Uterine Cancer

Uterine cancer is a serious condition that affects the female reproductive system. Women must be aware of the signs and symptoms of uterine cancer, as early detection and treatment can significantly improve the chances of a successful outcome. In this article, we will explore the different aspects of uterine cancer, including its types, symptoms, and prognosis.

What is Uterine Cancer?

Uterine cancer is a general term that encompasses cancers that originate in the uterus, the hollow, pear-shaped pelvic organ where foetal development occurs. The two main types of uterine cancer are endometrial cancer, which develops in the inner lining of the uterus called the endometrium, and uterine sarcoma, which starts in the muscles or other tissues of the uterus. Understanding the differences between these types is crucial for accurate diagnosis and treatment.

There are two main types of uterine cancer:

• Endometrial cancer: This is the most common type of uterine cancer, accounting for about 95% of all cases Cancer Council (2026).Endometrial cancer starts in the cells that make up the endometrium, the lining of the uterus. It can be further divided into histologic subtypes, including adenocarcinoma, squamous cell carcinoma, and serous carcinoma.
• Uterine sarcoma: This is a rare type of uterine cancer, accounting for about 5-10% of all cases. Uterine sarcoma starts in the muscles or other tissues in the uterus. It can be more aggressive than endometrial cancer and may require different treatment approaches.

Some of the early warning signs of uterine cancer include:

• Abnormal vaginal bleeding, such as bleeding after menopause, between periods, or noticeable changes in menstrual flow
• Pelvic pain or discomfort
• Unusual, non-bloody vaginal discharge
• Difficulty urinating
• Abdominal pain
• Unexplained weight loss
• Changes in bowel habits

Other  symptoms of uterine cancer may include:

• Unexplained weight loss: Sudden and unexplained weight loss can be a concerning sign. It is particularly worrisome when accompanied by other symptoms.
• Changes in menstrual cycle: Women may notice irregular periods or changes in flow. This includes periods that are significantly heavier or last longer than usual.
• Pelvic fullness or pressure (in advanced cases): A feeling of fullness or pressure in the abdomen can develop. This may be accompanied by visible swelling.
• Urinary symptoms: Some women experience frequent urination, urgency, or difficulty urinating. These symptoms can arise if the cancer affects nearby structures.
• Gastrointestinal issues: Symptoms such as bloating, nausea, or changes in bowel habits may also arise. These can be subtle but should not be ignored.

Uterine cancer is staged based on how far the cancer cells have spread from the inner lining of the uterus (the endometrium). Here are the general stages (MSKCC):

• Stage 1: Cancer cells are present only inside the uterus, specifically in the endometrium, which is the inner lining of the uterus.
• Stage 2: Cancer has spread to the connective tissue of the cervix but not outside the uterus. Lymph node involvement is not present at this stage.
• Stage 3: Cancer has spread to tissues outside the uterus but not to the rectum or bladder. It may involve nearby lymph nodes, the ovaries, vagina, or pelvic tissues.
• Stage 4: Cancer has spread to the inner lining of the rectum, bladder, or distant organs such as the lungs or liver. It may also involve distant lymph nodes. This is the most advanced stage of uterine cancer.

Uterine cancer, primarily affecting the lining of the uterus (endometrial cancer), has several known risk factors and potential causes:

• Hormonal imbalance: Prolonged exposure to oestrogen without progesterone can lead to abnormal cell growth in the uterus. Conditions like polycystic ovary syndrome (PCOS) and hormone replacement therapy can contribute to this imbalance.
• Age: Uterine cancer is more common in women over 50, particularly after menopause. The risk increases significantly after age 60.
• Obesity: Fat tissue produces oestrogen. This additional oestrogen in overweight or obese individuals can increase the likelihood of developing uterine cancer.
• Family history and genetics: A family history of uterine, breast, or colon cancers may elevate risk. Genetic syndromes, such as Lynch syndrome (hereditary non-polyposis colorectal cancer), also increase susceptibility.
• Reproductive history: Irregular menstrual cycles, early onset of menstruation, late menopause, or not having children can increase risk. Women who have not been pregnant may have a higher chance of developing uterine cancer.
• Medical conditions: Conditions such as diabetes and hypertension can contribute to the risk. Additionally, having conditions that cause high oestrogen levels, like endometrial hyperplasia, can be a precursor to cancer.
• Lifestyle factors: Poor diet, lack of physical activity, and smoking can contribute to obesity and hormonal imbalances, indirectly increasing the risk of uterine cancer.
• Radiation therapy: Women who have undergone radiation treatment to the pelvis for other cancers may have an increased risk of developing uterine cancer later on.

Certain factors are associated with a higher likelihood of getting uterine cancer:

• Older age, with most cases diagnosed after menopause
• Being overweight or obese, which increases oestrogen levels
• Starting menstruation early or going through menopause late, leading to more lifetime oestrogen exposure
• Having an inherited genetic predisposition, such as Lynch syndrome or a strong family history of uterine or colon cancer
• Never having been pregnant
• Undergoing oestrogen-only hormone replacement therapy
• Having had radiation therapy to the pelvis previously

Uterine cancer, particularly endometrial cancer, can lead to several complications, both from the disease itself and the treatments. Common complications include:

• Metastasis: Uterine cancer may spread to other parts of the body, such as the ovaries, bladder, intestines, or lungs. This spread complicates treatment and can worsen the prognosis.
• Anaemia: Patients may develop anaemia due to heavy bleeding associated with the cancer. Symptoms of anaemia include fatigue, weakness, and pale skin, all of which can negatively impact daily activities.
• Lymphoedema: If lymph nodes are removed or damaged during treatment, patients may develop lymphoedema. This condition leads to swelling in the legs or pelvis and can cause discomfort and mobility issues.
• Surgical complications: Surgery, such as a hysterectomy, carries inherent risks, including infection, blood loss, and damage to surrounding organs. Recovery from surgery may involve pain and a prolonged healing process.
• Radiation side effects: Patients undergoing radiation therapy may experience side effects such as skin irritation, fatigue, and gastrointestinal issues. These effects can significantly impact the quality of life during treatment.
• Emotional and psychological impact: A diagnosis of uterine cancer can lead to anxiety, depression, and changes in body image. Many patients find it helpful to seek support from mental health professionals to cope with these challenges.
• Fertility issues: Younger women may face challenges related to fertility as a result of treatment. It is essential to discuss options for preserving eggs or embryos before beginning treatment.
• Recurrence: Even after successful treatment, there is a risk of cancer recurrence. Regular follow-ups and monitoring are crucial for detecting early signs of recurrence.

Although uterine cancer cannot be prevented entirely, some steps can reduce the risk of developing this disease. Here are some strategies for prevention:

• Maintain a healthy weight: Obesity is a significant risk factor for uterine cancer. Adopting a balanced diet and engaging in regular physical activity can help maintain a healthy weight.
• Eat a balanced diet: A diet rich in fruits, vegetables, whole grains, and lean proteins may lower the risk. Limiting processed foods, red meats, and high-fat dairy products is also beneficial.
• Regular exercise: Engaging in regular physical activity helps manage weight and balance hormone levels. Aim for at least 150 minutes of moderate exercise per week.
• Control blood sugar levels: Managing conditions like diabetes can reduce the risk of uterine cancer. This may involve diet, exercise, and medication as prescribed by a doctor.
• Hormonal balance: For women with conditions that cause high oestrogen levels, such as polycystic ovary syndrome (PCOS), discussing management options with a doctor can be important. Hormonal therapies should be carefully considered.
• Use of birth control: Oral contraceptives may lower the risk of endometrial cancer. Discussing the benefits and risks with a doctor can help determine if this option is suitable.
• Regular check-ups and screenings: Routine gynaecological exams and screenings can help identify any abnormal changes early. Women should discuss their individual risk factors with their doctor.
• Smoking cessation: Quitting smoking can improve overall health and may reduce the risk of several cancers, including uterine cancer.

Diagnosing uterine cancer involves a combination of medical history evaluation, physical examinations, and various diagnostic tests. Here are the key steps in the diagnostic process:

• Medical history: Doctors will start by taking a detailed medical history. This includes asking about symptoms, menstrual history, family history of cancer, and any other relevant health issues.
• Physical examination: A pelvic exam allows the provider to assess in the uterus and surrounding organs for abnormalities. This examination may reveal signs of enlargement or other issues.
• Ultrasound: This test uses sound waves to create images of the uterus and can help identify abnormalities, such as thickening of the endometrium.
• Endometrial biopsy: This procedure involves taking a small sample of endometrial tissue to detect cancer cells. It can often be done in a doctor's office and provides critical diagnostic information.
• Magnetic resonance imaging (MRI): MRI provides detailed images of the uterus and surrounding tissues, helping assess the extent of cancer.
• Computed tomography (CT) scan: A CT scan may be used to detect metastasis to other organs.
• Dilation and curettage: If an endometrial biopsy is inconclusive, a D&C may be performed. This surgical procedure involves scraping the lining of the uterus to obtain more tissue for examination.
• Hysteroscopy: In this procedure, a thin, lighted tube (hysteroscope) is inserted through the vagina into the uterus. It allows the doctor to visualise the uterine lining and take biopsies if necessary.
• Genetic testing: For women with a family history of uterine or related cancers, genetic testing for mutations (such as those in the Lynch syndrome–associated genes) may be recommended.

The treatment of uterine cancer, including endometrial cancer and uterine sarcomas, is tailored based on factors such as the type, stage, grade of the tumour, and the patient’s age, overall health, and reproductive goals. A multidisciplinary approach is often used, combining surgery, radiation, medication, and newer targeted therapies.

1. Surgery

Surgery is the cornerstone of treatment and often includes a hysterectomy (removal of the uterus), which may also involve the cervix, ovaries, fallopian tubes, and lymph nodes.

• Total hysterectomy
• Radical hysterectomy (includes surrounding tissues)
• Lymphadenectomy (removal of pelvic/para-aortic lymph nodes)

2. Radiation Therapy

Radiation may be used before surgery (to shrink tumours), after surgery (to prevent recurrence), or as the primary treatment when surgery isn’t an option.

• External Beam Radiation Therapy (EBRT)
• Brachytherapy (internal radiation)

3. Chemotherapy

Chemotherapy is used in advanced stages or when cancer has spread. It may also be used before surgery (neoadjuvant) or after surgery (adjuvant).

Common chemotherapy medicines include:

• Carboplatin: A platinum-based chemotherapy medicine that damages cancer cell DNA, making it effective in treating advanced or recurrent uterine cancer.
• Paclitaxel: Disrupts cell division by stabilising microtubules, often used alongside carboplatin to enhance the effectiveness of chemotherapy in uterine cancer.
• Cisplatin: A platinum compound that causes DNA crosslinking and inhibits cancer cell replication, used in aggressive or advanced uterine cancer.
• Doxorubicin: An anthracycline that interferes with DNA replication, helpful in high-risk or recurrent uterine cancer cases.
• Ifosfamide: An alkylating agent, mainly used in uterine sarcoma, it disrupts DNA synthesis and slows cancer progression.
• Docetaxel: A taxane that inhibits microtubule disassembly, used when other chemotherapy regimens are ineffective or not tolerated.

4. Hormone Therapy

Hormone therapy is used in hormone-sensitive uterine cancers, particularly endometrial cancers that express oestrogen/progesterone receptors.

Hormonal medications include:

• Medroxyprogesterone: A synthetic progestin that helps slow the growth of hormone-sensitive uterine tumours by opposing oestrogen effects.
• Megestrol: A progestin that binds to progesterone receptors, used in advanced or recurrent endometrial cancers to inhibit tumour growth.
• Tamoxifen: A selective estrogen receptor modulator (SERM) that blocks estrogen in uterine tissues, but is generally used cautiously as it may increase the risk of endometrial changes.
• Letrozole: An aromatase inhibitor that reduces estrogen levels, useful in postmenopausal women with hormone-sensitive uterine cancer.
• Anastrozole: Lowers estrogen production, helping to suppress tumour growth in hormone receptor-positive uterine cancers.
• Goserelin: It reduces ovarian hormone production, useful for ovarian suppression in premenopausal women with hormone-sensitive uterine cancer.

5. Targeted Therapy

Targeted therapies interfere with specific molecules involved in cancer growth. These are used for advanced or recurrent cancers, especially when other treatments fail.

Examples include:

• Lenvatinib: A multi-kinase inhibitor that blocks tumour blood vessel formation and growth signals, used in combination with immunotherapy for advanced uterine cancer.
• Bevacizumab: It inhibits blood supply to tumours, slowing their growth in recurrent or metastatic uterine cancer.
• Everolimus: It disrupts cancer cell metabolism and growth, and is used in advanced hormone-resistant uterine cancers.
• Trastuzumab: A HER2-targeted therapy used in uterine cancers overexpressing HER2, particularly in serous subtypes.

6. Immunotherapy

Immunotherapy boosts the body’s immune response to cancer cells.

Approved immunotherapy drugs include:

• Pembrolizumab: It enhances the immune system’s ability to detect and destroy cancer cells.
• Dostarlimab: It is used to treat mismatch repair-deficient (dMMR) endometrial cancers by helping restore immune recognition of cancer cells.

Living with uterine cancer can be a challenging experience that impacts various aspects of life. Here are some key considerations and strategies for managing daily life after a diagnosis:

• Regular check-ups with your doctor are essential for monitoring for signs of cancer recurrence and for addressing any symptoms or concerns you may have.
• Seek support from family, friends, or support groups to help cope with the emotional impact of living with uterine cancer.
• Maintain a healthy diet, exercise regularly, and avoid smoking and excessive alcohol consumption to improve your overall health and well-being.
• Perform pelvic floor exercises to strengthen the muscles that support the bladder and bowel, especially after treatment affecting pelvic structures.
• Manage treatment side effects proactively. Work with your doctor to find strategies to alleviate side effects like fatigue, nausea, or pain.

If you experience any symptoms of uterine cancer, such as abnormal vaginal bleeding, pelvic pain, or unexplained weight loss, it is essential to see your doctor promptly. Early detection and treatment can significantly improve the prognosis for uterine cancer. Additionally, if you have any concerns or questions about your treatment, or if you experience any new or worsening symptoms, do not hesitate to contact your doctor.

• Uterine cancer, including endometrial cancer and uterine sarcoma, is a malignant growth in the uterus, most commonly affecting the endometrium.
• Treatment options for uterine cancer include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.
• The choice of treatment depends on the type and stage of the cancer, the patient's overall health, and the patient's preferences.
• Living with uterine cancer involves regular follow-up care, adopting a healthy lifestyle, seeking support, and communicating with your doctor.
• Early detection and prompt treatment are crucial for improving the prognosis of uterine cancer.