Uterine cancer, also known as womb cancer, includes two types of
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
that develop from the tissues of the
uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
.
Endometrial cancer forms from the
lining of the uterus, and
uterine sarcoma
The uterine sarcomas form a group of malignant tumors that arises from the smooth muscle or connective tissue of the uterus.
Signs and symptoms
Clinically, uterine sarcomas and leiomyomas (fibroids) both have similar symptoms such as increased u ...
forms from the muscles or support tissue of the uterus.
Endometrial cancer accounts for approximately 90% of all uterine cancers in the United States.
Symptoms of endometrial cancer include changes in
vaginal bleeding
Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductiv ...
or pain in the
pelvis.
[ Symptoms of uterine sarcoma include unusual vaginal bleeding or a mass in the ]vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
.[
Risk factors for endometrial cancer include ]obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
, metabolic syndrome, type 2 diabetes
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
, taking pills that contain estrogen without progesterone, a history of tamoxifen
Tamoxifen, sold under the brand name Nolvadex among others, is a selective estrogen receptor modulator used to prevent breast cancer in women and treat breast cancer in women and men. It is also being studied for other types of cancer. It has b ...
use, late menopause
Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often ...
, and a family history of the condition.[ Risk factors for uterine sarcoma include prior ]radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radi ...
to the pelvis.[ Diagnosis of endometrial cancer is typically based on an ]endometrial biopsy
The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.
Medical uses
There are a ...
.[ A diagnosis of uterine sarcoma may be suspected based on symptoms, a ]pelvic exam
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, d ...
, and medical imaging.[
Endometrial cancer can often be cured while uterine sarcoma typically is harder to treat.][ Treatment may include a combination of surgery, ]radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radi ...
, chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...
, hormone therapy, and targeted therapy
Targeted therapy or molecularly targeted therapy is one of the major modalities of medical treatment ( pharmacotherapy) for cancer, others being hormonal therapy and cytotoxic chemotherapy. As a form of molecular medicine, targeted therapy blocks ...
.[ Just over 80% of women survive more than 5 years following diagnosis.][
In 2015 about 3.8 million women were affected globally and it resulted in 90,000 deaths.] Endometrial cancer is relatively common while uterine sarcomas are rare.[ In the United States, uterine cancers represent 3.5% of new cancer cases.] They most commonly occur in women between the ages of 45 and 74 with a median age of diagnosis of 63.[
]
Types
The terms uterine cancer and womb cancer may refer to several different types of cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
that occur in the uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
, namely:
Endometrial cancer
* ''Endometrial carcinomas'' originate from cells in the glands of the endometrium (uterine lining). These include the common and readily treatable ''well-differentiated endometrioid adenocarcinoma,'' as well as the more aggressive '' uterine papillary serous carcinoma'' and ''uterine clear-cell carcinoma
Uterine clear-cell carcinoma (CC) is a rare form of endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate. Like uterine papillary serous carcinoma CC does not develop from endometrial ...
''.
* '' Malignant mixed Müllerian tumors'' (also known as uterine carcinosarcomas) are rare endometrial tumors which show both glandular ( carcinomatous) and stromal (sarcoma
A sarcoma is a malignant tumor, a type of cancer that arises from transformed cells of mesenchymal ( connective tissue) origin. Connective tissue is a broad term that includes bone, cartilage, fat, vascular, or hematopoietic tissues, and sar ...
tous) differentiation.
Uterine sarcoma
The uterine sarcomas form a group of malignant tumors that arises from the smooth muscle or connective tissue of the uterus.
Signs and symptoms
Clinically, uterine sarcomas and leiomyomas (fibroids) both have similar symptoms such as increased u ...
s
* ''Leiomyosarcomas'' originate from the muscular layer of the uterus (or myometrium
The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes) but also of supporting stromal and vascular tissue. Its main function is to induce uterine contractions.
Struc ...
). Of note, leiomyosarcomas are distinct from uterine leiomyomas, which are benign tumors of the uterus.
*''Endometrial stromal sarcoma
Endometrial stromal sarcoma is a malignant subtype of endometrial stromal tumor arising from the stroma (connective tissue) of the endometrium rather than the glands. There are three grades for endometrial stromal tumors, as follows. It was pre ...
s'' originate from the connective tissues of the endometrium, and are far less common than endometrial carcinomas.
Signs and symptoms
Both types of uterine cancer can present with abnormal vaginal bleeding and discharge. Abnormalities can include change in duration or amount of menstrual bleeding as well as new bleeding between menses
Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of horm ...
or after menopause. Sensations of new or increasing pelvic pressure or pain can also indicate tumor growth in the uterus. Any of these findings warrant further workup by a doctor.
Causes and risk factors
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.
Risk factors for endometrial cancer include obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
, metabolic syndrome, type 2 diabetes
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
, taking pills that contain estrogen without progesterone, a history of tamoxifen
Tamoxifen, sold under the brand name Nolvadex among others, is a selective estrogen receptor modulator used to prevent breast cancer in women and treat breast cancer in women and men. It is also being studied for other types of cancer. It has b ...
use, late menopause, and certain hereditary conditions (Lynch syndrome
Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is an autosomal dominant genetic condition that is associated with a high risk of colon cancer as well as other cancers including endometrial cancer (second most common), ovary, ...
, Cowden syndrome). Risk factors for uterine sarcoma include prior radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radi ...
to the pelvis, a history of tamoxifen use, a history of childhood retinoblastoma
Retinoblastoma (Rb) is a rare form of cancer that rapidly develops from the immature cells of a retina, the light-detecting tissue of the eye. It is the most common primary malignant intraocular cancer in children, and it is almost exclusively fo ...
, and hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome.
Diagnosis
To evaluate for uterine cancer, a clinician might perform a pelvic exam
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, d ...
to visually inspect internal pelvic organs and to feel the size and position of the uterus and ovaries. A “pap smear
The Papanicolaou test (abbreviated as Pap test, also known as Pap smear (AE), cervical smear (BE), cervical screening (BE), or smear test (BE)) is a method of cervical screening used to detect potentially precancerous and cancerous processes in t ...
” 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
Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecologic ...
is often done to collect a sample of uterine lining tissue. An ultrasound
Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
is also often performed to look for tumors.
Screening and Prevention
Screening for uterine cancers is not recommended except for in women with certain hereditary conditions that increase their risk (Lynch, Cowden, HLRCC).
In general, combined oral contraceptive pill
The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. The pill contains two important hormones: proges ...
s and progestin-only pills are protective against uterine cancers. Weight loss and/or bariatric surgery reduces the risk for patients with obesity.
Treatment
Treatment of uterine cancer may differ depending on the type of cancer and staging of the tumor. In early stages, minimal invasive surgery is preferred.
For endometrial cancer, five main types of treatments are used, including surgery, radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radi ...
, chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...
, hormone therapy, and targeted therapy. The most common treatment modality for endometrial cancer is surgery, whereby the uterus is removed via a total hysterectomy. Hysterectomies may also be accompanied by removal of ovaries and fallopian tubes, called a salpingo-oophorectomy
In medicine, salpingo-oophorectomy is the removal of an ovary and its Fallopian tube. This procedure is most frequently associated with prophylactic surgery in response to the discovery of a BRCA mutation, particularly those of the normally tumo ...
. 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
mTOR inhibitors are a class of drugs that inhibit the mechanistic target of rapamycin (mTOR), which is a serine/threonine-specific protein kinase that belongs to the family of phosphatidylinositol-3 kinase (PI3K) related kinases (PIKKs). mTOR re ...
, and signal transduction inhibitors which all act to target cancer cells specifically.
As of 2021, treatment options for uterine sarcoma include surgery, radiation therapy, chemotherapy, and hormone therapy.
Prognosis
Prognosis varies for the different types of endometrial cancer. Factors that influence prognosis across types of uterine cancer are age at diagnosis, the stage
Stage or stages may refer to:
Acting
* Stage (theatre), a space for the performance of theatrical productions
* Theatre, a branch of the performing arts, often referred to as "the stage"
* ''The Stage'', a weekly British theatre newspaper
* Sta ...
of the cancer, the grade
Grade most commonly refers to:
* Grade (education), a measurement of a student's performance
* Grade, the number of the year a student has reached in a given educational stage
* Grade (slope), the steepness of a slope
Grade or grading may also ref ...
of the cancer, histology
Histology,
also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vi ...
, depth of invasion
An invasion is a Offensive (military), military offensive in which large numbers of combatants of one geopolitics, geopolitical Legal entity, entity aggressively enter territory (country subdivision), territory owned by another such entity, gen ...
into the myometrium, and the presence of spread to nearby lymph nodes or other regions. Endometrial cancer typically has a good 5-year-survival when diagnosed early. Generally, the prognosis is poorer for uterine sarcomas as compared to endometrial cancers.
Epidemiology
Uterine cancer effects approximately 3.1% of females during their lifetime.[ Uterine cancer resulted in 45,000 deaths worldwide in 1990, with this number increasing to 58,000 deaths in 2010.] 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. 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.[
]
United Kingdom
Uterine cancer is the fourth most common cancer in females in the UK (around 8,500 women were diagnosed with the disease in 2011), and it is the tenth most common cause of cancer death in females (around 2,000 women died in 2012).
United States
Uterine cancer has a high prevalence in the United States, with approximately 772,247 women with the disease in 2016. Of those uterine cancers, approximately 90% of the cases are endometrial cancers. This is the fourth most commonly diagnosed type of cancer.
In the United States, uterine cancer is the most common invasive gynecologic cancer. The number of women diagnosed with uterine cancer has been steadily increasing, with 35,040 diagnosed in 1999 and 56,808 diagnosed in 2016. The age-adjusted rate of new cases in 1999 was 23.9 per 100,000 and has increased to 27.3 per 100,000 in 2016. The incidence of uterine cancer increased even more in 2019, with an approximated 61,880 new cases.
The rates of incidence and death for uterine cancer differ depending on race. The rate of diagnosis is highest for white females, with 28.1 new cases per 100,000 persons. Black females have a similar incidence with 27.4 new cases per 100,000 persons. Other ethnic groups had lower incidences: Hispanic females had 24.1 new cases per 100,000 persons, Asian/Pacific Islander females had 20.8 new cases per 100,000 persons, and American Indian/Alaska Native females had 19.7 new cases per 100,000 persons. For the death rates of uterine cancer, black females had the highest rates, 8.5 deaths per 100,000 persons. The death rates for the other ethnic groups were dramatically lower. White females had 4.4 deaths per 100,000 persons, Hispanic females had 3.9 deaths per 100,000 persons, American Indian/Alaska Native females had 3.5 deaths per 100,000 persons, and Asian/Pacific Islander females had 3.1 deaths per 100,000 persons.
Research
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
Infrared (IR), sometimes called infrared light, is electromagnetic radiation (EMR) with wavelengths longer than those of visible light. It is therefore invisible to the human eye. IR is generally understood to encompass wavelengths from arou ...
on simple blood test samples detected uterine cancer with high accuracy (87%), and could detect precancerous growths in all cases.
References
External links
Clinically reviewed uterine cancer information for patients
UK uterine cancer statistics
Foundation for Women's Caner
{{DEFAULTSORT:Uterine Cancer
Gynaecological cancer
Uterine tumour
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