Uterine Cancer

Uterine cancer develops when the cells of the tissues that make up the uterus reproduce more rapidly and survive longer than normal.

The excess cells form cancerous tumors, which may be of two types:

• Endometrial cancer: This is the most common type. It is a carcinoma that originates in the endometrium, the lining that covers the inside of the uterus. The most common subtype is endometrioid carcinoma, which is usually detected early and has a favorable prognosis. However, serous carcinoma, clear cell carcinoma, and carcinosarcoma are highly aggressive subtypes, although they occur less frequently.
• Uterine sarcoma: This is uncommon but more difficult to treat. It affects the muscular tissue of the uterus, which forms the middle layer of the uterine wall. The most common subtypes are uterine leiomyosarcoma, endometrial stromal sarcoma, and undifferentiated uterine sarcoma.

Although they are sometimes confused, uterine cancer and cervical cancer are different diseases. While uterine cancer arises in the tissues that make up the uterus and is often associated with hormonal imbalances, cervical cancer begins in the lower part of the uterus that connects to the vagina and is closely associated with human papillomavirus (HPV) infection.

The prognosis of uterine cancer is generally favorable because it presents highly characteristic symptoms that allow for early detection. Nevertheless, survival depends on the tumor type and stage at diagnosis. The estimated five-year survival rate is approximately 90% when the disease is identified at an early stage. However, it may decrease to 60% if the lymph nodes are involved.

Symptoms

The most common symptoms of uterine cancer include:

• Non-menstrual vaginal bleeding, which may be light or heavy. This is common in perimenopausal women.
• Abnormal vaginal discharge, typically thick, brown in color, and foul-smelling.
• Dyspareunia (pain during sexual intercourse).
• Bleeding during or after sexual intercourse.
• Persistent pelvic pain.
• Difficulty urinating.

Causes

The exact causes of uterine cancer remain unknown. Studies indicate a direct relationship with elevated estrogen levels after menopause, which may result from one of the following hormonal disorders:

• Polycystic ovary syndrome (PCOS): causes hormonal imbalances.
• Lynch syndrome: an inherited mutation in genes responsible for repairing DNA damage.
• Cowden syndrome: causes mutations in the PTEN gene, which regulates cell division and cell death.

Risk Factors

The risk of developing uterine cancer increases in the presence of any of the following factors:

• Previously described conditions (PCOS, Lynch syndrome, Cowden syndrome).
• Late menopause, after 52 years of age.
• Nulliparity.
• Chronic anovulation: the ovaries do not release eggs.
• Infertility.
• Obesity.
• Endometrial hyperplasia: excessive growth of the uterine lining.
• Diabetes mellitus.
• Hypertension.
• Personal history of ovarian or breast cancer.
• Family history of uterine cancer.
• Family history of, or carrier status for, the genetic predisposition associated with hereditary nonpolyposis colorectal cancer (HNPCC).
• Estrogen-only hormone replacement therapy without progesterone.
• Certain medications used to treat breast cancer.

Complications

The main complication of uterine cancer is metastasis, meaning the spread of cancer to nearby or distant organs. In general, uterine cancer may spread to the lymph nodes, vagina, peritoneum, bladder, rectum, lungs, liver, brain, or bones.

Prevention

Because uterine cancer is associated with genetically driven hormonal abnormalities, it cannot be prevented in most cases. To reduce the risk, the following recommendations are advised:

• Do not smoke.
• Follow a healthy, balanced diet.
• Maintain a healthy body weight.
• Control diabetes and hypertension.
• Engage in regular moderate physical activity.
• Attend regular gynecological check-ups.

Which specialist treats Uterine Cancer?

Uterine cancer is usually diagnosed within the specialty of Gynecology and Obstetrics, while treatment is carried out by specialists in Medical oncology and Radiation oncology.