Uterine Cancer

By far, the most common kind of cancer that occurs in the uterus is cancer of the lining of the uterus, called the endometrium (also known as endometrial cancer, or adenocarcinoma). It is the most common gynecologic cancer, and the most treatable. It is typically diagnosed fairly early, because it presents as abnormal bleeding. Ninety percent of women diagnosed with uterine cancer are cured completely.

Risk Factors for Uterine Cancer

Any condition that increases your estrogen, relative to progesterone, will put you at risk for endometrial cancer. An estrogen dominant state is the main cause of endometrial cancer, and is associated with, or caused by, the following conditions:

1. obesity
2. insulin resistance/diabetes
3. polycystic ovarian syndrome (PCOS)
4. use of exogenous estrogen without progesterone
5. irregular/infrequent spontaneous menses
6. infertility
7. never having a pregnancy
8. history of hypertension, gall bladder disease, thyroid disease
9. personal or family history of breast, ovarian or colon cancer
10. early onset of menses
11. late menopause
12. cigarette smoking
13. endometrial hyperplasia/atypia (precancer of the uterus)

Symptoms

Abnormal bleeding is the main symptom of endometrial cancer. It is rare in women under 40, although becoming somewhat more common in the current obesity epidemic. The average age at diagnosis is 60 years. Being alert for abnormal bleeding, or changes in your menstrual pattern, is the best way to find endometrial cancer. There isn't a screening test and this doesn't show up on a PAP. Any postmenopausal bleeding should be considered endometrial cancer until proven otherwise, by biopsy.

Diagnosis

Diagnosis is made by biopsy. Tests for endometrial cancer may include some or all of the following:

1. Pelvic ultrasound. After menopause, the lining of the uterus shouldn't be more than 5mm thick.
2. Endometrial biopsy - this is done by placing a thin straw like device through the cervix (the part of the uterus that extends into the vagina, and into the uterine cavity, and using suction to obtain some cells from the lining of the uterus.
3. Hysteroscopy is a test in which a small telescopic camera is used to let the physician have a look inside the uterus and obtain a targeted sample of the uterine lining. It can also be used to remove a specific polyp that may be of concern.
4. Dilation and curettage (D&C) is a test in which the cervix is dilated and the lining of the uterus is gently curetted to obtain a sample of the lining.

Treatment

Treatment is often surgical, and usually as simple as removing the uterus, a procedure called open hysterectomy. Occasionally these hysterectomy may be performed vagianlly or laparoscopically. Depending on the grade of the cells on the endometrial biopsy, lymph node sampling may be done as well. If the cancer is more widespread, then radiation may be done as well.

Prevention

1. Have a regular annual exam
2. Avoid excess weight and treat metabolic syndrome and insulin resistance/PCOS or any other condition causing you to be estrogen dominant
3. Avoid prolonged exposure to estrogen without a progesterone or progestin
4. Oral contraceptives (low dose) reduce your risk.

More Information

More information on uterine cancer can be found in the ACOG Brochure called Cancer of the Uterus or through a very well written ACOG Publication called Protect and Detect