By Dr. Mathias Sapuri
About the uterus
The pear-shaped uterus is hollow and located in a woman’s pelvis between the bladder and rectum. The uterus, also known as the womb, is where a baby grows when a woman is pregnant. It has 3 sections: the narrow, lower section called the cervix; the broad section in the middle called the isthmus; and the dome-shaped top section called the fundus. The wall on the inside of the uterus has 2 layers of tissue: endometrium (inner layer) and myometrium (outer layer), which is muscle tissue.
During a woman's childbearing years, her ovaries typically release an egg every month and the lining of the uterus grows and thickens in preparation for pregnancy. If the woman does not get pregnant, this thick lining passes out of her body through her vagina, a process known as menstruation. This process continues until menopause, when a woman’s ovaries stop releasing eggs.
About uterine cancer
Uterine cancer is the most common cancer occurring in a woman’s reproductive system. Uterine cancer begins when healthy cells in the uterus change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor can grow but generally will not invade other tissues.
Noncancerous conditions of the uterus include:
• Fibroids: Benign tumors in the muscle of the uterus
• Benign polyps: Abnormal growths in the lining of the uterus
• Endometriosis: A condition in which endometrial tissue, which usually lines the inside of the uterus, is found on the outside of the uterus or other organs.
• Endometrial hyperplasia: A condition in which there is an increased number of cells and glandular structures in the uterine lining. Endometrial hyperplasia can have either normal or atypical cells and simple or complex glandular structures. The risk for developing cancer in the lining of the uterus is higher when endometrial hyperplasia has atypical cells and complex glands.
There are 2 major types of uterine cancer:
• Adenocarcinoma. This type makes up more than 80% of uterine cancers. It develops from cells in the endometrium. This cancer is commonly called endometrial cancer. One common endometrial adenocarcinoma is called endometrioid carcinoma, and treatment varies depending on the grade of the tumor, how far it goes into the uterus, and the stage or extent of disease (see Stages and Grades). A less common type is called endometrial serous carcinoma. This form is treated like ovarian cancer, which is also commonly of the serous type.
• Sarcoma. This type of uterine cancer develops in the supporting tissues of the uterine glands or in the myometrium, which is the uterine muscle. Sarcoma accounts for about 2% to 4% of uterine cancers. In most situations, sarcomas are treated differently than adenocarcinomas. Types of endometrial sarcoma include leiomyosarcoma and endometrial stromal sarcoma. Learn more about sarcoma.
Cancer confined to the uterine cervix is treated differently than uterine cancer; learn more about cervical cancer. The rest of this section covers the more common endometrial (adenocarcinoma) cancer.
About genetics and family history and uterine cancer
A higher risk for uterine cancers can be inherited, passed from generation to generation, or may skip 1 generation to appear in the next. This happens about 5% of the time, and the syndrome associated with inherited uterine cancer is called Lynch syndrome. Lynch syndrome is associated with several other types of cancer, including types of colon, kidney, bladder, and ovarian cancers.
When cells divide and multiply, DNA errors can occur. There are 6 proteins in the body that fix these errors. If 1 of these proteins does not work properly, errors in the DNA can accumulate and yield enough DNA damage that cancer may develop. This problem with DNA repair is called mismatch repair defect (MMR). MMR is the main sign of Lynch syndrome.
Your cancer can be tested for Lynch syndrome through a special staining process called immunohistochemistry (IHC). If IHC shows that your cancer lacks 1 of these DNA repair proteins or if you have a family history of a cancer associated with Lynch syndrome, discuss this with your doctor or talk with a genetic counselor. Family members may wish to be tested, too. People affected by Lynch syndrome should tell their doctors so they can receive increased screening for Lynch-associated cancers. Other family members may consider preventive surgery for uterine and ovarian cancer. Learn more about Lynch syndrome.
Uterine Cancer - Statistics
This year, an estimated 63,230 women in the United States will be diagnosed with uterine endometrial cancer. Uterine cancer is the fourth most common cancer for women in the United States. Approximately 92% of uterine cancers occur in the endometrium. The incidence of endometrial cancer is rising, mostly because of a rise in obesity, which is an important risk factor for this disease.
It is estimated that 11,350 deaths from this disease will occur this year. It is the sixth most common cause of cancer death among women in the United States. Although uterine cancer rates are slightly higher among white women than black women, black women are more likely to die from uterine cancer than white women.
The 5-year survival rate tells you what percentage of women live at least 5 years after the cancer is found. Percentage means how many out of 100. The 5-year survival rate for women with uterine cancer is 81%. The 5-year survival rates for white and black women with the disease are 84% and 62% respectively. Black women are less likely to be diagnosed with early-stage disease, and their survival rate at every stage is lower.
When the cancer is diagnosed, if it is still confined to the area where it started, it is called “local,” and the 5-year survival rate is about 95%. Approximately 69% of white women are diagnosed at this stage compared to 53% of black women. If the cancer has spread regionally, the 5-year survival rate is about 69%. If it is diagnosed after the cancer has spread into other areas of the body, the survival rate is 16%.
It is important to remember that statistics on the survival rates for women with uterine cancer are an estimate. The estimate comes from annual data based on the number of women with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnoses or treatments available for less than 5 years. Women should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.
Uterine Cancer - Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
The following factors may raise a woman’s risk of developing uterine cancer:
• Age. Uterine cancer most often occurs in women over 50; the average age is 60.
• Obesity. Fatty tissue in women who are overweight produces additional estrogen, a sex hormone that can increase the risk of uterine cancer. This risk increases with an increase in body mass index (BMI), which is the ratio of a person's weight to height. About 40% of uterine cancer cases are linked to obesity.
• Race. White women are more likely to develop uterine cancer than women of other races/ethnicities. However, black women have a higher chance of developing advanced cancer. Black and Hispanic women also have a higher risk of developing aggressive tumors.
• Genetics. Uterine cancer may run in families where colon cancer is hereditary. For instance, women in families with Lynch syndrome, also called hereditary non-polyposis colorectal cancer (HNPCC), have a higher risk for uterine cancer. It is recommended that all women under the age of 60 with endometrial cancer should have their tumor tested for Lynch syndrome even if they have no family history of bowel cancer or other cancers. The presence of Lynch syndrome has important implications for women and their family members. About 2% to 5% of women with endometrial cancer have Lynch syndrome. In the United States, about 1,000 to 2,500 women diagnosed with endometrial cancer each year may have this genetic condition. Read about Lynch syndrome.
• Diabetes. Women may have an increased risk of uterine cancer if they have diabetes, which is often associated with obesity (see above).
• Other cancers. Women who have had breast cancer, colon cancer, or ovarian cancer have an increased risk of uterine cancer.
• Tamoxifen. Women taking the drug tamoxifen (Nolvadex) to prevent or treat breast cancer have an increased risk of developing uterine cancer. The benefits of tamoxifen usually outweigh the risk of developing uterine cancer, but all women who are prescribed tamoxifen should discuss the benefits and risks with their doctor.
• Radiation therapy. Women who have had previous radiation therapy for another cancer in the pelvic area, which is the lower part of the abdomen between the hip bones, have an increased risk of uterine cancer.
• Diet. Women who eat foods high in animal fat may have an increased risk of uterine cancer.
• Estrogen. Extended exposure to estrogen and/or an imbalance of estrogen is related to many of the following risk factors:
o Women who started having their periods before age 12 and/or go through menopause later in life. Learn more about menopause and cancer risk.
o Women who take hormone replacement therapy (HRT) after menopause, especially if they are taking estrogen alone. The risk is lower for women who take estrogen with progesterone, which is another sex hormone.
o Women who have never been pregnant.
Different factors contribute to different types of cancer. Researchers continue to investigate what factors increase risk for this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.
Research has shown that certain factors can lower the risk of uterine cancer:
• Taking birth control pills. Birth control pills have a combination of estrogen and progesterone that are taken cyclically to produce a monthly menstrual period, which reduces the risk of an overgrowth of the uterine lining, especially when taken over a long period of time.
• Using a progestin-secreting intrauterine device (IUD), which is a form of birth control.
• Considering the risk of uterine cancer before starting HRT, especially estrogen replacement therapy alone. Using a combination of estrogen and progesterone for HRT may help lower risk.
• Maintaining a healthy weight.
• If you have diabetes, good disease management, such as regularly monitoring blood glucose levels, can lower risk.
Uterine Cancer - Symptoms and Signs
Women with uterine cancer may experience the following symptoms or signs. Sometimes, women with uterine cancer do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.
The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding, during or after menopause, is often a sign of a problem.
• Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, this includes menorrhagia, which is an abnormally heavy or prolonged bleeding, and/or abnormal uterine bleeding (AUB).
• Abnormal Pap test results
• Difficulty or pain when urinating
• Pain during sexual intercourse
• Pain in the pelvic area
If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This conversation helps identify the cause of the problem, called a diagnosis.
If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.
Uterine Cancer - Diagnosis
Doctors use many tests to find, or diagnose, cancer. They do tests to learn whether cancer has spread to a different part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may do tests to learn which treatments could work best.
For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.
This list describes options for diagnosing this type of cancer. Not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:
• The type of cancer suspected
• Your signs and symptoms
• Your age and medical condition
• The results of previous medical tests
In addition to a physical examination, the following tests may be used to diagnose uterine cancer:
• Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily used to check for cervical cancer. Sometimes a Pap test may find abnormal glandular cells, which are caused by uterine cancer.
• Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes a few minutes. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. People who have abnormal vaginal bleeding before the test may still need a dilation & curettage (D&C; see below), even if no abnormal cells are found during the biopsy.
• Dilation and Curettage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure to block the awareness of pain. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, lighted flexible tube through the cervix into the vagina and uterus.
After endometrial tissue has been removed, during a biopsy or D&C, the sample is checked for cancer cells, endometrial hyperplasia, and other conditions.
• Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to obtain the pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see above).
• Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to drink.
• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein. This is particularly useful for detailed images if the treatment option is mainly hormone management (see Treatment Options). MRI is often used in women with low-grade cancer to see how far the cancer has grown into the wall of the uterus. Knowing this can help determine whether a woman’s fertility can be preserved.
After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, additional testing will be performed to discover how far the disease has grown. This helps to categorize the disease by stage and directs the type of treatment that will be needed.
Uterine Cancer - Stages and Grades
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.
Doctors use diagnostic tests to discover the cancer's stage, and they may need information based on samples of tissue from surgery, so staging may not be complete until all of the tests are finished and the surgery to remove the tumor has been done (see Treatment Options). Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a woman's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. For uterine cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique or FIGO) is used.
FIGO stages for uterine cancer
The stage provides a common way of describing the cancer, enabling doctors to work together to plan the best treatments. Doctors assign the stage of endometrial cancer using the FIGO system.
Stage I: The cancer is found only in the uterus or womb, and it has not spread to other parts of the body.
• Stage IA: The cancer is found only in the endometrium or less than one-half of the myometrium.
• Stage IB: The tumor has spread to one-half or more of the myometrium.
Stage II: The tumor has spread from the uterus to the cervical stroma but not to other parts of the body.
Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area.
• Stage IIIA: The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body.
• Stage IIIB: The tumor has spread to the vagina or next to the uterus.
• Stage IIIC1: The cancer has spread to the regional pelvic lymph nodes
• Stage IIIC2: The cancer has spread to the para-aortic lymph nodes with or without spread to the regional pelvic lymph nodes
Stage IV: The cancer has metastasized to the rectum, bladder, and/or distant organs.
• Stage IVA: The cancer has spread to the mucosa of the rectum or bladder.
• Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs.
Doctors describe this type of cancer by its grade (G), which describes how much cancer cells resemble healthy cells when viewed under a microscope.
The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer appears similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.
The letter "G" is used to define a grade for uterine cancer.
GX: The grade cannot be evaluated.
G1: The cells are well differentiated.
G2: The cells are moderately differentiated.
G3: The cells are poorly differentiated.
Recurrent uterine cancer
Recurrent cancer is cancer that has returned after treatment. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. If there is a recurrence, this tends to occur within 3 years of diagnosis, but later recurrences can sometimes occur. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.
• Vaginal bleeding or discharge
• Pain in the pelvic area, abdomen, or back of the legs
• Difficulty or pain when urinating
• Weight loss
• Persistent cough/shortness of breath
If there is a recurrence, more testing will help to determine the extent of disease. You and your doctor should talk about treatment options.
Uterine Cancer - Treatment Options
This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.
In cancer care, different types of doctors, called a multidisciplinary team, often work together to create a patient’s overall treatment plan, which combines different types of treatments. Your health care team should include a gynecologic oncologist, which is a doctor who specializes in the cancers of the female reproductive system.
Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Uterine cancer is treated by 1 or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy. Combinations of treatments are often recommended, but they depend on the stage and characteristics of the cancer. Each treatment option is described below, followed by an outline of treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, the woman’s overall health, age, and personal preferences, including whether or how treatment will affect her ability to have children. Women with uterine cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins. Women who want to preserve their fertility may be referred to a reproductive endocrinologist (REI). It may be helpful to discuss what options for fertility preservation are covered by your health insurance.
Your care plan may include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions.
Surgery is the removal of the tumor and some surrounding healthy tissue, called a margin, during an operation. It is typically the first treatment used for uterine cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have (see “Side effects of surgery” below). Learn more about the basics of cancer surgery.
Common surgical procedures for uterine cancer include:
• Hysterectomy. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, the upper part of the vagina, and nearby tissues). For patients who have been through menopause, the surgeon will typically also perform a bilateral salpingo-oophorectomy, which is the removal of both fallopian tubes and ovaries.
A hysterectomy may be performed by abdominal incision, by laparoscopy or robotically, which uses several small incisions, or vaginally. A hysterectomy is usually performed by a gynecologic surgeon, which is a surgeon who specializes in surgery of the woman’s reproductive system. In robotic-assisted surgery, a camera and instruments are inserted through small, keyhole-size incisions. The surgeon directs the robotic instruments to remove the uterus, cervix, and surrounding tissue. Talk with your doctor about the risks and benefits of the different surgical approaches and which might approach be best for you.
• Lymphadenectomy. At the same time as a hysterectomy, the surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus. Sometimes a sentinel lymph node biopsy is performed. This procedure might involve an injection of dye into the uterus during the hysterectomy and removal of the few lymph nodes where dye collects. This procedure has proven useful for breast and other cancers, and doctors are researching its usefulness in uterine cancer.
Side effects of surgery
After surgery, the most common short-term side effects include pain and tiredness. If a woman is experiencing pain, her doctor will prescribe medications to relieve the pain. Other immediate side effects may include nausea and vomiting and difficulty emptying the bladder and having bowel movements. The woman's diet may be restricted to liquids, followed by a gradual return to solid foods.
If the ovaries are removed, this ends the body's production of sex hormones, resulting in early menopause (if the woman has not already gone through menopause). While removal of the ovaries substantially reduces the sex hormones that are produced by the body, the adrenal glands and fat tissues will still provide some hormones. Soon after removing the ovaries, a woman is likely to experience menopausal symptoms, including hot flashes and vaginal dryness.
After a hysterectomy, a woman can no longer become pregnant. For this reason, it is very important for patients who wish to become pregnant in the future to talk with their doctor about all their options before any treatment begins. Sometimes, options to preserve your ability to have children might include less extensive surgery followed by hormone therapy (see below). Your doctor can talk with you about the potential risks and benefits of this approach and provide information to help you make an informed decision.
Before any operation for uterine cancer, women are encouraged to talk with their doctors about sexual and emotional side effects, reproductive health concerns, and ways to address these issues before and after cancer treatment.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
Some women with uterine cancer need radiation therapy and surgery (see above). The radiation therapy is most often given after surgery to destroy any remaining cancer cells. Radiation therapy is occasionally given before surgery to shrink the tumor. If a woman cannot have surgery, the doctor may recommend radiation therapy as another option.
Radiation therapy options for endometrial cancer may include radiation therapy directed towards the whole pelvis or applied only to the vaginal cavity, often called vaginal brachytherapy.
Side effects from radiation therapy will depend on the extent of radiation therapy given and may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished, but long-term side effects causing bowel or vaginal symptoms are possible.
Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.
Learn more about the basics of radiation therapy. For more information about radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.
Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist or gynecologic oncologist, a doctor who specializes in treating women’s reproductive cancer with medication. When recommended for endometrial cancer, chemotherapy usually is given after surgery, either with or without radiation therapy. Chemotherapy is also considered if the endometrial cancer returns after initial treatment.
Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.
The goal of chemotherapy is to destroy cancer remaining after surgery or to shrink the cancer and slow the tumor's growth if it comes back or has spread to other parts of the body. Although chemotherapy can be given orally, most drugs used to treat uterine cancer are given by IV. IV chemotherapy is either injected directly into a vein or through a catheter, which is a thin tube inserted into a vein.
The side effects of chemotherapy depend on the individual, the type of chemotherapy, and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. Advances in chemotherapy during the last 10 years include the development of new drugs for the prevention and treatment of side effects, such as antiemetics for nausea and vomiting and growth factors to prevent low white blood cell counts.
Other potential side effects of chemotherapy for uterine cancer include the inability to become pregnant and early menopause, if the patient has not already had a hysterectomy (see “Surgery” above). Rarely, some drugs cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously to protect their kidneys.
Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.
Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them. These tumors are generally adenocarcinomas and are grade 1 or 2 tumors. Hormone therapy for uterine cancer often involves a high dose of the sex hormone progesterone given in pill form. Other hormone therapies include hormone-expressing intrauterine devices (IUDs) and the aromatase inhibitors (AIs), such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin), which are often used for the treatment of women with breast cancer. An AI is a drug that reduces the amount of the hormone estrogen in a woman's body by stopping tissues and organs other than the ovaries from producing it. Hormone therapy may be used for women who cannot have surgery or radiation therapy or it can be used in combination with other types of treatment.
Side effects of hormone therapy may include fluid retention, increase in appetite, insomnia, muscle aches, and weight gain. Most side effects are manageable with the help of your health care team. Talk with your doctor about what you can expect.
Getting care for symptoms and side effects
Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with her physical, emotional, and social needs.
Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer while they receive treatment to ease side effects. Patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medications, nutritional changes, relaxation techniques, emotional support, and other therapies. You may receive palliative treatments like those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.
Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.
Metastatic uterine cancer
If cancer spreads to a part of the body that is different from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might be an option. Learn more about getting a clinical trials. Palliative care will be important to help relieve symptoms and side effects.
For most patients, a diagnosis of metastatic cancer is very stressful and may be difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may be helpful to talk with other patients, including through a support group.
Remission and the chance of recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Find out more about recurrent uterine cancer in Stages.
When this occurs, a new cycle of testing will begin to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as hormone therapy, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Sometimes, surgery is suggested when a cancer recurrence is small or confined, called a localized recurrence. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.
If treatment doesn’t work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.
Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help cope with the loss. Learn more about grief and loss.
Uterine Cancer - About Clinical Trials
What are clinical trials?
Doctors and scientists are always looking for better ways to care for women with uterine cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.
Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Women who participate in clinical trials can be some of the first to get a treatment before it is available to the public. There are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.
Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.
Deciding to join a clinical trial
Women decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies offer a way to contribute to the progress in treating uterine cancer. Even if they do not benefit directly from the clinical trial, their participation may yield future benefits for women with uterine cancer.
Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company before starting treatment to learn if and how your participation in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.
Sometimes people have concerns that they might not receive active treatment in a clinical trial but instead receive a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.
Patient safety and informed consent
To join a clinical trial, women must participate in a process known as informed consent. During informed consent, the doctor should:
• Describe all of the patient's options so that she understands how the new treatment differs from the standard treatment.
• List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.
• Explain what will be required of each patient while participating in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.
Clinical trials have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.
Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.
Uterine Cancer - Latest Research
Doctors are working to learn more about uterine cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.
• New therapies (updated 01/2019). The most notable development in the treatment of endometrial cancer, and many other types of cancer, is doctors’ increasing understanding of tumor genomics. This area of science seeks to identify mutations in the tumor’s genes that might “drive” or cause the tumor to grow. Testing can be done on your tumor sample to look for these mutations, and the results will help decide whether your treatment options include a type of treatment called targeted therapy, which may include clinical trials.
In endometrial cancer, mutations in a pathway called PI3K/AKT/MTOR are commonly found. Patients with recurrent uterine cancer may benefit from using a drug that targets this pathway, such as everolimus (Afinitor). Other drugs that target this pathway are available. A study from 2014 showed that combining everolimus with the chemotherapy letrozole (Femara) slowed the growth of the disease in women with recurrent endometrial cancer. The MTOR inhibitor, temsirolimus (Torisel), is a targeted therapy approved to treat renal cell carcinoma, a type of kidney cancer. Clinical trials are investigating its use to treat recurrent, metastatic, or high-risk uterine cancer.
Another type of targeted therapy that has shown some results for patients with endometrial cancer are called angiogenesis inhibitors. For example, bevacizumab (Avastin) targets blood vessel growth that feeds tumors.
Uterine serous carcinoma is a rare but aggressive type of endometrial cancer. About 30% of these tumors express the HER2 gene. In a phase II clinical trial, researchers found that trastuzumab (Herceptin) combined with a combination of chemotherapy was effective in treating these kinds of tumors. Trastuzumab is a HER2targeted therapy mostly used to treat HER2-positive breast cancer. In the women in this study, trastuzumab stopped the progression of the disease for a median of 12.6 months compared to 8.0 months for those who received only standard chemotherapy. The median is the midpoint, meaning that half of the patients had their disease stopped for less than the median and half had their disease stopped for more than the median.
Other research includes immunotherapy, which are treatments designed to boost the body's natural defenses to fight the cancer. There is interest in a specific area of immunotherapy called “checkpoint inhibitors,” such as PD-1 or CTLA4 targeted immunotherapies. Examples of immunotherapies are nivolumab (Opdivo) or ipilimumab (Yervoy). They help activate the immune system and can cause tumors to shrink. Some of these immunotherapies work better in combination with other treatment types. There are ongoing clinical trials examining different drugs and various combinations in uterine cancer. There is early evidence that uterine cancers with mismatch repair defects (see Introduction) are much more sensitive to immunotherapy, and this is being studied.
• Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current endometrial cancer treatments to improve patients’ comfort and quality of life.
Patients are strongly encouraged to talk with the doctor about clinical trials when decisions are being made about their treatment options.
Uterine Cancer - Coping with Treatment
Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.
As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.
Coping with physical side effects
Common physical side effects from each treatment option for uterine cancer are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health, sexual health, and fertility depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.
Sometimes, physical side effects can last after treatment ends. Doctors call these “long-term side effects.” They call side effects that occur months or years after treatment “late effects.” Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.
Coping with emotional and social effects
You can have emotional and social effects along with physical effects after a cancer diagnosis. These may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing their feelings to their loved ones or with people not knowing what to say in response.
Patients and their families are encouraged to share their feelings with a member of their health care team. You can find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.
Coping with financial effects
Cancer treatment can be expensive. It is often a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost prevents them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations, in a separate part of this website.
Caring for a loved one with cancer
Family members and friends often play an important role in taking care of a person with uterine cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.
Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers accept:
• Providing support and encouragement
• Giving medications
• Helping manage symptoms and side effects
• Coordinating medical appointments
• Providing a ride to appointments
• Assisting with meals
• Helping with household chores
• Handling insurance and billing issues
Learn more about caregiving.
Talking with your health care team about side effects
Before starting treatment, talk with your doctor about possible side effects. Ask:
• Which side effects are most likely?
• When are they are likely to happen?
• What can we do to prevent or relieve them?
Be sure to tell your health care team about any side effects that happen during treatment and afterward. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.
Ask how much care you may need at home with daily tasks during and after treatment. This can help you make a caregiving plan.
Uterine Cancer - Follow-Up Care
Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.
Your follow-up care may include regular physical examinations and medical tests. Doctors want to keep track of your recovery in the months and years ahead. In addition to a physical examination with a pelvic examination, follow-up care may include blood tests and x-rays. These tests may be done more frequently in the first and second year after treatment. Tell your doctor about any new symptoms, especially a loss of appetite, bladder or bowel changes, pain, vaginal bleeding, chronic cough, pain in the pelvic area, or weight changes. These symptoms may be signs that the cancer has come back or signs of another medical condition.
Learn more about the importance of follow-up care.
Watching for recurrence
One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of undetected cancer cells may remain in the body. Over time, these cells may increase until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.
The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.
Managing long-term and late side effects
Most people expect to experience side effects while receiving treatment. It is often surprising to survivors that some side effects may linger beyond the treatment period. These are called “long-term” side effects. Other side effects, called “late effects,” may develop months or even years afterwards. Long-term and late effects can include physical and emotional changes.
Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.
Keeping personal health records
You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.
This is a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.
If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you during your lifetime.
Uterine Cancer - Survivorship
What is survivorship?
The word “survivorship” means different things to different people. Common definitions include:
• Having no signs of cancer after finishing treatment.
• Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, either to reduce the risk of recurrence or manage chronic disease.
Survivorship is one of the most complicated parts of having cancer because it is different for everyone.
Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.
Survivors may feel stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.
Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:
• Understanding the challenge you are facing
• Thinking through solutions
• Asking for and allowing the support of others
• Feeling comfortable with the course of action you choose
Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.
Changing role of caregivers
Family members and friends may go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer. Like survivors, caregivers may find an in-person support group or online community helpful.
As treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will be reduced or end. Caregivers can learn more about adjusting to life after caregiving in this article.
A new perspective on your health
For many people, survivorship serves as a strong motivator to make positive lifestyle changes.
Women recovering from uterine cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Heart health is particularly important for uterine cancer survivors. It’s important to have regular physical activity to help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.
It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Regular breast and colon cancer screenings are important. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.
Talk with your GYNECOLOGIST to develop a survivorship care plan that is best for your needs.
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