Know the Facts: Uterine Cancer

Cancer occurs when cells in an area of the body grow abnormally. The endometrium is the lin­ing layer of the uterine cavity where most uterine cancers begin. In endometrial cancer, the most com­mon type of uterine cancer, cells in the endometrial lining grow out of control, may invade the muscle of the uterus, and sometimes spread beyond the uterus, most often to the ovaries, lymph nodes, or abdomen.

A uterine sarcoma is a type of uterine cancer in which malignant cells form in the muscle of the uterus (leiomyosarcoma) or in the network of support cells in the uterine lining (stromal sarcoma). Only about 5 percent of uterine cancers are uter­ine sarcomas, but they tend to have more-aggressive clinical behavior and can spread quickly.

Risk Factors

Risk factors for endometrial can­cer include diabetes, hyperten­sion, tamoxifen use, later age of menopause (after age 52), and the use of estrogen without progester­one. About 75 percent of women diagnosed with endometrial can­cer have already undergone meno­pause. One of the strongest and most common risk factors for the development of endometrial cancer, however, is obesity. Women who are obese have higher circulating levels of estrogen, which increases the risk for endometrial cancer.

Heredity also plays a role in a small percentage of women with endome­trial cancer. Some families (such as Camille Grammer’s—see “Share the Story” on page 40) have a high frequency of endometrial, colon, and ovarian cancer. If you have rel­atives with endometrial, colon, and/ or ovarian cancer, discuss this with your physician. If your family his­tory suggests an increased risk of a hereditary cancer syndrome, referral to a specialist in cancer genetics or a healthcare provider with expertise in genetics is recommended.

Symptoms

The most common warning sign for uterine cancer, including endo­metrial cancer, is abnormal vagi­nal bleeding. Recognizing this key symptom can provide an opportu­nity for early diagnosis and treat­ment. In older women any bleeding after menopause may be a symptom of endometrial cancer. Younger women are also at risk and should note irregular or heavy vaginal bleeding, as these can be symptoms of endometrial cancer.

The following symptoms may be caused by endometrial cancer or by other conditions and warrant a dis­cussion with your healthcare pro­vider:

• Vaginal bleeding or spotting after menopause
• New onset of heavy menstrual periods or bleeding between periods
• A watery pink or white dis charge from the vagina
• Two or more weeks of persistent pain in the lower abdomen or pelvic area
• Pain during sexual intercourse

Treatment

If you suspect or have been diag­nosed with endometrial cancer, con­sultation with a gynecologic oncolo­gist is strongly recommended. These are the only physicians specifically trained to understand the nuances of endometrial cancer care, and cur­rent data suggest that management by a gynecologic oncologist results in improved outcomes.

Endometrial cancer may be treated with surgery, radiation therapy, che­motherapy, or hormonal therapy. Depending on your situation, your treatment team may recommend using a combination of treatments.

All treatments for endometrial cancer have side effects, but many can be managed or avoided. Treat­ments may affect unexpected parts of your life, including your func­tion at work and home, your inti­mate relationship, and your deeply personal thoughts and feelings.

Before beginning treatment it is important to learn about the possi­ble side effects and talk with your treatment team about your con­cerns. They can prepare you for what to expect and tell you which side effects should be reported to them immediately. They can also help you find ways to manage the side effects you experience.

The Foundation for Women’s Cancer urges all women to take the following steps.

• Learn the symptoms.
• Listen to your body.
• Act by getting regular checkups; report all unusual symptoms that persist for more than two weeks; and seek care from a gynecologic oncologist—a specialist with an additional seven years of training—for the best outcomes.

The foundation offers educational materials that explore this topic in more depth. For more information on risks, prevention, and treatment of all gynecologic cancers, please visit foundationforwomenscancer.org.

Chad Hamilton, MD, completed his fellowship in gynecologic oncology at Stanford University and the Uni­versity of California, San Francisco. He currently serves as the gyneco­logic oncology service chief and Fel­lowship Program director at Walter Reed National Military Medical Center in Bethesda, Maryland. He is a committee chair for the Society of Gynecologic Oncology, a subspe­cialty board examiner for the Amer­ican Board of Obstetrics and Gyne­cology, and a strong supporter of the Foundation for Women’s Cancer and its National Race to End Wom­en’s Cancer. This article represents the views of the author and should not be construed as reflecting the official views of the Department of Defense.