Uterine cancer falls into two categories: endometrial cancer, which is more common, and uterine sarcoma, which is rare and often presents no symptoms until advanced stages. It’s important to be aware of the risk factors and symptoms of both types so you can refer patients to specialists as early as possible.
“Anyone who has a diagnosis of uterine cancer should be referred to someone who specializes in women’s cancers,” said Dr. Daniel Donato Jr., FACOG, FACS, gynecologic oncology surgeon at Rocky Mountain Cancer Centers (RMCC). “Patients who have a suspicion of uterine cancer after an inconclusive biopsy should also be referred as soon as possible. Oncologic management should begin right away after diagnosis.”
Types of Uterine Cancer
Understanding the differences between the types of uterine cancer as well as which patients are at higher risk can help lead to earlier diagnosis and improved treatment outcomes.
- Endometrial cancer: As the most common gynecologic cancer, endometrial cancer is most often diagnosed in early stages. Approximately 90% of women with endometrial cancer experience abnormal vaginal bleeding prior to diagnosis. Other symptoms include non bloody discharge, pelvic pain, a mass, and unexplained weight loss. Surgery is often the only needed treatment, although extrauterine spread at diagnosis and other factors can put some patients at higher risk of recurrence.
- Uterine sarcoma: Comprising fewer than 1% of gynecologic malignancies and only as many as 5% of uterine malignancies, uterine sarcoma is rare and more difficult to treat. Because often no symptoms are present in early stages, diagnosis frequently happens after the disease has reached a more advanced stage. When symptoms appear, they are similar to those of endometrial cancer and can also include frequent urination and constipation.
Risk Factors for Uterine Cancer
The risk of developing endometrial cancer goes up for patients with certain genetic, hormonal, lifestyle, and other risk factors.
“The biggest risk factors for uterine cancer tend to be obesity and having excess estrogen or estrogen-like components that the body can produce. Uterine cancer is typically estrogen-driven for most people,” Dr. Donato said. “Patients who are morbidly obese who have a lot of circulating estrogen-like components in their body are in the highest risk group.”
Additional risk factors include:
- Tamoxifen: Use of tamoxifen for breast cancer treatment or prevention can act like estrogen in the uterus. For postmenopausal women, tamoxifen can promote growth in the uterine lining, which can increase the risk of endometrial cancer.
- Hormone replacement therapy: Estrogen treatment used alone without progesterone for menopausal symptoms can increase the risk for cancer in women who still have a uterus.
- Age: The risk for cancer rises with increasing age.
- Number of menstrual cycles: Having a higher-than-average number of menstrual periods can increase the risk of uterine cancer, including having the first period before age 12 and/or going through menopause at a later age.
- Ovarian cancer: Granulosa cell tumors in the ovaries can sometimes lead to endometrial cancer.
- Polycystic ovarian syndrome (PCOS): Hormone imbalances from PCOS can increase cancer risk.
- Diabetes: Studies have found women with Type 2 diabetes may be twice as likely to develop endometrial cancer.
- Family history: Women who have a mother, sister, or daughter with uterine cancer are at higher risk. Genetic syndromes also increase risk. For example, those with Lynch syndrome have up to a 70% risk of developing endometrial cancer during their lifetime.
- Endometrial hyperplasia: While mild or simple hyperplasia has a slightly increased risk, atypical hyperplasia has a high chance of becoming cancer.
- High-fat diet: Some studies show consuming a lot of high-fat foods may negatively affect the way the body uses estrogen. Eating a diet heavy in fatty foods can also increase cancer risk because it leads to obesity.
Some factors, including the use of oral contraceptives or an intrauterine device and having multiple pregnancies, can lower the risk for endometrial cancer.
Unlike endometrial cancer, uterine sarcoma has only a couple of proven risk factors. These include:
- Prior pelvic radiation therapy
- Tamoxifen for breast cancer treatment
Because of the risks associated with tamoxifen, patients on this treatment should have follow-up pelvic examinations. If any abnormal uterine bleeding occurs, patients should have an endometrial biopsy.
Making a Diagnosis
While uterine cancer is most often diagnosed in women over 50, younger women can also develop the disease.
“Postmenopausal women who are morbidly obese are typically the patients in which we see uterine cancer,” Dr. Donato said. “However, even premenopausal women who are still having their periods and are morbidly obese are at increased risk of developing uterine cancer at a younger age, such as in their thirties. We do sometimes see it in young girls, typically those who are morbidly obese who don’t ovulate and have a lot of circulating estrogens.”
No routine screening test exists for uterine cancer, which means most diagnoses occur in women who present with symptoms. When a patient has abnormal bleeding or other symptoms of uterine cancer, imaging should be scheduled as soon as possible. The first step is usually a pelvic ultrasound. If anything unusual appears on the ultrasound, the next step is typically an endometrial biopsy or a dilation and curettage, if necessary.
“After diagnosis from a biopsy, we don’t typically do other imaging before we do surgery, unless other symptoms such as severe abdominal pain or shortness of breath are present and there are concerns about issues in the lungs,” Dr. Donato said. “Otherwise, we start with surgery and, depending on the surgical findings and pathology report, decide if any further imaging is necessary or develop a treatment plan.”
In many cases, especially for endometrial cancer, surgery is curative.
“It’s usually an early-stage type of cancer,” Dr. Donato said. “Tumors in the uterus are often well-differentiated, which means they are not extremely aggressive.”
However, treatment and prognosis vary depending on the stage and grade of the tumor, as well as hormone receptor status.
“About 95% of the time, surgery is part of the treatment for uterine cancers,” Dr. Donato said. “The standard of care is robotic-assisted or minimally invasive surgery. For patients who can’t tolerate surgery, radiation is an option, although radiation alone doesn’t have the best clinical outcomes. Radiation doesn’t cure the cancer, but it can help stop bleeding for a while and improve quality of life.”
Depending on the stage of the cancer, surgical options include:
- Total abdominal hysterectomy
- Bilateral salpingo-oophorectomy
- Pelvic and periaortic selective lymphadenectomy
- Resection of all gross tumor
Surgery might be accompanied by:
- Pelvic radiation therapy
- Adjuvant chemotherapy
- Adjuvant radiation therapy
“The only time we would use the chemo and radiation would be if the patient has positive lymph nodes or the cancer has otherwise spread,” Dr. Donato said. “And that doesn't happen all that often. So, the majority of uterine cancer patients are usually cured with just surgery.”
For some patients, immunotherapy is also an option.
“Immunotherapy is one of the newer treatment types available, and there is a lot of good data on their use,” Dr. Donato said. “It can be especially helpful for people who can’t tolerate chemo or any further surgical or radiation treatments. They are usually used as a second or third option for people who have failed other more traditional therapies.”
Use our online referral form to refer a patient to a gynecological surgeon at Rocky Mountain Cancer Centers today.