Frequently Asked Questions About Uterine Cancer
Here are some answers to frequently asked questions about uterine cancer.
Q: What is the uterus?
A: The uterus is a hollow, pear-shaped organ. It is located in a woman’s pelvis between the bladder and rectum. Fallopian tubes on both sides connect it to each ovary. The bottom part of the uterus is called the cervix. The cervix connects the uterus with the vagina. The middle round part of the uterus is called the corpus. The round part at the top of the uterus is called the fundus. The uterus holds a developing fetus during pregnancy.
The walls of the uterus are made up of 3 layers.
- The inner layer is called the endometrium.
- The middle layer is called the myometrium.
- The outer layer is called the serosa. The serosa covers only the upper part of the uterus.
Q: What causes uterine cancer?
A: All the causes of uterine cancer are not known. In general, it is believed that 2 types of endometrial cancer exist. The most common type is related to prolonged exposure to estrogen. Estrogen exposure can occur due to taking medications (estrogen replacement therapy without progesterone), or due to production of estrogen by your own body. Patients who are heavy tend to produce more estrogen. That’s because fat cells convert hormones produced by the adrenal glands into estrogen. So heavier patients are at increased risk for developing this type of endometrial cancer. The other type of endometrial cancer, called type 2, does not appear to be related to hormones and is seen more commonly in older women.
Q: What are the types of uterine cancer?
A: The uterus is composed of a muscular wall and a lining surface. Any of the tissues that make up the uterus can turn into a cancer. They are named based on where they occur in the uterus.
Endometrial carcinoma. This is the most common form of uterine cancer. Cancer that grows in tissues that form linings throughout the body is called carcinoma. Endometrial carcinoma is cancer that forms in the lining of the uterus.
The lining is called the endometrium. It’s the tissue that thickens every month so it will be ready to receive a fertilized egg. If the egg is not fertilized, it passes through the uterus and the endometrium sheds through the vagina. This is menstruation.
Uterine sarcoma. This is a much less common form of uterine cancer. It may arise from the uterine muscle (myometrium). It may also arise from the support tissue (stroma) within the uterus.
Q: What are the symptoms of uterine cancer?
A: These are the most common symptoms of uterine cancer:
- Unusual bleeding or discharge from the vagina
- Any bleeding from the vagina after menopause
- Pain when urinating or when having a bowel movement
- Pain during sexual intercourse
- Pain in the pelvic area or lower abdomen
In addition to uterine cancer several other health problems can cause these symptoms. So if you notice any of them, talk with your doctor right away.
Q: What are the risk factors for uterine cancer?
A: Certain factors can make you more likely to get uterine cancer. These are called risk factors. Having one or more risk factors does not mean you will get uterine cancer. In fact, you can have all the risk factors and not get the disease. Or you can have no risk factors and still get it. Here are the main risk factors for uterine cancer. Many of these risk factors are for endometrial carcinoma.
These risks involve having too much exposure to the hormone estrogen:
- Tamoxifen. Tamoxifen is a drug used to prevent or treat breast cancer. Women who take tamoxifen may have a higher risk of uterine cancer.
- Estrogen replacement therapy. Women who use estrogen replacement therapy without progesterone replacement have a higher chance of getting uterine cancer.
- Endometrial hyperplasia. Endometrial hyperplasia means there are more cells than there should be in the lining of the uterus. This is a precancerous condition that might turn into cancer. Women who have this condition have a higher risk of uterine cancer. The risk is even stringer if the cells have an abnormal appearance (atypia). Women with endometrial hyperplasia may have unusual bleeding.
- Obesity. Women who are 50 or more pounds overweight get uterine cancer more often than women who are not obese. Health conditions linked to obesity, such as diabetes, also increase your risk.
- Early menstruation. Women who had their first period before they were 12 have a higher risk for uterine cancer.
- Late menopause. Women who reach menopause after age 50 have a higher risk for uterine cancer.
- Older age. Most women who get uterine cancer are older than age 50.
- Family history of uterine cancer. Women with family members who have had uterine cancer are more likely to get it.
- Race. Women who are white have a higher chance of getting uterine cancer than nonwhite women.
- No pregnancies. Women who have never been pregnant have a higher chance of uterine cancer.
- Other cancers. Women who have had colon, rectal, or breast cancer have a higher chance of getting uterine cancer.
Q: Why does obesity increase the risk for uterine cancer?
A: When you’re obese, you have more fatty tissue in your body. Fatty tissue creates more estrogen. That’s because it can convert normal adrenal gland hormones into estrogen. The more estrogen your uterus is exposed to, especially in the absence of progesterone, the greater your risk is of developing endometrial carcinoma.
Q: How can I reduce my risk for uterine cancer?
A: You can reduce your risk by avoiding as many risk factors as possible. For example, eating well and exercising regularly may help you keep your weight at a healthy level. Many other steps also lower your risk. For example, if you use estrogen replacement therapy, check with your doctor to be sure you’re combining it with progesterone. If you’re not planning to have children, consider using birth control medication to limit your body’s creation of estrogen. Talk with your healthcare team about other steps you can take to lower your risk.
Q: What screening tests are available for uterine cancer?
A: There is no standard screening test to find uterine cancer. A Pap smear, a test routinely used to find cervical cancer, is not very useful in finding uterine cancer. If you’re at high risk for endometrial carcinoma, talk with your doctor about screening.
Q: How is a diagnosis of uterine cancer made?
A: The symptoms linked to uterine cancer can be caused by less serious problems. To find out the cause of any of these symptoms, the doctor asks you about your health history. The doctor also asks about your family medical history. He or she does a careful physical exam. This includes a pelvic exam and Pap test. This test does not show if you have uterine cancer. That’s because it checks cells in the cervix, not the uterus. But it can help make sure you don’t have another problem with similar symptoms.
The doctor may order a biopsy to help make a diagnosis. During a biopsy, the doctor removes some tissue from the inner uterine lining, called the endometrium. This can usually be done in the doctor’s office with no or little anesthetic. Another type of biopsy is dilation and curettage (D&C). This involves scraping tissue from different parts of the lining of the uterus. A D&C is usually done in a surgery center or hospital.
Q: If I have uterine cancer, will I need a hysterectomy?
A: Surgery to take out the uterus is called a hysterectomy. It is the main way to treat most types of uterine cancer. Sometimes, a hysterectomy can get rid of all the cancer in your body. When it does, it provides a cure. This frequently is the case with early stages of endometrial carcinoma. Your surgeon may also take out your fallopian tubes and ovaries. This will stop the production of estrogen. This is done because the cancer could spread to these areas. In addition, the surgeon may consider the removal of lymph nodes from the pelvis and abdomen. Based on the results from surgery, you doctor may recommend additional treatments. These include radiation, hormone therapy, or chemotherapy.
Q: What is staging of uterine cancer?
A: Staging is a way to describe how large the cancer is. It also describes how far the cancer has spread. Finding the stage helps your doctor decide on the best treatment for you. For uterine cancer, these are the 4 stages:
- Stage I. Stage I uterine cancer is only in the uterus. It is not in the cervix.
- Stage II. Stage II cancer means that there are also cancer cells in the cervix.
- Stage III. Stage III cancer has spread outside of the uterus. It may have spread to the ovaries, tubes, or surface of the uterus (serosa). Or cancer cells may be detected in abdominal fluid. Involvement of lymph nodes is also classified as stage III.
- Stage IV. This means that the cancer has spread to other parts of the body. It may have spread to the abdominal cavity, lungs, or liver.
Q: What are the treatments for uterine cancer?
A: Treatments for uterine cancer include surgery, radiation therapy, hormone therapy, and chemotherapy.
Surgery is the most common treatment for uterine cancer. Often, it is the only treatment needed. A standard surgery for endometrial cancer is the removal of the uterus. This is called a hysterectomy. It’s also standard to remove the attached ovaries and fallopian tubes. In many cases, your doctor will recommend removal of lymph nodes from the abdomen and pelvis. The purpose for removing the nodes is to see if the cancer has spread. The complete surgery of hysterectomy with lymph node removal is called surgical staging. Surgical staging can be done through an incision on your abdomen. This is called a laparotomy or open procedure. It can also be done by laparoscopy. This is a minimally invasive surgery that uses cameras to help with the surgery. Your doctor will discuss which approach is best and why.
Radiation uses high-energy beams directed to an area in the body to kill cancer cells. For endometrial cancer the beams are directed at the pelvis. Radiation is most frequently used after surgery. In some cases, though, it is used before surgery. There are rare patients who have severe medical problems and cannot tolerate surgery safely. In those cases, radiation may be used in place of surgery. Sometimes, certain factors in the uterus or lymph nodes suggest the there is a strong chance cancer will return (recur) if only surgery is used. In those cases, radiation is an option after surgery. Radiation may be given by placing a device into the vagina. The device delivers radiation to the tissues. This treatment is called internal radiation. It may also be given by using a machine to focus the radiation beam into an area of the body. This is called external radiation.
Chemotherapy uses anticancer drugs typically administered by vein to kill cancer cells. It is a systemic therapy. That means it that travels from head to toe and works throughout the body. Radiation only works on the area where the radiation is given. Chemotherapy may be given to patients whose cancer has spread when they are diagnosed. It may also be used to treat a cancer that comes back, or recurs. Hormone therapy is a type of drug therapy. It frequently uses a class of hormones called progestins. The drugs are given by mouth or by injection. They travel through the body in the blood. The drugs work on special targets on cancer cells called hormone receptors. Hormone therapy is used to treat widespread disease. It’s also used for cancers that return (recur).
Q: Should everyone get a second opinion for a diagnosis of uterine cancer?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. Here are some of those reasons:
- Your treatment plan was not developed with the help of a cancer specialist. Cancer specialists include gynecologic oncologist, medical oncologist, and radiation oncologist.
- You don’t feel comfortable with the treatment decision.
- The type of cancer is rare, such as with uterine sarcoma.
- There are different ways to treat the cancer.
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:
- Ask a primary doctor. Your doctor may be able to recommend a specialist. This may be a gynecological oncologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Do not be afraid to ask your doctor about a second opinion.
- Call the National Cancer Institute’s Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
- Consult the Official ABMS Directory of Board Certified Medical Specialists. This reference book from the American Board of Medical Specialists lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries. You can also view it online at www.abms.org.
- Seek other options. Check with a local medical society, a nearby hospital or medical school, or a local cancer advocacy group. Ask for names of doctors who can give you a second opinion. Or ask other people who have had cancer to refer you to someone.
Q: What are the side effects of treatment?
A: Surgery causes temporary pain in the area of the operation. It can, though, be controlled with medicine. You’re likely to be uncomfortable during the first few days after surgery. Be sure to discuss pain relief with the doctor or nurse. You may also feel tired or weak for a while after surgery. You may have bleeding, cramps, or watery vaginal discharge for up to 6 weeks after surgery. You may have pain in your lower abdomen and trouble emptying your bladder. You may have trouble with bowel movements. All these problems are usually temporary. Your sexuality is also affected by surgery. This is especially the case after a hysterectomy. If you are of childbearing age, you may grieve because you can no longer have children. You may also have symptoms similar to going through menopause. Often, it helps to discuss these issues before surgery with your partner and your doctors.
Radiation affects both cancer cells and normal cells. Side effects of radiation depend on what part of the body is treated. Common side effects of radiation therapy are fatigue, skin changes, loss of appetite, nausea, and diarrhea. Sometimes, you might find that your vagina is narrower and less flexible. Sexual intercourse may be difficult. That’s because the skin in the treated area can be sensitive during treatment. Some of these effects will subside after treatment. Others may be permanent.
Chemotherapy affects both cancer cells and normal cells. The side effects you may notice depend on the particular drug(s) used. Common side effects of chemotherapy are:
- nausea and vomiting
- hair loss
- mouth sores
- diarrhea
- fatigue
Other serious side effects that may occur are infection and bleeding. Your doctor will work with you to control side effects.
Hormone therapy may cause side effects as well. You may feel tired. You may also be more or less hungry than usual.
Q: What kind of checkups will I need after being treated for uterine cancer?
A: After treatment for uterine cancer, you’ll most likely visit the doctor every 3 months for the first 1-2 years. Then you may need checkups every 6 months for the next 5 years. After that, you may need yearly checkups. At each office visit, your doctor will ask questions about symptoms that may suggest that the cancer is returning (recurring). These questions include:
- Do you have any pain?
- Has there been any leg swelling?
- Have you had any vaginal bleeding?
Be sure to mention any other changes you notice in your health. At each visit an examination will be performed. This may include:
- pelvic exam
- Pap tests
- other tests, such as blood and urine tests
You may also need imaging studies such as CT scans, ultrasounds, and X-rays.
Q: Are there support groups for women with uterine cancer?
A: Yes. Support groups are held all over the United States. Having someone to talk with who is going through similar experiences is often helpful. Support groups also offer you information on treatment options, prognosis, and follow-up care. Your doctor can recommend one in your area.
Q. What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. People who join trials also help researchers learn more about cancer. Also, by joining, they help future people with cancer. Doctors use clinical trials to learn how well new treatments work. They also learn what the side effects are. Promising treatments are ones that work better or have fewer side effects than current treatments. In some cases, clinical trials provide patients with access to new treatments that they would not be able to get otherwise. Not all patients are eligible for a clinical trial. Ask your doctor if a clinical trial is right for you.
