Cancer of the Uterus

Cancer of the uterus is the most common cancer of the female reproductive tract.

The Uterus

The uterus is a hollow, pear-shaped organ. It is located in a woman's lower abdomen between the bladder and the rectum. Attached to either side of the top of the uterus are the fallopian tubes, which extend from the uterus to the ovaries.
The narrow, lower portion of the uterus is the cervix; the broad, middle part is the corpus; and the dome-shaped upper portion is the fundus. The walls of the uterus are made of two layers of tissue: the inner layer or lining (endometrium) and the outer layer or muscle (myometrium).

In women of childbearing age, the lining of the uterus grows and thickens each month so that it will be ready if pregnancy occurs. If a woman does not become pregnant, the thickened tissue and blood flow out of the body through the vagina; this flow is called menstruation.

What Is Cancer?

Cancer is a group of many different diseases that have some important things in common. They all affect cells, the body's basic unit of life. To understand cancer, it is helpful to know about normal cells and about what happens when cells become cancerous.
The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. A mass of extra tissue forms, and this mass is called a growth or tumor. Tumors can be benign or malignant.

• Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. Fibroid are common benign tumors of the uterine muscle. These tumors do not develop into cancer. Fibroids are found mainly in women in their forties. Women may have many fibroid tumors at the same time. In most cases, fibroids cause no symptoms and require no treatment, although they should be checked by a doctor. Depending on the size and location of the tumors, however, symptoms sometimes occur. These symptoms may include irregular bleeding, vaginal discharge, and frequent urination. When fibroids cause heavy bleeding or press against nearby organs and cause pain, surgery or other treatment may be recommended. When a woman reaches menopause, fibroids are likely to become smaller, and sometimes disappear. Endometriosis is another benign condition that affects the uterus. It does not develop into cancer. Endometriosis is seen mostly in women in their thirties and forties, particularly in women who have never been pregnant. It occurs when endometrial tissue begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility (ability to produce children). Treatment options generally include hormone therapy and surgery. Endometrial hyperplasia, also a benign condition, is an increase in the number of cells lining the uterus. Although it is not cancer, endometrial hyperplasia is considered a precancerous condition; in some cases, it may develop into cancer. Heavy menstrual periods, bleeding between periods, and bleeding after menopause are common symptoms of hyperplasia. The treatment is usually hysterectomy or hormone therapy with progesterone, depending on the extent of the condition and whether a woman wants to have children.
• Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

Most cancers are named for the part of the body in which they begin. The most common type of cancer of the uterus begins in the endometrium. This type of cancer is called endometrial or uterine cancer. In this booklet, we will use the term uterine cancer to refer to cancer that begins in the endometrium. A different type of cancer, uterine sarcoma, develops in the uterine muscle. Cancer that begins in the cervix is also a different type of cancer. This booklet does not deal with uterine sarcoma or cancer of the cervix. As uterine cancer grows, it may invade nearby organs. Uterine cancer cells also may break away from the tumor and spread to other parts of the body, such as the lungs, liver, and bones. When cancer spreads to another part of the body, the new cancer has the same kind of abnormal cells and the same name as the original (primary) cancer. For example, if uterine cancer spreads to the lungs, the cancer cells in the new tumor are uterine cancer cells. Cancer that has spread from the uterus to other parts of the body is called metastatic uterine cancer; it is not lung cancer.

Symptoms

Abnormal vaginal bleeding, especially after menopause, is the most common symptom of uterine cancer. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. Although uterine cancer usually occurs after menopause, it sometimes occurs around the time that menopause begins. Abnormal bleeding should not be considered simply part of menopause; it should always be checked by a doctor.

A woman should see a doctor if she has any of the following symptoms:

• Unusual vaginal bleeding or discharge
• Difficult or painful urination
• Pain during intercourse
• Pain in the pelvic area

These symptoms can be caused by cancer or other less serious conditions. Most often, they are not cancer, but only a doctor can tell for sure.

Diagnosis

If a woman has symptoms, her doctor asks about her medical history and conducts a physical exam. In addition to checking general signs of health, the doctor usually performs blood and urine tests and one or more of the following procedures:

• The doctor performs a pelvis exam, checking the vagina, uterus, ovaries, bladder, and rectum. The doctor feels these organs for any lumps or changes in their shape or size. An instrument called a speculum is used to widen the vagina so the doctor can see the upper portion of the vagina and the cervix.
• The Pap test is often performed during a pelvic exam. The doctor uses a wooden scraper (spatula) or small brush to collect a sample of cells from the cervix and upper vagina. The cells are then sent to a medical laboratory to be checked for abnormal changes. Because uterine cancer begins inside the uterus, it may not show up on a Pap test, which examines cells from the cervix.
• A biopsy is necessary to help the doctor make a diagnosis. A biopsy can usually be done in the doctor's office. In a biopsy, the doctor removes a sample of tissue from the uterine lining. In some cases, a woman may require a dilation and curettage (D&C), which is usually same-day surgery done in a hospital with anesthesia. During a D&C, the opening of the cervix is widened and the doctor scrapes tissue from the lining of the uterus. A pathologist examines the tissue to check for cancer cells, hyperplasia, or other conditions. After a D&C, women may have cramps and vaginal bleeding during healing.

A woman who needs a biopsy may want to ask the doctor some of the following questions:

• What type of biopsy will I have? Why?
• How long will it take? Will I be awake? Will it hurt?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

Staging

Once uterine cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease in order to plan the best treatment. Staging procedures help the doctor find out whether the cancer has spread and, if so, what parts of the body are affected. For most women, staging procedures include blood and urine tests and chest x-ray. Doctors may also order a CT scan, MRI, sigmoidoscopy, colonoscopy, ultrasonography, or other x-rays.

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