Uterine cancer is a type of malignancy that originates in the tissues of the uterus, a pear-shaped organ in the female reproductive system. It is the fourth most common cancer in women worldwide and the most frequently diagnosed gynecologic cancer in the United States. Uterine cancer primarily includes two types: endometrial cancer, which arises from the inner lining of the uterus (endometrium), and uterine sarcoma, which develops in the muscle or other supporting tissues of the uterus.

This comprehensive article explores the types, causes, risk factors, symptoms, diagnostic procedures, treatment options, and preventive strategies for uterine cancer.

Types of Uterine Cancer

1. Endometrial Cancer

  • Definition: Cancer that originates in the endometrium, the inner lining of the uterus.
  • Subtypes:
    1. Endometrioid Adenocarcinoma: Most common and typically linked to excess estrogen.
    2. Clear Cell and Serous Carcinoma: More aggressive and less common forms.

2. Uterine Sarcoma

  • Definition: A rare type of cancer that forms in the muscle (myometrium) or connective tissues of the uterus.
  • Subtypes:
    1. Leiomyosarcoma: Arises from smooth muscle tissue.
    2. Endometrial Stromal Sarcoma: Develops in the supportive connective tissue.
    3. Undifferentiated Sarcoma: Highly aggressive and less differentiated.

Causes and Risk Factors

Causes

While the exact cause of uterine cancer is not fully understood, it is believed to result from genetic mutations that lead to uncontrolled cell growth in the uterus.

Risk Factors

  1. Hormonal Imbalances:
    • Prolonged exposure to estrogen without adequate progesterone.
    • Conditions like polycystic ovary syndrome (PCOS) and estrogen-only hormone replacement therapy.
  2. Age:
    • Most cases occur in women aged 50 and above.
  3. Obesity:
    • Excess body fat increases estrogen levels.
  4. Family History:
    • Genetic predisposition, including Lynch syndrome and mutations in genes like MLH1, MSH2, and MSH6.
  5. Reproductive History:
    • Nulliparity (never having given birth) and early menarche or late menopause.
  6. Chronic Conditions:
    • Diabetes, hypertension, and endometrial hyperplasia.
  7. Lifestyle Factors:
    • Sedentary lifestyle, high-fat diet, and excessive alcohol consumption.
  8. Radiation Therapy:
    • Previous pelvic radiation increases the risk of uterine sarcoma.

Symptoms of Uterine Cancer

Common Symptoms

  1. Abnormal vaginal bleeding or spotting (postmenopausal bleeding is a hallmark sign).
  2. Pelvic pain or discomfort.
  3. Painful urination or difficulty emptying the bladder.
  4. Unusual vaginal discharge.
  5. Enlarged uterus or palpable mass.

Advanced Symptoms

  1. Pain during intercourse.
  2. Fatigue and unexplained weight loss.
  3. Swelling in the abdomen or legs.
  4. Anemia due to chronic blood loss.

Diagnosis

Medical History and Physical Examination

  1. Patient History:
    • Assessment of symptoms, family history, and risk factors.
  2. Pelvic Examination:
    • Inspection and palpation of the uterus, ovaries, and surrounding tissues.

Diagnostic Tests

  1. Transvaginal Ultrasound:
    • High-frequency sound waves to visualize the uterus and detect abnormalities in the endometrial lining.
  2. Endometrial Biopsy:
    • Collection of tissue samples from the endometrium for histopathological examination.
  3. Hysteroscopy:
    • A camera-equipped device inserted into the uterus to examine the endometrium and obtain biopsies.
  4. Dilation and Curettage (D&C):
    • A surgical procedure to scrape and analyze endometrial tissue.

Imaging Studies

  1. Magnetic Resonance Imaging (MRI):
    • Provides detailed images of the uterus and surrounding structures.
  2. Computed Tomography (CT) Scan:
    • Assesses cancer spread to other organs.
  3. Positron Emission Tomography (PET) Scan:
    • Detects metastatic disease using a radioactive tracer.

Laboratory Tests

  1. CA-125 Blood Test:
    • Elevated levels may indicate advanced or recurrent disease.
  2. Genetic Testing:
    • Evaluates for hereditary cancer syndromes like Lynch syndrome.

Staging and Grading

Staging

Uterine cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) system:

  1. Stage I: Cancer is confined to the uterus.
  2. Stage II: Cancer has spread to the cervix but not beyond the uterus.
  3. Stage III: Cancer has spread to the ovaries, fallopian tubes, or nearby lymph nodes.
  4. Stage IV: Cancer has spread to distant organs such as the bladder, rectum, or lungs.

Grading

  • Based on how much tumor cells resemble normal cells:
    1. Grade 1: Well-differentiated (low-grade).
    2. Grade 2: Moderately differentiated.
    3. Grade 3: Poorly differentiated (high-grade).

Treatment Options

Surgery

  1. Hysterectomy:
    • Removal of the uterus, often including the ovaries and fallopian tubes (total or radical hysterectomy).
  2. Lymphadenectomy:
    • Removal of lymph nodes to check for cancer spread.
  3. Minimally Invasive Surgery:
    • Laparoscopic or robotic-assisted techniques.

Radiation Therapy

  1. External Beam Radiation Therapy (EBRT):
    • Targets cancer cells using high-energy beams.
  2. Brachytherapy:
    • Internal radiation delivered directly to the uterus.

Chemotherapy

  1. Drugs Used:
    • Paclitaxel, carboplatin, and doxorubicin.
  2. Indications:
    • For advanced or recurrent cancer.

Hormone Therapy

  1. Progestins:
    • Synthetic progesterone to counteract estrogen.
  2. Aromatase Inhibitors:
    • Reduce estrogen production.
  3. Selective Estrogen Receptor Modulators (SERMs):
    • Block estrogen receptors in cancer cells.

Targeted Therapy and Immunotherapy

  1. Targeted Drugs:
    • Bevacizumab (inhibits blood vessel formation).
  2. Immunotherapy:
    • Pembrolizumab (checkpoint inhibitor for mismatch repair-deficient tumors).

Prognosis

Survival Rates

  • Endometrial Cancer:
    • 5-year survival rate is over 90% for early-stage disease.
  • Uterine Sarcoma:
    • Prognosis is generally poorer due to aggressive nature and late-stage diagnosis.

Factors Influencing Prognosis

  1. Stage at diagnosis.
  2. Tumor grade and histological subtype.
  3. Patient’s overall health and response to treatment.

Prevention Strategies

  1. Maintain a Healthy Weight:
    • Reduces excess estrogen production.
  2. Manage Chronic Conditions:
    • Control diabetes and hypertension.
  3. Use Contraceptives:
    • Combined oral contraceptives reduce endometrial cancer risk.
  4. Regular Screenings:
    • Especially for women with a family history of cancer or genetic predisposition.
  5. Lifestyle Modifications:
    • Avoid smoking, limit alcohol, and adopt a balanced diet rich in fruits and vegetables.

Future Directions in Uterine Cancer Management

Research Innovations

  1. Molecular Profiling:
    • Identifying genetic mutations for personalized treatments.
  2. Novel Therapies:
    • Development of new immunotherapies and targeted drugs.

Public Health Initiatives

  • Raising awareness about early symptoms and risk factors.
  • Improving access to gynecologic care in underserved populations.

Uterine cancer is a significant health concern, but advances in early detection, treatment, and prevention offer hope for improved outcomes. Awareness of risk factors, symptoms, and timely medical attention are crucial for early diagnosis and successful management. Continued research and public health efforts will further enhance the quality of care and survival rates for women worldwide.

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Last Update: December 26, 2024