Uterine Cancer

UTERINE CANCER TREATMENT INFORMATION

How Does the Uterus Work?

The uterus is the sac in a woman's pelvis which allows the baby to develop from a fertilized egg and houses it until birth. In a woman of child-bearing age, the uterus undergoes substantial changes during every monthly cycle. The inner lining of the uterus, called the "endometrium," becomes thicker as the ovary is preparing to release an egg. This thickening is in preparation for receiving the egg and allowing a surface for the egg to couple with a man's sperm. If this fertilization takes place, the uterus' inner lining continues to become thicker to house the new embryo, and eventually to form a "placenta" (organ to transfer nourishment from the mother) for the developing fetus. When the baby is fully developed, the muscle layers of the uterus, called the "myometrium," help propel it out through the birth canal. The uterus is partially surrounded by a thin membrane, the "serosa," which completes the third "layer" after the endometrium and myometrium. The lowest portion of the uterus is called the "cervix" which connects to the vaginal opening.

Although the cervix is technically part of the uterus, cancers arising there, and in the vagina, are different and so are considered separate topics. The uterus has a rich blood supply from vessels which connect to ones in the ovaries, cervix and vagina. This makes a possible route of spread for infections or cancer to other pelvic organs. The uterus also has a rich network of "lymph glands," bean-sized filters which purify the blood and help destroy germs. The "lymph channels" which connect these glands provide another way that infections or cancer can spread within the pelvis, or even to distant areas of the body. The uterus' inner lining is built up by a "proliferation" (division and growth) of the endometrial cells which form it. The cells naturally form into gland-like patterns, making a rich spongy surface, full of blood vessels, for a fetus to grow in. If the egg is not fertilized, then the uterus' inner lining has been built up in vain. A change in hormone levels signals the uterus' lining to slough off, disposing the egg and lining through the vagina. This is called a woman's monthly period. Once last month's lining has been ejected, the hormones again change to repeat the buildup process and await the next possible fertilization. In most woman, this cycle continues from the age of the first period (menarche) to the last period (menopause) over about 4 decades. Most women have no trouble with the uterus, but some develop an abundance of scar-like tissue which can spread locally and cause pain, called "endometriosis." Ultimately, the uterus should shrink up after menopause, and bleeding from it should totally cease.

What is Uterus Cancer?

As you can see from the way the uterus' inner lining cycles between thickening and getting sloughed off, there are new cells forming in the uterus followed by cell death. It is a very dynamic system. Normally, the formation of new cells, from the division of previous ones, is a very tightly controlled process. In the fertile woman, this control is by the female hormones estrogen and progesterone. The cell surfaces have "receptors" that allow them to identify the hormones present, and respond accordingly. Uterine cancer starts in just one cell. A change occurs in this cell which causes it to lose control of it's division, and so it starts dividing in an uncontrolled manner. Eventually it will form a clump of abnormal cells, called a "tumor," which simply means a swelling. "Benign" tumors stay in their local area of origin, they are not cancer. A uterine "fibroid" is an example of a benign tumor, and endometriosis may be thought of as many benign tumors. In contrast, "malignant" tumors have the capacity to spread throughout the body, they are cancer. Most swellings in the uterus aren't malignant, but when they are, they will spread if untreated and eventually kill the patient.

How Common is Uterine Cancer?

Uterine cancer is the most common gynecological cancer in American women, with 35,000 new cases each year. It causes 3000 deaths each year. You can see that less than one woman in ten dies of their disease. This is because most cases of uterine cancer are caught early, when it is more curable. Women in other countries do less well than American women, since their disease is usually more advanced when diagnosed. In general, the death rate from uterus cancer in American women has been decreasing over the past 5 decades.

What Causes or Increases the Risk for Uterine Cancer?

As with any cancer, the exact reason why one woman gets uterine and another does not is unknown . However, there are well-recognized risk factors which increase a woman's chance of developing it. These have much in common with breast cancer risks, since both cells in the uterus and breast respond to hormone stimulation:

1) Obesity is linked to a 10 times greater risk of getting uterine cancer. Thus, other conditions associated with being too fat, such as diabetes and high-blood pressure are also linked to uterine cancer. The reason why obese woman get more uterine cancer is thought due to hormone changes caused by fat cells. Specifically, fat cells cause more estrogen to be produced, which builds up the uterine lining more than normal. The more this lining is built up, the more chance that one of the lining cells will become cancerous. In fact, anything that increases the amount of a woman's estrogen over time increases her risk for both breast and uterine cancer.
2) Older Age (after menopause) is a factor for developing uterine cancer. The average age of a uterus cancer patient is 60 years old. Only about 10% of patients are less than 40 years old.
3) Childless women are more likely to get uterine (and breast) cancer, since they have more "unopposed estrogen stimulation of the uterus." This means that a woman's uterine lining has a period of "rest" during pregnancy, estrogen levels are low and progesterone levels are high. Anything that stops the estrogen level from being high, even for a while, lowers the risk of uterine cancer.
4) Birth Control Pills containing only estrogen stimulate the uterine lining and thus increase the risk of cancer. That is why modern birth control pills are not pure estrogen (as they once were) but contain progesterone which allows the uterine lining a monthly "rest." Giving supplemental estrogen after menopause helps keep proper bone density and heart disease risk low, but slightly increases the risks to develop uterine and breast cancer.
5) Heredity-- Women who's mothers or maternal aunts have uterine or breast cancer are at increased risk. There are certain "family cancer syndromes" that raise the risk of uterine, breast, ovarian and colon cancer. Also, certain rare genetic diseases like "Stein-Leventhal" syndrome (cystic disease of the ovary) increase estrogen and thus the risk of uterine cancer.
6) Hyperplasia (thickening) of the uterine lining, especially when the cells look abnormal, can raise the chance of getting uterine cancer to 20%.
7) Radiation Exposure is a rare, but possible cause of uterine cancers, especially those arising from the muscular wall of the uterus ("sarcomas").

***Alcohol and Tobacco use do not increase the risk of uterine cancer.

What are the Symptoms of Uterine Cancer?

1) Bleeding out the vagina is the most common symptom of uterine cancer, and is very suspicious for cancer in a woman after her menopause. Uterine bleeding is seen in over 90% of patients and is why the disease is usually caught early.Of woman with new onset vaginal bleeding after menopause, 30% will have cancer, with the chance of it being uterine or cervical about equal. In women still having periods, abnormal spotting or changes in the cycle are seen. These abnormalities may be increased bleeding ("menorrhagia"), or at the wrong time ("metrorrhagia"). The bleeding may both be increased and at the wrong times ("menometrorrhagia"). There may also be a foul discharge suggestive of infection, or sloughed-off tumor. Infection may be the first indication of a cancer problem.
2) Abnormal Pap Smear may be seen in uterine cancer, and this usually suggests a more advanced uterine cancer. It is uncommon in the absence of bleeding. The Pap smear is about 80% accurate for detecting cervical cancer, but only about 40% accurate for picking up uterine cancer.
3) Advanced Disease Symptoms from a large tumor include pelvic pain, and change in bowel and bladder habits (since the uterus is sandwitched between the rectum and bladder in the female pelvis). Also seen are increasing abdominal girth, and swelling in the groin from spread to lymph glands, and signs of distant spread to bone, lung, liver and brain. This distant spread is rare unless the cancer is large.

How Does Uterine Cancer Spread?

The vast majority of uterine cancers start on the inner lining ("endometrium"). In fact, the disease is also called endometrial cancer. As the cancer grows, it penetrates into the muscular wall of the uterus. When it penetrates deeply, the cancer is said to show "deep myometrial invasion." At this point it becomes more likely to spread to the local lymph glands in the pelvis and groin. When these lymph glands are invaded by cancer, they enlarge. The cancer can further grow into the fallopian tubes, cervix and vagina, or into the bladder or rectum. Sometimes, it can escape through the outer lining ("serosa" ) of the uterus or out the fallopian tubes to "seed" into the abdomen, and grow multiple tumors upon it's inner membrane lining, called the "peritoneum." The larger the cancer is, the more chance it has to migrate locally and shed cells distantly, spreading to the pelvic organs, lymph glands, abdomen, bone, lung, liver and brain.

What are the Types of Uterine Cancer?

1) Adenocarcinoma is the most common type of uterine cancer, it arises from the glands of the endometrium. About 80% of uterine cancers are adenocarcinomas, and they have varying aggressiveness. The pathologist assigns a "grade" to this cancer, which basically says how cancerous it looks under the microscope. While "Grade I" looks a lot like normal uterine tissue and can be very indolent, "Grade III" looks very cancerous and will probably be aggressive. "Grade II" is intermediate in looks and behavior. About 40% of adenocarcinomas are "Grade I," 20% are "Grade II," and 40% are "Grade III." There may be a mixture of grades or even cancer types in the tumor.
2) Adenosquamous Carcinoma is about 10% and are a combination of 2 types of malignant cells, both the glandular ("adeno") and the cervical ("squamous") type. They need not involve the cervix, but tend to be more advanced at presentation and were once though less curable, but this is now disputed.
3) Papillary Serous Carcinoma is the worst type since it is very aggressive and tends to come back even when caught early. It represents 5% of uterine cancers.
4) Clear Cell Carcinoma is an aggressive cancer accounting for about 2% of uterine cancers. It is associated with a woman's mother having used a hormone called DES while pregnant, and is getting less common with DES no longer used.
5) Sarcomas of the uterus arise from its muscle wall.There are many subtypes and they tend to spread through the bloodstream to the lungs. They can contain muscle, cartilage and bone, and their treatment is different from the above types.

How is the Extent of Uterine Cancer Gauged?

Like all cancers, the extent of uterine cancer is given by the "Stage." The system used most commonly is called the"FIGO" staging, it goes like this:

"Stage I" means the cancer is limited to the uterus proper.
"IA" means just the inner lining (endometrium) is involved.
"IB" means less than 1/2 of the muscular wall is invaded
"IC" means more than 1/2 the muscular wall is invaded.

"Stage II" means there is extension to the cervix.
"IIA" means just the cervix's glands are involved
"IIB" means the cervix's muscle is involved.

"Stage III" means the disease is more advanced but still in the pelvis.
"IIIA" means the cancer has spread toward the ovaries or cancer
cells (microscopic) have escaped into the abdomen.
"IIIB" means the cancer has spread down into the vagina
"IIIC" means the lymph glands are involved.

"Stage IV" means extension to the bowel or bladder, or distant spread.
"IVA" means bowel or bladder invasion by the cancer
"IVB" means the cancer has spread to distant sites in the body (i.e. lung, liver, bone or brain).

(Note: This staging is based upon the results seen at surgery by the pathologist).

Uterine, or "endometrial" cancer is very common in the U.S.A., and great strides have been made in curing this disease. While historic treatment used surgery only, newer approaches combine therapies to increase the length of survival and chance of cure.

It is crucial to be knowledgable in choosing the right therapy for cancer of the uterus. Proper treatment choices can literally make the difference between life and death. It is important to have the peace-of-mind of knowing you have done everything possible to fight this cancer successfully.

If you're looking for cancer information, consult your physician. He or she can give you reliable medical advice on how to best treat your cancer. From women's cancers like uterine and breast cancer to cancers that affect all people, ask your doctor if you suspect you might be affected.

CancerAnswers's materials explain, in plain English, the definition, types, frequency, risk factors, evaluation, historic and latest effective treatment for uterine cancer. We tell you everything you need to know to help you make the right choices today for a uterine cancer problem.

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