it is, as well as whether it is localized or has spread (metastasized). Other factors include overall health, age, and personal preferences, such as whether it is important to preserve fertility.
Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy.
Surgery A hysterectomy, the removal of the uterus and the cervix, is the main surgical treatment. A bilateral salpingo-oophorectomy, removal of the ovaries and fallopian tubes, is also an option. Your doctor may remove lymph nodes from the pelvic area to test for any cancer that may have spread outside of the uterus.
Hormone Therapy Medication is prescribed to lower the body’s hormone levels so that uterine cancer cells, which grow in response to hormones, might die off.
Chemotherapy Chemotherapy is the use of a several drugs in conjunction with one another to kill cancer cells.
Radiation Therapy Internal and external-beam radiation employ high-energy rays to kill cancer cells.
Targeted Drugs Targeted drug treatments home in on specific markers in cells. They are often combined with chemotherapy.
Immunotherapy Drug treatments can help your immune system recognize and fight cancer. In the case of uterine cancer, a type of immunotherapy known as a checkpoint inhibitor, specifically a drug called Keytruda (pembrolizumab), may be used. Keytruda is sometimes used in tandem with the targeted therapy Lenvima (lenvatinib). (7)
Uterine cancer treatments, such as hormone therapy and a hysterectomy, may result in hormonal imbalances or menopause. Side effects can include typical symptoms of menopause, such as hot flashes and vaginal dryness. These treatments can also cause muscle and joint aches.
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Prevention of Uterine Cancer
While there is no sure way to prevent uterine cancer, certain behaviors can lower your risk factors:
- Maintaining a Healthy Weight Women who are overweight or obese are up to 3 times more likely to get endometrial cancer.
- Exercising Regularly Higher levels of physical activity have been linked to a lower risk of endometrial cancer. Regular exercise can also help you maintain a healthy weight and lower the risk of high blood pressure and diabetes, both of which are risk factors for endometrial cancer.
- Using Oral Contraceptives or an IUD These forms of contraception may reduce your endometrial cancer risk. (8)
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Black Americans and Uterine Cancer
Although uterine cancer rates are slightly higher among white women than Black women, Black women are more likely to die from uterine cancer than white women. Racial disparities are reflected in higher rates and shorter survival among Black women, according to a study published in the Journal of Clinical Oncology. One reason for the shorter survival time is late diagnosis. Approximately 69 percent of white women are diagnosed when the cancer is local compared with 54 percent of Black women. Because Black women are less likely to be diagnosed in the early stage of the disease, their survival rate is lower at every stage. (10)
Resources We Love
Foundation for Women’s Cancers
This nonprofit foundation is dedicated to increasing public awareness of gynecologic cancer risk awareness, prevention, early detection, and optional treatment.
National Foundation for Cancer Research
The nonprofit organization provides scientists in the lab the funding they need to make game-changing discoveries in cancer treatment, detection, and prevention, and ultimately, for a cure.
Editorial Sources and Fact-Checking
- Uterine Cancer Statistics. Centers for Disease Control and Prevention. June 8, 2020.
- Basic Information About Gynecologic Cancers. Centers for Disease Control and Prevention. August 7, 2019.
- Uterine Cancer Types. Cancer Treatment Centers of America. November 4, 2020.
- Uterine (Endometrial) Cancer Signs and Symptoms. Memorial Sloan Kettering Cancer Center.
- Uterine (Endometrial) Cancer Risk Factors and Prevention. Memorial Sloan Kettering Cancer Center.
- Uterine Sarcoma Diagnosis and Staging. Memorial Sloan Kettering Cancer Center.
- Immunotherapy for Endometrial Cancer. American Cancer Society. September 17, 2019.
- Endometrial Cancer: Diagnosis and Treatment. Mayo Clinic. March 20, 2020.
- Uterine Cancer Statistics. Cancer.net. January 2020.
- Clarke MA, Devesa SS, Harvey SV, et al. Hysterectomy-Corrected Corpus Cancer Incidence Trends and Differences in Relative Survival Reveal Racial Disparities and Rising Rates of Nonendometrial Cancers. Journal of Clinical Oncology. August 2019.