Uterine cancer care

Uterine cancer or cancer of the uterus (the womb) is the most common cancer of the female reproductive  system. Almost all cases start in the lining of the uterus, called the endometrium. It is also commonly known as endometrial cancer. The cells of the endometrium are what are shed during a woman’s monthly menstrual cycle. The types of uterine/endometrial cancer are:

• adenocarcinoma
• serous carcinoma
• small cell carcinoma
• squamous cell carcinoma
• transitional carcinoma
• uterine carcinosarcoma

You may be at greater risk for uterine/endometrial cancer if you:

• are obese
• are older than 40
• eat a high-fat diet
• have a close family member who has had uterine, colon or ovarian cancer. This may be a sign of Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC).
• have diabetes
• have had breast or ovarian cancer; complex atypical endometrial hyperplasia, a precancerous condition; or ovarian diseases, such as polycystic ovarian syndrome (PCOS)
• have had pelvic radiation to treat other kinds of cancer.
• have never been pregnant, have had trouble getting pregnant or had fewer than five periods in a year before starting menopause
• have taken estrogen without progesterone for hormone replacement during menopause
• have taken tamoxifen as a treatment for breast cancer
• started your period before your were 12 years old or went through menopause late

If you have two or more risk factors, it doesn’t mean you’ll develop uterine/ endometrial cancer, but you may want to talk to your doctor to see if you should have more frequent exams.

Symptoms

• If you have gone through menopause, see your doctor if you have vaginal bleeding, spotting or an unusual discharge
• If you have not gone through menopause, see your doctor if for more than two weeks you experience:
  • abnormal vaginal discharge
  • pelvic pain or pressure
  • unusual bleeding between periods or heavier flow
  • weight loss

Prevention and screening

There is no reliable screening for uterine cancer. If you have symptoms or are at high risk for uterine cancer, your doctor may perform an endometrial biopsy or a transvaginal ultrasound.

Genetic counseling may be recommended if you:

• have a relative who has tested positive for a Lynch syndrome gene mutation (MLH1, MSH2, MSH6, PMS2 genes) 
• have any close relatives with colon, rectal or endometrium cancer
• have had colon or rectal cancer

were diagnosed with endometrial cancer before age 50

Diagnosis

These tests can be used to diagnose or rule out uterine cancer:

• biopsy
• blood tests
• chest X-ray
• CT scan
• D&C (dilatation and curettage)
• Hysteroscopy
• MRI
• PET scan
• physical and pelvic examination
• transvaginal ultrasound
• ultrasound

Your doctor may do these tests in his or her office or may refer you to another doctor. Your doctor might perform more tests if your endometrial biopsy does not provide enough information or if symptoms continue.

Treatment may include:

• Surgery, including a total hysterectomy (removal of your uterus), bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), or removal of lymph nodes in your pelvis and lower abdomen
• Chemotherapy
• Radiation therapy
  • brachytherapy
  • 3D-conformal radiation therapy
  • intensity-modulated radiotherapy (IMRT):
• Hormone therapy, with aromatase inhibitors, progestins or tamoxifen
• Immunotherapy