Uterine cancer (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
The uterus is a hollow, muscular organ where a fetus grows. There are different types of uterine cancer. The most common type of uterine cancer is called endometrial cancer, which starts in the lining of the uterus. Common symptoms of uterine cancer include unusual vaginal bleeding, trouble urinating, pelvic pain and pain during intercourse. Treatments include having a hysterectomy, hormone therapy and radiation.

What are the symptoms of Uterine cancer?
Early uterine cancer does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:


 * Unusual vaginal bleeding


 * Trouble urinating


 * Pelvic pain and pain during intercourse


 * Fatigue and unexplained weight loss

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell their doctor so that the problems can be diagnosed and treated as early as possible.

Who is at highest risk?
Clinical data has suggested that the development of uterine cancer is related to several factors. Abnormal estrogen levels may be the most important indicator.

Hormone levels: Any change in the balance of estrogen and progesterone that leads to the production of more estrogen increases the risk for developing endometrial cancer.
 * Estrogen therapy: Clinical data shows the use of estrogen without progesterone can lead to endometrial cancer.


 * Birth control pills: Clinical observations suggest that the use of birth control pills can lower the risk of endometrial cancer.


 * Total number of menstrual cycles: Medical studies show that more menstrual cycles during a woman’s lifetime raises her risk of endometrial cancer.


 * Pregnancy: Studies show that a higher number of pregnancies may protect against endometrial cancer because of the the shift towards more progesterone during the pregnancy period.


 * Obesity: Besides ovaries, estrogen can also be produced by fat tissue. So, women with more fat tissue in their bodies have higher risk of developing endometrial cancer.  After menopause, estrogen produced by the fat tissue has a larger influence than it did before menopause.


 * Tamoxifen: As a drug used to treat chest cancer, Tamoxifen effects the tissue in the chest and the tissue in the uterus very differently. It promotes the grow of the endometrium and increases the risk of endometrial cancer.


 * Ovarian tumors: The granulosa-theca cell tumor, one type of ovarian tumor, can produce estrogen and increase the risk of endometrial cancer.


 * Polycystic ovarian syndrome: This is a condition with abnormal hormone levels, such as higher estrogen levels and lower levels of progesterone. This can also increase the risk of endometrial cancer.


 * A diet high in animal fat

Endometrial hyperplasia: Atypical hyperplasia is a precancerous lesion of endometrial cancer.

Prior pelvic radiation therapy: Radiation can increase the risk of endometrial cancer by damaging the DNA of cells.

Diabetes: Epidemiological data shows that endometrial cancer may be as much as four times more common in women with diabetes.

Family history: Clinical survey's show peeople with a family history of endometrial cancer have a higher risk of developing the disease.

Age: The risk of endometrial cancer increases as women become older.

When to seek urgent medical care?
Call your health care provider if symptoms of uterine cancer develop. If you experience a larger amount of vaginal bleeding, seek urgent medical care as soon as possible.

Diagnosis
To diagnose uterine cancer, your doctor may suggest you following tests:
 * Hysteroscopy and endometrial biopsy: This is the most important test used to diagnose uterine cancer when people have certain risk factors or when signs and symptoms suggest this disease may be present. The gynecologist inserts a tiny telescope into the uterus through the cervixan and obtains abnormal samples. The tissue samples will be checked by the doctors of pathology department under a microscope to see whether cancer is present or not.
 * Dilation and curettage (D & C) and endometrial biopsy: If a hysteroscopy and endometrial biopsy cannot supply valuable information, this test needs to be done after general anesthesia is administered.
 * Transvaginal ultrasound or sonography: These tests use sound waves to make pictures of the organs. Transvaginal ultrasound uses a probe inserted into the vagina to create images of the uterus and other pelvic organs and tell whether a tumor is present or not.
 * Computed tomography (CT) scan: CT scans are often used to diagnose uterine cancer. It can confirm the location of the cancer and show the organs near the uterus, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful for determining the stage of the cancer and in determining whether surgery is a good treatment option.
 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) because it produces more detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
 * Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy which in turn is used to produce the images. PET can provide more helpful information than either CT or MRI scans. It is useful to see if the cancer has spread to the lymph nodes and it is also useful for your doctor to locate where the cancer has spread.
 * Chest X-ray: This plain x-ray of your chest may be done to see if the cancer has spread to your lungs.
 * Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.
 * CA-125: The level of CA-125 in blood can serve as a marker of helping diagnose, detecting treatment effect and monitoring recurrence.

Treatment options
Patients with uterine cancer have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, hormone treatment, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.


 * Surgery: Surgery is the main treatment for uterine cancer. The type of surgery is determined by your stage. Surgical removal of the uterus, cervix, both fallopian tubes and both ovaries is recommended.


 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.


 * Chemotherapy: This treatment uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.


 * Hormone therapy: This treatment uses hormones or hormone blocking drugs to battle cancer. Usual drugs include progestins, Tamoxifen, gonadotropin-releasing hormone agonists and aromatase inhibitors.

Diseases with similar symptoms

 * Uterine submucous myoma


 * Endometrial polyps


 * Senile vaginitis


 * Functional uterine bleeding in menopausal transition


 * Primary carcinoma of fallopian tube

Where to find medical care for Uterine cancer?
Directions to Hospitals Treating Uterine cancer

What to expect (Outlook/Prognosis)?
Generally speaking, the prognosis of uterine cancer is relatively good because it can be diagnosed in the early stages. The prognosis depends on the following:


 * The stage of uterine cancer


 * Whether or not the tumor can be removed by surgery


 * The patient’s general health

Possible complications
Complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D and C or endometrial biopsy.

There can also be complications from hysterectomy, radiation, and chemotherapy.

Prevention
Although the reasons for the development of uterine cancer are not clear, epidemic data shows the following intervention may help to reduce your risk of uterine cancer:


 * Keeping healthy lifestyle: Weight-control, healthy diet and regular exercise.


 * Available use of hormone drugs: When you need the hormone drugs to treat your discomfort, you should go see your doctor and take the medicine under the doctor's direction.


 * Getting proper treatment of pre-cancerous disorders of the endometrium