Uterine Cancer

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The uterus is a hollow organ in females located in the pelvis, commonly called the womb. The uterus functions to support fetal development until birth. The uterus is shaped like an upside-down pear; the top is the fundus, the middle is the corpus, and bottom is the cervix; the inner layer of the uterus is the endometrium, and the outer layer is muscle (myometrium).

Uterine cancer is the abnormal (malignant) growth of any cells that comprise uterine tissue. The buildup of cancer cells may form a mass (malignant tumor). Non-cancer cells that form a mass are termed benign tumors.

Although the exact causes of uterine cancers are not known, risk factors include women with endometrial overgrowth (hyperplasia), obesity, women who have never had children, menses beginning before age 12, menopause after age 55, estrogen therapy, taking tamoxifen, radiation to the pelvis, family history of uterine cancer, and Lynch syndrome (most commonly seen as a form of inherited colorectal cancer). Common signs and symptoms of uterine cancer are ;

abnormal vaginal bleeding (most common symptom),
vaginal discharge,
pain with urination and/or sex, and
pelvic pains.

Uterine cancer is diagnosed usually with a pelvic exam, Pap test, ultrasound, and biopsy. Occasionally, CT or MRI may be done to help confirm the diagnosis.


Uterine cancer stages (0 to IV) are determined by biopsy, chest X-ray, and/or CT or MRI scans. Treatment options may include one or more of the following: surgery, radiation, hormone therapy, and chemotherapy. Treatment depends on the uterine cancer stage, your age, and general health with uterine cancer stage IV as the most extensive and usually caused by the most aggressive type of cancer cells. You and your doctors can decide what treatment plan is best for you.





Surgical therapy usually involves removal of the uterus, ovaries, fallopian tubes, adjacent lymph nodes, and part of the vagina. Radiation therapy may be by external radiation or by internal radiation (brachytherapy). The following stages are used for endometrial cancer:

Stage I
In stage I, cancer is found in the uterus only. Stage I is divided into stages IA and IB, based on how far the cancer has spread. Stage IA: Cancer is in the endometrium only or less than halfway through the myometrium (muscle layer of the uterus). Stage IB: Cancer has spread halfway or more into the myometrium.

Stage II
In stage II, cancer has spread into connective tissue of the cervix, but has not spread outside the uterus.

Stage III
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis.

Stage IIIA: Cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries, and ligaments of the uterus.
Stage IIIB: Cancer has spread to the vagina and/or to the parametrium (connective tissue and fat around the uterus).
Stage IIIC: Cancer has spread to lymph nodes in the pelvis and/or around the aorta (largest artery in the body, which carries blood away from the heart).

Stage IV
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread.
Stage IVA: Cancer has spread to the bladder and/or bowel wall.
Stage IVB: Cancer has spread to other parts of the body beyond the pelvis, including the abdomen and/or lymph nodes in the groin.

Endometrial cancer may be grouped for treatment as follows:

Low-risk endometrial cancer
Grades 1 and 2 tumors are usually considered low-risk. They usually do not spread to other parts of the body.

High-risk endometrial cancer
Grade 3 tumors are considered high-risk. They often spread to other parts of the body. Uterine papillary serous, clear cell, and carcinosarcoma are three subtypes of endometrial cancer that are considered grade 3.

Recurrent endometrial cancer
Recurrent endometrial cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the uterus, the pelvis, in lymph nodes in the abdomen, or in other parts of the body.

Chemotherapy usually requires IV administration of drugs designed to kill cancer cells. Most chemotherapy treatments need to be done in repeated cycles of drug administration followed by a rest period.

Hormone therapy (usually progesterone) is used on uterine cancer cells that require another hormone (estrogen) for growth. Second opinions can be obtained by referrals made by your doctor to others in the local medical society or to other doctors elsewhere. Follow-up care is important. Complications can be treated early, and possible cancer recurrence can be diagnosed early. Support groups are varied and many are local. The National Cancer Institute (NCI) can help locate support groups and possible clinical trials that test the newest treatments.

Signs and symptoms of endometrial cancer

include unusual vaginal bleeding or pain in the pelvis. These and other signs and symptoms may be caused by endometrial cancer or by other conditions. Check with your doctor if you have any of the following:

Vaginal bleeding or discharge not related to menstruation (periods).
Vaginal bleeding after menopause.
Difficult or painful urination.
Pain during sexual intercourse.
Pain in the pelvic area.

Five types of standard treatment are used:

Surgery Surgery (removing the cancer in an operation) is the most common treatment for endometrial cancer. The following surgical procedures may be used:
Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

Bilateral salpingo-oophorectomyx-rays Radical hysterectomy: Surgery to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed. Lymph node dissection: A surgical procedure in which the lymph nodes are removed from the pelvic area and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or hormone treatment after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat endometrial cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.

Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies, mTOR inhibitors, and signal transduction inhibitors are three types of targeted therapy used to treat endometrial cancer.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Bevacizumab is used to treat stage III, stage IV, and recurrent endometrial cancer.

mTOR inhibitors block a protein called mTOR, which helps control cell division. mTOR inhibitors may keep cancer cells from growing and prevent the growth of new blood vessels that tumors need to grow. Everolimus and ridaforalimus are used to treat stage III, stage IV, and recurrent endometrial cancer.

Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Metformin is being studied to treat stage III, stage IV, and recurrent endometrial cancer.




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