Uterine Cancer (Endometrial Cancer)

While the exact cause of uterine cancer is unknown, researchers have linked it to several risk factors.

Uterine cancer risk factors include:

• Starting menstruation early (before age 12) or beginning menopause late (after age 52)
• Never getting pregnant
• Age
• Obesity
• Undergoing hormone therapy for breast cancer
• Having an inherited colon cancer syndrome called hereditary nonpolyposis colorectal cancer (HNPCC)
• Having taken estrogen without progesterone for menopausal hormone therapy

Keep in mind, having one or more risk factor does not mean you will definitely get uterine cancer, and having no risk factors does not mean you won't get it.

Although a great deal of research has been conducted to develop a screening test for uterine cancer, there has been limited success. This makes it especially important to recognize warning signs and risk factors, and learn what you can do to reduce your risk. It's also important to regularly have a well-woman exam, which can help identify uterine cancer and other gynecological conditions.

The symptoms of uterine cancer may cause one or more of the following conditions:

• Bleeding heavier than usual during your period
• Spotting between periods
• Bleeding after menopause
• Pelvic pain
• An abnormal, watery or blood-tinged vaginal discharge
• Pain during intercourse
• Pain during urination or blood in urine

Keep in mind that these symptoms can also indicate conditions other than uterine cancer. If you are experiencing any of these symptoms, contact your doctor as soon as possible so that the cause can be diagnosed and treated promptly.

If you are experiencing symptoms of uterine cancer, your doctor will first ask you some questions and do a pelvic exam to look for any changes in the uterus, vagina, ovaries, fallopian tubes, bladder or rectum.

If your doctor suspects uterine cancer, he or she may recommend one of the following tests:

• Transvaginal ultrasound – uses an ultrasound wand that is inserted into the vagina and aimed at the uterus to visualize the endometrium (the inner lining of the uterus). If it appears unusually thick or if other signs of a tumor are present, your doctor may recommend a biopsy.
• Biopsy – a thin, flexible tube is inserted into the uterus through the cervix in order to remove a small amount of endometrium (the inner lining of the uterus) so a pathologist can examine the cells for cancer
• Hysteroscopy – involves a tiny telescope that your doctor inserts into the uterus through the cervix. The uterus is then filled with saltwater (saline). This lets your doctor see and biopsy anything that appears abnormal.
• Imaging tests – computed tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan may be used to help visualize the growth to determine if it cancerous.

At Houston Methodist, we are dedicated to providing leading-edge diagnosis and treatment options for uterine cancer. Depending on the type and stage of the cancer, your care team may use one or more of the following uterine cancer treatment options:

Surgery for Uterine Cancer

Surgery is the primary treatment for most uterine cancers. The types of surgical procedures used include:

• Simple hysterectomy – also called total hysterectomy, involves removal of the whole uterus, including the cervix, but leaves intact the loose connective tissue around the uterus (parametrium), the tissue connecting the uterus and sacrum (uterosacral ligaments) and the vagina. The uterus can be removed through the vagina or through a small incision in the abdomen.
• Bilateral salpingo-oophorectomy – often done at the same time as a hysterectomy, involves removal of both fallopian tubes and both ovaries.
• Lymph-node dissection – often done at the same time as a hysterectomy, removes the lymph nodes in the pelvis and around the aorta (the main artery that runs from the heart down into the abdomen).
• Radical hysterectomy – removes the entire uterus in addition to the parametrium and uterosacral ligaments, as well as the upper part of the vagina. This procedure is rarely performed to treat uterine cancer and is usually done if cancerous cells have also been found in the cervix.

Many of the surgical procedures used to remove uterine cancer can be performed through minimally invasive techniques, including laparoscopy and robotic surgery.

Radiation Therapy for Uterine Cancer

Radiation therapy uses high-energy rays to kill cancer cells in a specific area. In the treatment of uterine cancer, radiation therapy may be used before or after surgery, or as an alternative treatment if surgery is not an option.

There are two main types of radiation therapy available to treat uterine cancer:

• External radiation therapy – uses a large machine to direct radiation at your pelvis or other areas where cancerous cells have appeared. Sessions take only a few minutes each and usually occur five days a week for several weeks.
• Internal radiation therapy – also called brachytherapy, involves insertion of a narrow cylinder into the vagina. A radioactive substance is loaded into the cylinder. Once the cylinder is removed, no radioactivity is left in the body. Treatments last only a few minutes and may be repeated two or three times over several weeks.

Chemotherapy for Uterine Cancer

Chemotherapy kills uterine cancer cells using drugs that are given intravenously by IV or orally. You may receive your chemotherapy treatments in a clinic, at your doctor’s office or at home if oral medication is prescribed.