Uterine cancer

The terms uterine cancer and womb cancer may refer to several different types of cancer that occur in the uterus, namely:

Both types of uterine cancer can present with abnormal vaginal bleeding and discharge.[11][12] Abnormalities can include change in duration or amount of menstrual bleeding as well as new bleeding between menses or after menopause. Sensations of new or increasing pelvic pressure or pain can also indicate tumor growth in the uterus.[12] Any of these findings warrant further workup by a doctor.

It is not known with certainty what the causes for uterine cancer may be, though hormone imbalance is cited as a risk factor. Estrogen receptors, known to be present on the surfaces of cells of this type of cancer, are thought to interact with the hormone causing increased cell growth, which can then result in cancer. The exact mechanism of how this occurs is not understood.[13]

Risk factors for endometrial cancer include obesity, metabolic syndrome, type 2 diabetes, taking pills that contain estrogen without progesterone, a history of tamoxifen use, late menopause, and certain hereditary conditions (Lynch syndrome, Cowden syndrome).[7][1][11] Risk factors for uterine sarcoma include prior radiation therapy to the pelvis, a history of tamoxifen use, a history of childhood retinoblastoma, and hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome.[2][12]

To evaluate for uterine cancer, a clinician might perform a pelvic exam to visually inspect internal pelvic organs and to feel the size and position of the uterus and ovaries. A “pap smear” may also be done to brush the sides of the cervix to collect cells for testing and to look at under a microscope. A dilatation and curettage is often done to collect a sample of uterine lining tissue. An ultrasound is also often performed to look for tumors.[14]

Screening for uterine cancers is not recommended except for in women with certain hereditary conditions that increase their risk (Lynch, Cowden, HLRCC).[11][12]

In general, combined oral contraceptive pills and progestin-only pills are protective against uterine cancers. Weight loss and/or bariatric surgery reduces the risk for patients with obesity.[11]

Treatment of uterine cancer may differ depending on the type of cancer and staging of the tumor.[15] In early stages, minimal invasive surgery is preferred. [16]

For endometrial cancer, five main types of treatments are used, including surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. The most common treatment modality for endometrial cancer is surgery, whereby the uterus is removed via a total hysterectomy.[15] Hysterectomies may also be accompanied by removal of ovaries and fallopian tubes, called a salpingo-oophorectomy. Additionally, hormone therapy which seeks to block the growth of cancer cells may also be used in the treatment of endometrial cancer. Targeted therapy may include monoclonal antibodies, mTOR inhibitors, and signal transduction inhibitors which all act to target cancer cells specifically.[15]

As of 2021, treatment options for uterine sarcoma include surgery, radiation therapy, chemotherapy, and hormone therapy.[15]

Prognosis varies for the different types of endometrial cancer. Factors that influence prognosis across types of uterine cancer are age at diagnosis, the stage of the cancer, the grade of the cancer, histology, depth of invasion into the myometrium, and the presence of spread to nearby lymph nodes or other regions.[17] Endometrial cancer typically has a good 5-year-survival when diagnosed early.[18] Generally, the prognosis is poorer for uterine sarcomas as compared to endometrial cancers.[19]

Age-standardized death from cancer of the uterine body per 100,000 inhabitants in 2004.[20]

  no data

  less than 0.5

  0.5–1

  1–1.5

  1.5–2

  2–2.5

  2.5–3

  3–3.5

  3.5–4

  4–4.5

  4.5–5

  5–8

  more than 8

Uterine cancer effects approximately 3.1% of females during their lifetime.[8] Uterine cancer resulted in 45,000 deaths worldwide in 1990, with this number increasing to 58,000 deaths in 2010.[21] North America and Northern Europe have the highest rates of uterine cancer. Asia, Southern Europe, Australia and South America have moderate rates, with the lowest rates in Africa and Eastern Asia.[22] About 81% of women with uterine cancer survive for five years. This rate is higher with more localized cancer at 95% survival rate for five years and lower for a distant spread of the cancer, at a 16.8% survival rate for five years.[8]

As current diagnostic methods are invasive and inaccurate, researchers are looking into new ways to catch womb cancer, especially in its early stages. A study found that using a technique involving infrared light on simple blood test samples detected uterine cancer with high accuracy (87%), and could detect precancerous growths in all cases.[27][28]

• Clinically reviewed uterine cancer information for patients
• UK uterine cancer statistics
• Foundation for Women's Caner