Signs and Symptoms of Uterine Cancer to Know

Uterine cancer, most commonly in the form of endometrial cancer, is a serious but often treatable condition. It primarily affects women over 50, with symptoms like unusual bleeding making early detection possible. In this article, we’ll discuss what uterine cancer is, how it’s diagnosed, and the treatment options available to help women get the best possible outcome.

What is Uterine Cancer? 

Uterine cancer is a gynecologic cancer in which cancer cells develop in the uterus or womb. The uterus is a hollow, pear-shaped organ of the female reproductive system where the fetus develops and the baby grows during pregnancy.

Each year, about 65,000 women receive a diagnosis of uterine cancer in the United States. According to the American Cancer Society, National Cancer Institute, and National Comprehensive Cancer Network, the prognosis (outlook) for uterine cancer is generally good, especially with early detection. A hysterectomy (surgical removal of the uterus) is usually the main approach to treat uterine cancer.

Uterine cancer, also called uterine neoplasms, includes two types of cancer:

• Endometrial cancer begins in the endometrium (the inner lining of the uterus). This is the more common type of uterine cancer, making up for about 95% of uterine cancer cases.

• Uterine sarcoma develops in the myometrium (the muscular wall of the uterus)  Uterine sarcoma is much rarer than endometrial cancer. 

Uterine vs. Endometrial Cancer  

As mentioned, there are two main types of uterine cancer: endometrial cancer and uterine sarcoma. However, endometrial cancer is often referred to as uterine cancer because it makes up 95% of all uterine cancer cases. 

Uterine vs. Cervical Cancer 

The cervix is the lower and narrow part of the uterus connecting to the vagina; it provides the birth canal and allows fluid (such as menstruation) to move from the uterus into the vagina. 

As mentioned, uterine cancer refers to cancer that occurs in the uterus. Although the cervix is part of the uterus, cancer affecting the cervix is specifically called cervical cancer, which develops in the cells lining the cervix.

Symptoms and Warning Signs  

Common Symptoms

Signs and symptoms of uterine cancer include:

• Unusual bleeding or spotting between periods before menopause.

• Heavy, prolonged, frequent, or irregular vaginal bleeding in women over 40.

• Abnormal bleeding or spotting (even a small amount) after menopause.

• Lower abdominal pain or pelvic cramps.

• Thin, white, or clear vaginal discharge in postmenopausal women.

What Are the First Signs of Endometrial Cancer?  

The most common first sign of uterine cancer is unusual vaginal bleeding happening between periods or bleeding after menopause. Because uterine cancer usually presents with these early symptoms, it is often detected in the early stages when it is more treatable.

Importance of Early Detection  

It’s important to seek timely medical care for any unusual symptoms, such as abnormal vaginal bleeding. Early detection of uterine cancer can significantly improve treatment outcomes and survival rates.

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Causes and Risk Factors  

Causes of Uterine Cancer  

The exact cause of uterine cancer is unknown. However, scientists believe that endometrial cancer starts when mutations (changes) occur in the DNA (genetic material) of the glandular cells in the endometrium (inner lining of the uterus). This mutation causes the cells to grow and multiply uncontrollably, leading to the formation of a tissue mass called a tumor.  

A malignant (or cancerous) tumor can invade surrounding tissues and spread to other body parts through a process called metastasis.

What Are The Risk Factors For Uterine Cancer?

Certain people are at increased risk of uterine cancer. Risk factors include:

• Obesity (often associated with a high-fat diet)

• Polycystic ovary syndrome (PCOS)

• Taking estrogen by itself (estrogen-only hormone replacement therapy without progesterone) )

• Ovarian tumors, which are associated with high estrogen and progesterone levels

• Endometrial hyperplasia is an increased growth of the endometrium. Atypical hyperplasia is associated with a higher risk of becoming cancerous

• Metabolic syndrome

• A long menstruation span (number of years of menstrual periods). This can be due to:

  • Early menarche (start of menstruation before age 12)

  • Late menopause (stopping of menstruation after age 50)

• Never being pregnant

• Radiation therapy to the pelvis

• Tamoxifen, a drug used to treat breast cancer, which has estrogen-like effects on the uterus

• First-degree relative with a history of endometrial cancer

• Race: Black and Hispanic people have a higher risk for the development of endometrial cancer and for developing more aggressive tumors

Age

The chances of developing uterine cancer increase with age. While premenopausal women and women under 45 years of age can develop this type of cancer, it is uncommon in this age group. Most uterine cancers are diagnosed in women over 50.

Family History/Genetic Conditions   

Genetic conditions such as Lynch syndrome occur due to a cancer-causing gene that is passed from a parent to their child. People with Lynch syndrome or hereditary nonpolyposis colorectal cancer (HNPCC) and Cowden Syndrome have a higher risk of endometrial cancer and other cancers, such as colon cancer. The cancers also tend to occur at a younger age.

How is Uterine Cancer Diagnosed?  

If your healthcare professional suspects endometrial cancer based on your medical history, symptoms, physical exam, and pelvic exam, they may order the following diagnostic tests:

• Blood tests such as a CA-125 assay. This test looks for a protein found on the surface of cancer cells; it is often present at high levels in people with endometrial cancer.

• Imaging tests such as transvaginal ultrasound, CT (computed tomography) scans, and MRI (magnetic resonance imaging) scans.

• Endometrial biopsy to obtain a small sample of tissue from your uterus for examination in the laboratory. The test is done using a thin, flexible tube inserted into the uterus.

• Hysteroscopy is used to obtain detailed images of the uterus by inserting a hysteroscope (a thin tube-like instrument) through the vagina, cervix, and into the uterus.

• Dilatation and curettage (D&C), a more invasive procedure, is done to remove uterine lining tissue. It is done in the operating room.

Note: A Pap test cannot detect uterine cancer. This test looks for cervical cancer.

A definitive diagnosis of uterine cancer can only be made with an endometrial biopsy (a test in which a small sample of endometrial tissue is removed and examined under the microscope in the laboratory). Sometimes, doctors cannot determine the stage of the cancer until you have surgery to treat endometrial cancer.

Stages of Uterine Cancer

Knowing the type and stage of uterine cancer can help your healthcare team plan treatment. 

• Type 1 endometrial cancer is less aggressive and does not spread quickly. This type is “estrogen-dependent,” meaning it is related to estrogen exposure

• Type 2 endometrial cancer is more aggressive and more likely to spread outside the uterus and, therefore, needs more aggressive treatment. This type is not estrogen-dependent, meaning it is not related to estrogen exposure.

The stage of uterine cancer tells doctors how far it has spread. 

• Stage I uterine cancer is limited to the uterus.

• Stage II uterine cancer has spread to the cervix.

• Stage III uterine cancer has spread to the vagina and surrounding organs such as the fallopian tubes, ovaries, and/or lymph nodes.

• Stage IV uterine cancer has spread to the uterine bladder or other distant organs and/or lymph nodes.

How Do Doctors Treat Cancer of the Uterus?

Surgery

Hysterectomy surgery is the most common treatment for uterine cancer. Most people with uterine cancer require the removal of the uterus, fallopian tubes, and ovaries. The procedure is called a total hysterectomy and bilateral salpingo-oophorectomy (TH/BSO). Variations of the procedure approach include a minimally invasive hysterectomy, vaginal hysterectomy, total abdominal hysterectomy, or radical hysterectomy. 

The surgeon may also do a lymph node dissection (removal of tissue from a lymph node to evaluate under the microscope) if there is evidence of cancer cells in nearby lymph nodes. Additional treatments may include pelvic washings, which are utilized to better study the cells in the pelvic cavity. During this procedure, the pelvic cavity is flooded with sterile saline and then drained. The cells that are collected in the drained fluid are then studied for evidence of cancer. 

Radiation Therapy

Doctors can use targeted beams of radiation to destroy cancer cells. This can be in the form of external radiation or vaginal brachytherapy (placing a radioactive source in the vagina). Women who want to keep their uterus to preserve fertility or those who are not healthy enough to undergo surgery may receive radiation therapy for uterine cancer. Radiation therapy is also offered to women with high-grade uterine tumors after surgery to kill any remaining cancerous cells. 

Chemotherapy  

For women with advanced uterine cancers, the oncology care team may recommend chemotherapy and/or radiation therapy after surgery to prevent the recurrence of the cancer. Chemotherapy drugs used for treating uterine cancer include carboplatin and paclitaxel.

Hormone Therapy

The use of hormones to alter the growth rate of endometrial tumors is sometimes utilized when attempting to maintain fertility. For example, progestin can slow the growth of endometrial tumors and is the primary hormonal treatment utilized when an individual may try to get pregnant in the future. However, all hormonal treatment requires close monitoring. Surgery is done after pregnancy occurs and childbearing is complete.

Other Treatments

Immunotherapy and targeted drugs may be options for some people with advanced uterine cancer. Immunotherapy helps the body’s immune system find and kill cancerous cells, while targeted therapy targets certain features of cancer cells. People with stage IV uterine cancer can consider participating in clinical trials for new treatments.

Managing Side Effects of Treatment  

If you have been diagnosed with uterine cancer, it helps to know the side effects of cancer treatment, so you know what to expect and can work with your healthcare team to manage them. It’s worth noting that everyone responds differently to treatment, and your side effects may not be the same as someone else who took the same treatment.

Medications are available to treat the common side effects of chemotherapy treatments, such as fatigue, nausea, vomiting, diarrhea, hair loss, and low blood cell counts. Newer targeted drugs cause fewer side effects.

Side effects of hormonal therapy can include fluid retention, hot flashes, night sweats, blood clots (rare), increased appetite, and weight gain. 

Women who undergo hysterectomy (surgical removal of the uterus) will no longer have menstrual periods and cannot get pregnant. If the ovaries are also removed, there is immediate menopause due to the removal of estrogen-producing ovaries. As a result, individuals may experience symptoms associated with menopause, including temperature dysregulation (hot flashes, night sweats), vaginal dryness, mood changes, weight gain, and more. Symptoms associated with surgical menopause are often more severe than natural menopause. Your healthcare provider can prescribe treatments to relieve these symptoms.

Survival Rates and Prognosis   

A 5-year relative survival rate compares women with endometrial cancer to the general population. For example, if the 5-year relative survival rate for stage I endometrial cancer is 90%, it means that women who have stage 1 endometrial cancer are, on average, 90% as likely to live for 5 years after the diagnosis compared to healthy women who don’t have endometrial cancer.

Factors Affecting Prognosis 

The prognosis (outlook), life expectancy, and survival rate for uterine cancer depend on the type and stage of the cancer. 

What Is The Survival Rate of Endometrial Cancer?

The relative 5-year survival rate for endometrial cancer is as follows:

• Localized cancer limited to the uterus: 95%

• Cancer with regional spread to nearby organs: 70%

• Cancer with spread to distant organs: 19%

• All stages combined: 81%

How Curable Is Endometrial Cancer?

Endometrial cancer is highly curable, especially when diagnosed and treated early, with surgery often being the primary treatment. 

Can You Live A Long Life After Uterine Cancer?

Yes, you can live a long life after uterine cancer, provided the cancer is diagnosed and treated early.

Recovery and Follow-Up Care 

Your doctor will recommend regular follow-up visits after uterine cancer treatment, initially every 3-6 months for the first 2-3 years, then every 6-12 months for up to 5 years, and then annually. At these visits, your doctor will perform a physical exam and order imaging studies, such as a CT scan of the abdomen and pelvis, to look for signs of recurrent disease.

Seek immediate medical care for signs of cancer recurrence, such as:

• Abnormal bleeding from the vagina

• Unexplained weight loss

• Pelvic pain

• Swelling in the belly or legs

• Shortness of breath

Frequently Asked Questions About Uterine Cancer

Does Endometrial Cancer Spread Quickly?

Type 1 endometrial cancer (the more common form) grows slowly and typically remains inside the uterus. Type 2 endometrial cancer (which is less common) grows more quickly and frequently spreads to other parts of the body. 

How Serious Is Endometrial Cancer?

Uterine cancer is very serious. It can be fatal if it remains undiagnosed and spreads to other parts of the body. The survival rate falls from 95% for cancer localized to the uterus to 19% if the cancer has spread to distant parts of the body from the uterus. Early detection and treatment are vital for a favorable outcome.

What Can Be Mistaken For Uterine Cancer?

Conditions such as uterine fibroids (non-cancerous growths in the uterus), ovarian cysts, polycystic ovary disease, and endometriosis can cause symptoms that resemble uterine cancer. Your doctor can perform diagnostic tests to determine if your symptoms are related to uterine cancer or a different diagnosis.

Does Taking Oral Contraceptives Increase Cancer Risk?

Taking oral contraceptives can both increase or decrease cancer risk in the reproductive organs. Studies suggest that taking combined oral contraceptives (which contain both estrogen and progesterone) is associated with an increased risk of breast cancer and cervical cancer and a decreased risk of uterine cancer (endometrial cancer), ovarian cancer, and colon cancer.