Uterine cancer

Uterine cancer, also known as womb cancer, includes two types of cancer that develop from the tissues of the uterus. Endometrial cancer forms from the lining of the uterus, and uterine sarcoma forms from the muscles or support tissue of the uterus. Endometrial cancer accounts for approximately 90% of all uterine cancers in the United States. Symptoms of endometrial cancer include changes in vaginal bleeding or pain in the pelvis. Symptoms of uterine sarcoma include unusual vaginal bleeding or a mass in the vagina. Risk factors for endometrial cancer include obesity, metabolic syndrome, type 2 diabetes, taking pills that contain estrogen without progesterone, a history of tamoxifen use, late menopause, and a family history of the condition. Risk factors for uterine sarcoma include prior radiation therapy to the pelvis. Diagnosis of endometrial cancer is typically based on an endometrial biopsy. A diagnosis of uterine sarcoma may be suspected based on symptoms, a pelvic exam, and medical imaging. Endometrial cancer can often be cured while uterine sarcoma typically is harder to treat. Treatment may include a combination of surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. Just over 80% of women survive more than 5 years following diagnosis. In 2015 about 3.8 million women were affected globally and it resulted in 90,000 deaths. Endometrial cancer is relatively common while uterine sarcomas are rare. In the United States, uterine cancers represent 3.4% of new cancer cases. They most commonly occur in women between the ages of 45 and 74 with a median age of diagnosis of 63.

Types The terms uterine cancer and womb cancer may refer to several different types of cancer that occur in the uterus, namely:

Endometrial cancer Endometrial carcinomas originate from cells in the glands of the endometrium (uterine lining). These include the common and readily treatable well-differentiated endometrioid adenocarcinoma, as well as the more aggressive uterine papillary serous carcinoma and uterine clear-cell carcinoma. Malignant mixed Müllerian tumors (also known as uterine carcinosarcomas) are rare endometrial tumors which show both glandular (carcinomatous) and stromal (sarcomatous) differentiation.

Uterine sarcomas Leiomyosarcomas originate from the muscular layer of the uterus (or myometrium). Of note, leiomyosarcomas are distinct from uterine leiomyomas, which are benign tumors of the uterus. Endometrial stromal sarcomas originate from the connective tissues of the endometrium, and are far less common than endometrial carcinomas.

Signs and symptoms Both types of uterine cancer can present with abnormal vaginal bleeding and discharge. Abnormalities can include change in duration or amount of menstrual bleeding as well as new bleeding between menses or after menopause. Sensations of new or increasing pelvic pressure or pain can also indicate tumor growth in the uterus. Any of these findings warrant further workup by a doctor.

Causes and risk factors It is not known with certainty what the causes for uterine cancer may be, though hormone imbalance is cited as a risk factor. Estrogen receptors, known to be present on the surfaces of cells of this type of cancer, are thought to interact with the hormone causing increased cell growth, which can then result in cancer. The exact mechanism of how this occurs is not understood. Risk factors for endometrial cancer include obesity, metabolic syndrome, type 2 diabetes, taking pills that contain estrogen without progesterone, a history of tamoxifen use, late menopause, and certain hereditary conditions (Lynch syndrome, Cowden syndrome). Risk factors for uterine sarcoma include prior radiation therapy to the pelvis, a history of childhood retinoblastoma, and hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome.

Diagnosis To evaluate for uterine cancer, a clinician might perform a pelvic exam to visually inspect internal pelvic organs and to feel the size and position of the uterus and ovaries. A pap smear may also be done to brush the sides of the cervix to collect cells for testing and to look at under a microscope. A dilatation and curettage is often done to collect a sample of uterine lining tissue. An ultrasound is also often performed to look for tumors.

Screening and prevention Screening for uterine cancers is not recommended except for in women with certain hereditary conditions that increase their risk (Lynch, Cowden, HLRCC). In general, combined oral contraceptive pills and progestin-only pills are protective against uterine cancers. Weight loss and/or bariatric surgery reduces the risk for patients with obesity.

Treatment Treatment of uterine cancer may differ depending on the type of cancer and staging of the tumor. In early stages, minimal invasive surgery is preferred. For endometrial cancer, five main types of treatments are used, including surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. The most common treatment modality for endometrial cancer is surgery, whereby the uterus is removed via a total hysterectomy. Hysterectomies may also be accompanied by removal of ovaries and fallopian tubes, called a salpingo-oophorectomy. Additionally, hormone therapy which seeks to block the growth of cancer cells may also be used in the treatment of endometrial cancer. Targeted therapy may include monoclonal antibodies, mTOR inhibitors, and signal transduction inhibitors which all act to target cancer cells specifically. As of 2021, treatment options for uterine sarcoma include surgery, radiation therapy, chemotherapy, and hormone therapy.

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