• Uterine cancer primarily affects the endometrium, the lining of the uterus, and is more common in postmenopausal women.
• Common symptoms of uterine cancer include abnormal vaginal bleeding, especially after menopause, and pelvic pain.
• Risk factors for uterine cancer include obesity, diabetes, high blood pressure, and certain hormonal imbalances.
• Uterine cancer diagnosis involves a physical exam, imaging, and endometrial biopsy, followed by staging to determine cancer spread.
• Uterine cancer treatment options typically include surgery, radiation, chemotherapy, and hormone therapy, often used in combination.

What is Uterine Cancer?

Uterine cancer refers to a malignant growth that originates in the cells of the uterus. The most common type, endometrial cancer, develops in the endometrium, the inner lining of the uterus. Less common types include uterine sarcomas, which form in the muscle wall of the uterus (myometrium) or its supporting tissues. According to the American Cancer Society, endometrial cancer is the most common cancer of the female reproductive system, with an estimated 67,880 new cases and 13,250 deaths in the United States in 2024, highlighting its significant public health impact.

The development of uterine cancer is often linked to an imbalance of hormones, particularly an excess of estrogen without sufficient progesterone to counteract its effects. This hormonal environment can stimulate the growth of endometrial cells, leading to hyperplasia (overgrowth of normal cells) and, in some cases, progression to cancer. Early detection is vital, as uterine cancer often presents with noticeable symptoms that prompt medical evaluation.

Symptoms of Uterine Cancer

Recognizing the symptoms of uterine cancer is critical for timely diagnosis. The most common and significant symptom is abnormal vaginal bleeding, particularly postmenopausal bleeding. Any bleeding, spotting, or discharge after menopause should be promptly evaluated by a healthcare provider. For premenopausal women, symptoms might include unusually heavy or prolonged periods, or bleeding between periods.

Other potential symptoms, though less common or appearing in later stages, can include:

• Pelvic pain or pressure, which may indicate a larger tumor or spread.
• Pain during intercourse (dyspareunia).
• Unexplained weight loss.
• A mass or lump in the pelvic area, though this is rare in early stages.
• Changes in bowel or bladder habits, if the cancer has spread to nearby organs.

It is important to note that these symptoms can also be caused by non-cancerous conditions, but persistent or new symptoms, especially abnormal bleeding, warrant immediate medical attention.

Causes of Uterine Cancer

While the exact causes of uterine cancer are not fully understood, several risk factors have been identified that increase a woman’s likelihood of developing the disease. These factors often relate to prolonged exposure to estrogen without adequate progesterone, which can stimulate endometrial cell growth. Key risk factors include:

• Obesity: Adipose tissue produces estrogen, and higher body fat levels can lead to increased estrogen exposure.
• Age: The risk increases with age, with most diagnoses occurring in women over 50.
• Hormone Therapy: Estrogen-only hormone replacement therapy (HRT) after menopause significantly increases risk; combining estrogen with progesterone reduces this risk.
• Tamoxifen: This drug, used to treat breast cancer, can act like estrogen on the uterus, increasing risk.
• Never having been pregnant (nulliparity): Pregnancy temporarily reduces estrogen exposure.
• Early menstruation or late menopause: A longer lifetime exposure to estrogen.
• Diabetes and High Blood Pressure: These conditions are often linked to obesity and hormonal imbalances.
• Genetic Syndromes: Lynch syndrome (hereditary nonpolyposis colorectal cancer or HNPCC) significantly increases the risk of uterine cancer.

Understanding these risk factors can help individuals and healthcare providers assess personal risk and consider appropriate screening or preventive strategies.

Diagnosing and Staging Uterine Cancer

The process of uterine cancer diagnosis involves several steps to confirm the presence of cancer and determine its characteristics. Early and accurate diagnosis is crucial for effective treatment planning. The diagnostic journey typically begins with a thorough medical history and physical examination, including a pelvic exam.

If uterine cancer is suspected, further tests are ordered. The primary diagnostic tool is an endometrial biopsy, where a small tissue sample is removed from the uterine lining and examined under a microscope for cancerous cells. This can be done in an office setting or through a dilation and curettage (D&C) procedure, which involves dilating the cervix and scraping tissue from the uterus, usually under anesthesia. Imaging tests like transvaginal ultrasound, MRI, or CT scans may also be used to visualize the uterus and surrounding areas, helping to assess the extent of any abnormalities.

Diagnostic Procedures

Several procedures are employed to accurately diagnose uterine cancer and differentiate it from other conditions. Beyond the initial biopsy, hysteroscopy, a procedure where a thin, lighted tube is inserted through the vagina and cervix into the uterus, allows the doctor to visually inspect the uterine lining and take targeted biopsies. Blood tests, while not diagnostic for uterine cancer itself, may be performed to check overall health, kidney and liver function, and sometimes to look for tumor markers, though these are not specific enough for diagnosis alone.

Once cancer is confirmed, additional tests are conducted to determine the stage of the cancer. This process, known as staging, is vital for guiding treatment decisions. Staging typically involves surgical exploration, where the surgeon removes the uterus (hysterectomy), fallopian tubes, ovaries, and often nearby lymph nodes. The removed tissues are then sent to a pathologist to determine the exact type of cancer, its grade (how aggressive it looks under a microscope), and how far it has spread.

Understanding Cancer Stages

The stages of uterine cancer describe the extent to which the cancer has grown and spread. Staging helps doctors determine the most appropriate treatment plan and provides an indication of prognosis. Uterine cancer is typically staged surgically, meaning the stage is determined during an operation. The most widely used system is the FIGO (International Federation of Gynecology and Obstetrics) staging system, which classifies cancer into four main stages:

Each stage is further divided into substages (e.g., IA, IB, IC) based on the depth of invasion into the uterine wall or specific sites of spread. This detailed staging allows for a highly personalized approach to treatment, ensuring that the therapy is tailored to the specific characteristics and extent of the disease.

Uterine Cancer Treatment Options and Prevention

The selection of uterine cancer treatment options depends on several factors, including the type and stage of the cancer, the patient’s overall health, and personal preferences. For most women with uterine cancer, surgery is the primary treatment. A total hysterectomy, which involves removing the uterus and cervix, is often performed. In many cases, the fallopian tubes and ovaries (salpingo-oophorectomy) are also removed, as well as nearby lymph nodes to check for cancer spread. This surgical approach aims to remove as much of the cancerous tissue as possible.

Beyond surgery, other treatments may be used alone or in combination. Radiation therapy uses high-energy rays to kill cancer cells and can be delivered externally (external beam radiation) or internally (brachytherapy). Chemotherapy involves using drugs to kill cancer cells throughout the body, often administered intravenously. Hormone therapy, which uses drugs to block or reduce estrogen, is particularly effective for hormone-sensitive uterine cancers, especially in advanced or recurrent cases. Targeted therapy and immunotherapy are newer approaches that may be considered for specific types of uterine cancer or in situations where other treatments have not been successful.

Uterine Cancer Prevention

While not all cases of uterine cancer are preventable, several strategies can help reduce the risk. Uterine cancer prevention often focuses on managing risk factors, particularly those related to hormonal balance and lifestyle. Maintaining a healthy weight through diet and regular physical activity is one of the most effective preventive measures, as obesity is a significant risk factor due to its impact on estrogen levels. Managing underlying conditions like diabetes and high blood pressure can also contribute to reducing risk.

For women undergoing hormone replacement therapy for menopausal symptoms, discussing the risks and benefits with a healthcare provider is important. If estrogen therapy is used, it is generally recommended to combine it with progesterone to protect the uterine lining, unless the uterus has been removed. Genetic counseling and screening may be recommended for individuals with a family history of Lynch syndrome, as this condition significantly increases the risk of uterine cancer. Regular gynecological check-ups and prompt evaluation of any abnormal symptoms, especially postmenopausal bleeding, are crucial for early detection, which can lead to more successful treatment outcomes.