Uterine Cancer

Uterine cancer is a general term that includes two types of cancer: endometrial cancer and uterine sarcoma. Endometrial cancer is more common (95% of all cases) and develops in the endometrium, the inner lining of your uterus. Uterine sarcoma is rare and develops in the myometrium, the muscle wall of your uterus.

In the United States, endometrial cancer is the most common cancer affecting the reproductive system of women and mainly develops after menopause. About 65,000 women, or 3%, will receive a diagnosis of uterine cancer at some point in their lives.

Signs & Risk Factors

Symptoms of these cancers include:

• Vaginal bleeding between periods before menopause.
• Vaginal bleeding or spotting after menopause, even a small amount.
• Lower abdominal pain or cramping in your pelvis, below your belly.
• Thin white or clear vaginal discharge if you’re postmenopausal.
• Extremely prolonged, heavy or frequent vaginal bleeding if your older than 40.

Risk Factors can include:

• Age: most cases occur over 50.
• Family history: people with inherited genetic disorders like Lynch Syndrome have an increased risk of several types of cancers.
• Obesity: some hormones can be changed to estrogen by fat tissue. The higher the amount of fat tissue, the greater the effect on estrogen levels.
• Diet high in animal fat: these fatty foods are also high in calories, which can lead to obesity.
• Diabetes: this disease is often related to obesity, a risk factor for many cancers.
• Ovarian disease: people who have certain ovarian tumors have high estrogen levels and low progesterone levels, increasing uterine cancer risk.
• Long menstruation span: if your period started before age 12 or if menopause occurs after age 50, your uterus has been exposed to estrogen for a longer span of time. However, the number of years menstruating may be more important than your age when periods started and ended.
• Never been pregnant: people who have never been pregnant have an increased risk.
• Estrogen replacement therapy (ERT): receiving estrogen therapy without progesterone to help relieve menopause systems.

If your doctor suspects you have uterine cancer after a physical exam and a pelvic exam, they may order imaging and additional tests to confirm the diagnosis. This can also include a biopsy.

After you have received your diagnosis, a team of cancer care experts trained in treating gynecologic cancers will guide you through the treatment process. Your uterine cancer care team may include a gynecologist or gynecologic oncologist, a radiation oncologist, and a medical oncologist.

• A gynecologist specializes in treating the female reproductive tract, while a gynecologic oncologist specializes in treating cancers of the female reproductive tract—this can include treatment with surgery and chemotherapy.
• A radiation oncologist uses high-energy rays to treat
• A medical oncologist specializes in treating cancer with medicine, which can include chemotherapy, targeted drug therapy, or immunotherapy.

Your care team may also include other clinical professionals, such as oncology nurses, social workers, pharmacists, genetic counselors, and dietitians. These clinicians all work together to develop the treatment path that is right for you.

Treatment for uterine cancer is different for each patient. Your team will work with you to develop a plan tailored to your cancer and your goals for your health. When you meet with your cancer care team, you should ask any questions you feel will help you understand your situation and your options. You may want to write your questions down before your appointment and bring something to take notes with.

Here are a few questions that may help you gain a better understanding of your options:

• What is the stage of my uterine cancer? What does that mean for my treatment options?
• What are the risks and side effects of my treatment options? Are these side effects treatable?
• Is the goal of this treatment to eliminate my cancer, manage my symptoms, or both?
• Will this treatment affect my ability to become pregnant in the future?
• Could this treatment cause early menopause?
• How will this treatment affect my daily life and normal activities?
• If my cancer is eliminated, what is the chance of recurrence? If my cancer does return, what would our next steps be?

Uterine Cancer Staging

Once you have been diagnosed with uterine cancer, your physician will determine the stage of your cancer to help guide your treatment plan. To do this, your physician will look at the extent of the primary tumor, any spread to nearby lymph nodes, and whether the cancer has spread to other parts of the body.

Uterine cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) staging system. The stage of the cancer is determined by examining tissue removed by surgery.

Stage I

Uterine cancer in this stage is found in the uterus and has not spread to other parts of the body.

• Stage IA cancers are found in the endometrium, which is the inner lining of the They may have grown less than halfway through the myometrium, which is the underlying muscle layer of the uterus.
• Stage IB cancers have grown from the endometrium more than halfway into the

Stage II

In this stage, the cancer has spread to the tissues around the cervix, but not the other parts of the body.

Stage III

Stage III endometrial cancers have spread beyond the uterus but are still in the pelvic area.

• Stage IIIA cancers have spread to the outer surface of the uterus and/or the fallopian tubes or
• Stage IIIB cancers have spread to the vagina or the tissues around the
• Stage IIIC1 cancers are growing in the body of the uterus. The cancer may have spread into nearby tissues but is not in the bladder or the It is also in the pelvic lymph nodes, but not the lymph nodes around the aorta.
• Stage IIIC2 cancers are similar to stage IIIC1 but have spread into the lymph nodes around the

Stage IV

Cancers in stage IV have spread to the rectum, bladder, or distant organs.

• Stage IVA cancers have spread to the inner lining of the rectum or They may or may not have spread into the lymph nodes. They have not spread to distant sites.
• Stage IVB cancers have spread to the lymph nodes in the groin, the upper abdomen, and/or distant parts of the body.

Uterine Cancer Treatment

Your cancer care team at Southern Cancer Center will work with you to develop a treatment plan that best fits your cancer and overall needs. The treatment your physician recommends may depend on a variety of factors, including the stage of your cancer, any potential side effects, and your personal preferences. It’s important to speak to your physician about your needs, goals for your health and lifestyle, and any other concerns you may have about treatment.

Surgery

The main treatment for uterine cancer is surgery to remove the uterus and cervix, which is called a

hysterectomy. This can be done several ways:

• A simple or total abdominal hysterectomy removes the uterus through an incision made in the
• A vaginal hysterectomy removes the uterus through the vagina and may be an option for women who are not healthy enough for other surgery types.
• A radical hysterectomy removes the uterus, the tissues next to the uterus, and the upper part of the vagina next to the cervix. This is done when the cancer has spread to the cervix or the area around the cervix.

For some patients, additional surgeries are done along with a hysterectomy. This can include:

• Bilateral salpingo-oophorectomy: This surgery removes the ovaries and the fallopian This is a separate procedure from a hysterectomy but can be done at the same time.
• Removal of lymph nodes: Your surgeon may remove lymph nodes near the tumor to see if the cancer has spread to other parts of the body. This can be done at the same time as a

Radiation Therapy

Radiation therapy treats cancer by using high energy rays to target and eliminate cancer cells. To treat uterine cancer, radiation is usually used after surgery to target any remaining cancer cells. Sometimes, it can be given before surgery to help shrink the tumor. Patients who are not healthy enough for surgery may have radiation therapy as their main treatment for uterine cancer.

Two types of radiation therapy can be used to treat uterine cancer:

• External beam radiation therapy focuses beams of energy at the tumor from outside of the
• Internal radiation therapy, also called brachytherapy, places radioactive materials inside the body near the cancer.

Chemotherapy

Chemotherapy uses anti-cancer drugs that travel through the bloodstream to reach cancer cells wherever they are in the body. For uterine cancer, chemotherapy is often given when the cancer has spread to other parts of the body and surgery is not an option. For most patients, a combination of different drugs is used to treat the cancer. This treatment is given in cycles, with a period of treatment followed by a rest period.

Hormone Therapy

Hormone therapy uses hormones or hormone-blocking drugs to treat advanced stages of uterine cancer or cancer that has returned after another treatment. This treatment is usually given along with chemotherapy.

Immunotherapy

Immunotherapy uses medicine to boost your immune system so it can recognize and target cancer cells. For example, the immunotherapy drug pembrolizumab (Keytruda®) can be used to treat some advanced stage uterine cancers after other treatments or if surgery or radiation therapy are not good options.

It is important to feel confident in your diagnosis and the physician leading your treatment. The physicians at Southern Cancer Center provide second opinions for all types of cancer diagnoses and treatment plans. To schedule a second opinion, please call our office to make an appointment with one of our medical oncologists.