UofL Health – Brown Cancer Center focuses our expertise and experience on each patient with uterine cancer. From diagnosis through treatment and follow-up, your care is personalized and designed to meet your individual needs.
Experts from our Gynecologic Oncology practice will consider all of the options and then recommend the most advanced treatment for you. We have the latest technology and techniques available to best serve you.
Your treatment team, which may include gynecologic oncologists, radiation oncologists, pathologists, radiologists, genetic counselors and rehabilitation collaborate and communicate each step of the way. We are constantly working to provide you with the best possible care.
Surgery is often a part of the treatment for uterine cancer. At Brown Cancer Center, our surgeons are experienced and skillful in the surgical treatment of uterine cancer. In many cases, minimally invasive surgery can be performed. These procedures may lessen the time it takes for you to heal and the time you need to spend in the hospital. In addition, we have radiation oncologists who specialize in the treatment of uterine cancer.
Facts
The uterus (womb) is where a fetus grows during pregnancy. It is composed of the cervix (the bottom part of the uterus) and the body of the uterus. The body of the uterus has the lining of the uterus (endometrium) and the wall of the uterus (myometrium). When a woman menstruates, or has a period, the endometrium is shed in the form of blood.
Uterine cancer is the most common cancer of the female reproductive organs. It is the fourth most common cancer among women in the United States. More than 40,000 women in the United States will be diagnosed with uterine cancer each year. The average age of a woman with uterine cancer is 60 years old. However, 25% of cases are diagnosed before a woman goes through menopause.
The most common kind of uterine cancer is endometrial cancer. There are two main types of endometrial cancer: endometrioid adenocarcinoma and uterine carcinosarcoma. The second most common kind of uterine cancer is uterine sarcoma, although these are rare.
Risk factors
There are several lifestyle factors that may increase your risk of uterine cancer. These include:
- Obesity: Being overweight increases your risk of uterine cancer 2-4 times.
- Eating a diet high in fat
- Age: Most uterine cancers are found in women older than 40.
- Tamoxifen use: Tamoxifen is often used for the treatment of breast cancer. It may cause the lining of the uterus to become thickened.
- Estrogen replacement therapy without progesterone therapy
- Personal/family history of uterine, ovarian, or colon cancer
- Personal/family history of Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer or HNPCC)
- Ovarian diseases such as polycystic ovarian syndrome (PCOS)
- Complex atypical endometrial hyperplasia: This is a precancerous condition
- Diabetes
- Never being pregnant
- Early start to menses
- Late menopause
- Breast or ovarian cancer
- Pelvic radiation
Not everyone with these risk factors will develop cancer, but it does increase the chances. Changes in diet and exercise may help reduce your risk.
Symptoms
Symptoms may vary from woman to woman. The most common symptoms are:
- Vaginal bleeding after going through menopause
- Unusual bleeding or heavy bleeding in women who have not gone through menopause
- Abnormal vaginal discharge
- Pelvic pain or pressure
- Weight loss
These symptoms do not always mean you have uterine cancer. However, you should see your doctor if you have these symptoms.
Some uterine cancers may be inherited. Tell your doctor of any family members with cancer to help determine if genetic counseling is right for you.
Diagnosis
Blood tests, biopsies, imaging studies and surgical procedures may be used to diagnose uterine cancer.
If you have symptoms that may signal uterine cancer, your doctor will examine you and discuss your medical history. If your doctor is concerned for uterine cancer, he/she may perform a biopsy or an imaging study. In order to obtain a biopsy, your doctor may perform one of the following:
Endometrial biopsy: Using a thin, flexible tube inserted through the cervix into the uterus, a small amount of tissue is removed. This can be done in the office.
Dilation and curettage (D&C): This is done in the operating room. The cervix is opened slightly and tissue can be removed from the inside of the uterus.
Hysteroscopy: This is also done in the operating room. A thin camera is inserted into the uterus through the vagina and cervix. The doctor is able to look inside the uterus and biopsy anything that appears abnormal.
One or more of these tests may be needed to diagnose cancer.
In addition to these procedures, imaging studies may be done. These may include:
- Ultrasound
- CT or CAT (computed axial tomography) scan
- MRI (magnetic resonance scan)
- PET (positron emission tomography) scan
- Chest X-ray
Blood tests may also be performed. These may include:
- Complete blood count (CBC)
- CA 125: Some uterine cancers release this substance and it may be increased. This may be used to help determine if cancer has spread outside of your uterus.
Treatment
If you are diagnosed with uterine cancer, your doctor will discuss the best treatment for you. Treatment will be tailored to you and will take into account your general health, type of cancer, and stage.
Surgery
Surgery is often the first step in treatment of uterine cancer. Surgery will often include:
- Total Hysterectomy: Removal of the uterus and cervix
- Bilateral Salpingo-Oophorectomy: Removal of the ovaries and fallopian tubes
- Lymph Node Dissection: Removal of lymph nodes in the pelvis and lower abdomen
- Removal of the omentum (fat pad in the pelvis)
Depending on your health and your cancer, surgery may be performed with a minimally invasive approach, or through small incisions. This may be done laparoscopically or with robotic surgery. The uterus is removed through the vagina and the top of the vagina is sewn shut. Sometimes a larger incision is needed to remove the uterus.
Following surgery, additional treatment with chemotherapy, hormone therapy or radiation therapy may be needed. These treatments will depend on the stage of cancer and the type of cancer.
Radiation therapy
Radiation therapy may be used to treat uterine cancer after a hysterectomy or may be used to treat uterine cancer if surgery is not possible. New radiation techniques allow for focused radiation and reduced side effects from treatment. A radiation oncologist will give you this treatment.
Chemotherapy and hormone therapy
The most advanced chemotherapeutic treatments will be used to treat your uterine cancer. Our gynecologic oncologists will oversee your chemotherapy. Sometimes hormone therapy may be used to treat cancer or when cancer comes back.
Genetic testing and counseling
Some uterine cancers may be passed down through generations. Lynch Syndrome is an inherited predisposition to certain cancers, including uterine cancer. Genetic counseling and testing may be recommended if:
- You were diagnosed with uterine cancer before age 50
- You have had colon or rectal cancer
- You have a close relative with colon, rectal or endometrial cancer
- Your tumor tests positive for gene mutations often found in Lynch Syndrome (MLH1, MSH2, MSH6, PMS2 genes)
If you have these characteristics, genetic counseling may be right for you.
