Uterine Cancer: Frequently Asked Questions

Here are some answers to some of the more common questions people ask about uterine cancer.

Q: What is the uterus?

A: The uterus is a hollow, pear-shaped organ, also known as the womb. It is located in a woman's pelvis between the bladder and rectum. Fallopian tubes on both sides of the uterus connect it to each ovary. The bottom part of the uterus is called the cervix. The cervix connects the uterus with the vagina. The middle round part of the uterus is called the corpus. The round part at the top of the uterus is called the fundus. The uterus is part of a woman's reproductive system. It holds a developing fetus during pregnancy.

The walls of the uterus are made up of three layers:

• Endometrium. This is the inner layer or lining of the uterus.

• Myometrium. This is the middle layer. It's the thick muscle layer.

• Serosa. This is the outer layer of tissue coating the uterus.

Q: What causes uterine cancer?

A: All the causes of uterine cancer are not known. Doctors believe that hormones that are out of balance often cause the type of uterine cancer called endometrial carcinoma. The ovaries make most of the female hormones estrogen and progesterone. If the uterus is exposed to too much estrogen over a long period of time, cancer cells may develop.

Q: What are the types of uterine cancer?

A: There are two main kinds of uterine cancer. They are named based on where they occur in the uterus:

• Endometrial carcinoma. This is by far the most common form of uterine cancer. Cancer that starts in tissues that form linings throughout the body is called carcinoma. Endometrial carcinoma is cancer that starts in the inner lining of the uterus called the endometrium. The endometrium is the tissue in the uterus that thickens every month so that it will be ready to receive a fertilized egg. If the egg is not fertilized, it passes through the uterus and the endometrium sheds through the vagina. This is menstruation or monthly periods.

• Uterine sarcoma. Cancer may also occur in the other tissues of the uterus besides the endometrium, such as in the muscle (myometrium). The myometrium works mainly during labor to help push the baby through the cervix and vagina. Other areas in which cancer can start are in the connective tissues or in the outer layer. Cancer in any of these tissues of the uterus is called sarcoma. This is a much less common form of uterine cancer.

Q: What are the symptoms of uterine cancer?

A: These are the most common symptoms of uterine cancer:

• Unusual bleeding, spotting, or discharge from the vagina

• Any bleeding from the vagina after menopause

• A mass or tumor in the lower abdomen (belly) that can be felt

• Pain in the pelvic area or lower abdomen (belly)

• Unexplained weight loss

These symptoms may be caused by uterine cancer or several other less serious health problems. If you notice any of them, talk with your doctor right away.

Q: What are the risk factors for uterine cancer?

A: Certain factors can make you more likely to get uterine cancer. These are called risk factors. But just because you have one or more risk factors does not mean you will definitely get uterine cancer. In fact, you can have all the risk factors and still not develop the disease. Or you can have no risk factors and still get uterine cancer. Here are the main risk factors for uterine cancer. Many of these risk factors are for endometrial carcinoma. These risks involve having too much exposure to the hormone estrogen:

• Tamoxifen use. Tamoxifen is a drug used to treat women who have breast cancer and is used to help prevent breast cancer in women at high risk. Women who take tamoxifen have a higher risk of getting uterine (endometrial) cancer.

• Estrogen therapy. Women who use estrogen therapy without also using progesterone have a higher chance of getting uterine (endometrial) cancer.

• Endometrial hyperplasia. Women who have endometrial hyperplasia have a higher risk of getting uterine (endometrial) cancer. Endometrial hyperplasia means that there are more cells than there should be in the lining of the uterus. This is called a precancerous condition because it might turn into cancer. Women with endometrial hyperplasia may have unusual bleeding.

• Obesity. Women who are obese get uterine (endometrial) cancer 3 times more often than women who are not obese. Obesity is a leading risk factor for endometrial cancer. Health conditions linked to obesity, such as diabetes, also increase your risk.

• Early menstruation. Women who had their first period before they were 12 have a higher risk for uterine (endometrial) cancer.

• Late menopause. Women who reach menopause after age 50 have a higher risk for uterine (endometrial) cancer.

• Older age. Most women who get uterine (endometrial) cancer are older than age 50.

• Family history of uterine (endometrial) cancer. Women with family members who have had uterine or colon cancer are more likely to get it.

• Race. African-American women have a higher chance of getting uterine cancer (sarcoma) than white or Asian women.

• No pregnancies. Women who have never been pregnant have a higher chance of uterine (endometrial) cancer.

• Previous radiation therapy to the pelvis. If you have had pelvic radiation in the past, your risk for developing uterine cancer (sarcoma and endometrial) is increased.

• Polycystic ovarian syndrome (PCOS). Women with PCOS have abnormal hormone levels. These imbalances can increase the risk of uterine (endometrial) cancer.

• Other cancers. Women who have had ovarian, colon, rectal, or breast cancer have a higher chance of getting uterine (endometrial) cancer.

Q: Why does obesity increase the risk for uterine cancer?

A: When you're obese, you have more fatty tissue in your body. Fatty tissue can change other hormones into estrogen. And the more estrogen your uterus is exposed to, the greater your risk is of developing endometrial carcinoma.

Q: How can I reduce my risk for uterine cancer?

A: You can reduce your risk for uterine cancer by avoiding as many risk factors as possible. For example, eating well and exercising regularly may help you stay at a healthy weight. Many other steps can help lower your risk for endometrial carcinoma. Talk with your health care team about your risk for uterine cancer and steps you can take to help lower your risk.

Q: What screening tests are available for uterine cancer?

A: There is no standard screening test to find uterine cancer. A Pap smear, a test routinely used to find cervical cancer, is not very useful in finding uterine cancer. If you're at high risk for endometrial carcinoma, talk with your doctor about screening tests that might be used.

Q: How is a diagnosis of uterine cancer made?

A: The symptoms linked to uterine cancer can also be caused by less serious problems. To find the cause of any of these symptoms, the doctor asks you about your health history and your family medical history. He or she does a careful physical exam. This includes a pelvic exam and Pap test. This test does not show if a woman has uterine cancer because it checks cells in the cervix, not the uterus. But it can help make sure you don't have another problem with similar symptoms.

The doctor may order a biopsy to help make a diagnosis. During a biopsy, the doctor removes some tissue from the inner uterine lining called the endometrium. This can usually be done in the doctor's office with no or little anesthetic. Another type of biopsy is dilation and curettage (D&C). This involves scraping tissue from different parts of the lining of the uterus. A D&C is usually done in a surgery center or hospital.

Imaging tests, such as ultrasound or MRI, are used to look at pictures of the uterus and see if there's a tumor or mass present, and whether it's in the lining or muscle wall.

Q: If I have uterine cancer, will I need a hysterectomy?

A: Surgery to take out the uterus, called a hysterectomy, is the main way to treat most types of uterine cancer. Sometimes, a hysterectomy can get rid of all the cancer in your body. This is especially true for early stages of endometrial carcinoma. While removing your uterus, your surgeon will usually take out your fallopian tubes and ovaries to stop the production of estrogen. This helps slow or stop the spread of uterine cancer. Typically, lymph nodes are also removed, to check for the possibility that the cancer has spread. You may have other treatments before or after surgery. These include radiation, hormone therapy, or chemotherapy.

Q: What is staging of uterine cancer?

A: Staging is a way to describe how large the cancer is and how far the cancer has spread. Finding the stage of uterine cancer helps your doctor determine the best treatment for you. For uterine cancer, these are the four stages:

• Stage I. Stage I uterine cancer is only in the uterus. It is not in the cervix.

• Stage II. Stage II cancer means that there are also cancer cells in the cervix, but the cancer has not spread to lymph nodes or other organs. 

• Stage III. Stage III cancer has spread outside of the uterus to nearby areas, such as the ovaries and the vagina, but it is still only in the pelvic area.

• Stage IV. This means that the cancer has spread beyond the pelvis to other parts of the body, such as lungs, liver, bone, or brain.

Q: What are the treatments for uterine cancer?

A: Treatments for uterine cancer include surgery, radiation therapy, hormone therapy, and chemotherapy:

• Surgery is the most common treatment for women with uterine cancer. Your doctor will likely take out your uterus and will usually take out the fallopian tubes, ovaries, and nearby lymph nodes. How much is removed depends on the size of the tumor, what the cancer cells look like, and how the cancer has spread.

• Radiation is another way to treat uterine cancer. For this treatment, X-rays are used to kill cancer cells. Radiation is often used after surgery to kill any cancer cells that may have been left behind.

• Hormone therapy is when medicines are used to keep the cancer cells from getting the hormones they need to grow. The medicines are given by mouth or by injection. They travel through the body in the blood. The medicines control the cancer cells that are both inside and outside the uterus. Hormone therapy may be used to be sure that cancer cells don't spread. It may also help to ease symptoms when cancer is advanced (has spread).

• Chemotherapy is the use of anticancer medicine to kill cancer cells. Chemotherapy may be used to be sure all the cancer cells have been killed. Or when cancer is advanced, chemotherapy can help ease symptoms. The medicine may be given by mouth or by injection. Either way, the medicine travels throughout the body in the bloodstream.

Q: Should everyone get a second opinion for a diagnosis of uterine cancer?

A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. Here are some of those reasons:

• You don't feel comfortable with the treatment decision.

• The type of cancer is rare, such as with uterine sarcoma.

• There are different ways to treat the cancer.

• You aren't able to see a cancer expert.

Q: How can someone get a second opinion?

A: There are many ways to get a second opinion:

• Get treated by a gynecologic oncologist. This subspecialist has advanced training in the diagnosis and treatment of gynecologic cancers. 

• Ask your primary doctor. Your doctor may be able to recommend a specialist. This may be a gynecological oncologist, surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Do not be afraid to ask your doctor about a second opinion.

• Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Seek other options. Check with a local medical society, a nearby hospital or medical school, or a local cancer advocacy group to get names of doctors who can give you a second opinion. Or ask other people who have had cancer to refer you to someone.

Q: What kind of checkups will I need after being treated for uterine cancer?

A: After treatment for uterine cancer, you'll most likely visit the doctor every three months for the first year after treatment. Then you may need checkups every six months for the next five years. After that, you may need yearly checkups. Checkups may include pelvic exams, Pap tests, and other tests, such as blood and urine tests. You may need imaging studies, such as CT scans, ultrasounds, and X-rays. Tell your doctor if you have any pain, leg swelling, and vaginal bleeding. Be sure to mention any other changes you notice in your health.

Q: Are there support groups for women with uterine cancer?

A: Yes. Support groups for women dealing with uterine cancer are held all over the United States. Having someone to talk with who is going through similar experiences is often helpful. Support groups also offer you information on treatment options, prognosis, and follow-up care. Your doctor can recommend one in your area.

Q. What are clinical trials?

A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies get to use treatments before the FDA approves them. People who join trials also help researchers learn more about cancer and help people who may develop cancer in the future.