Uterine Cancer

Uterine cancer is a disease in which cells in the uterus grow out of control. It is the most common cancer affecting the female reproductive system, and while it can be serious, many cases can be cured when detected early.

Table of contents

• What is uterine cancer?
• The uterus and where cancer develops
• Types of uterine cancer
• Who is at risk?
• Signs and symptoms
• How is uterine cancer diagnosed?
• Treatment options
• Living with uterine cancer

What is uterine cancer?

Uterine cancer is a disease in which cells in the uterus grow out of control^[1]. The uterus, also called the womb, is the pear-shaped organ in a woman’s pelvis where a baby grows during pregnancy^[1][4].

All women are at risk for uterine cancer as long as they have a uterus, and the risk increases with age^[1]. Most uterine cancers are found in women who are going through or who have gone through menopause — the time of life when menstrual periods stop^[1].

Uterine cancer is the most common cancer of the female reproductive system in Canada and the United States^[4][6]. In the United States, about 3% of women will receive a diagnosis of uterine cancer at some point during their lives, with approximately 65,000 women receiving a diagnosis each year^[11]. While a diagnosis can be scary, the most common form of uterine cancer is often curable, especially when caught at an early stage^[8].

The uterus and where cancer develops

The uterus is a hollow, muscular, pear-shaped organ in the female reproductive system^[4]. The inner lining of the uterus is called the endometrium, which is made up of tissue with many glands^[4]. The endometrium changes during the menstrual cycle — hormones called estrogen and progesterone cause the endometrium to thicken in case of pregnancy. If no pregnancy occurs, the body produces less progesterone, which causes the lining to shed during periods^[11].

The lower part of the uterus is called the cervix, which leads into the vagina^[4]. Uterine cancer refers to cancer in the body of the uterus, not the cervix — cervical cancer is a different type of cancer^[11].

• Uterus
• Endometrium
• Cervix

Types of uterine cancer

There are two main types of uterine cancer, with different characteristics and treatment approaches.

The most common type is endometrial cancer, which forms in the lining of the uterus called the endometrium^[1][8]. This type makes up about 95% of all cases of uterine cancer^[11]. Most endometrial cancers start in gland cells of the endometrium and are called endometrial carcinoma^[4]. Endometrial cancer can often be cured when found early^[7].

A less common type is uterine sarcoma, which starts in the muscle cells or other tissues of the uterus^[1][4][8]. While uterine sarcomas make up only around 5 to 10% of uterine cancer diagnoses, they are often more aggressive and harder to treat than endometrial cancer^[7][8].

Changes to cells in the uterus can also cause precancerous conditions, which means the abnormal cells are not yet cancer but could become cancer if not treated^[4]. The precancerous condition of the uterus is called endometrial hyperplasia, which involves thickening of the uterine lining^[4][6].

Who is at risk?

Researchers aren’t entirely sure what causes uterine cancer. Something happens to create changes in cells in the uterus, causing them to grow and multiply out of control and form a mass called a tumor^[11].

Many risk factors for uterine cancer relate to the balance between estrogen and progesterone in the body^[11]. Several factors and conditions can increase the risk of developing uterine cancer:

• Older age, particularly after menopause^[1][8]
• Obesity or being overweight^[6][8]
• Taking estrogen-only hormone replacement therapy after menopause^[6][8]
• Having type 2 diabetes^[6][8]
• Starting menstruation at an early age or menopause at a later age^[6][8]
• Never having been pregnant^[6][8]
• Taking tamoxifen, a medicine used to prevent or treat breast cancer^[6][8]
• Having polycystic ovary syndrome (PCOS)^[6][8]
• Having a mother, sister, or daughter with endometrial cancer^[6][8]
• Having certain genetic conditions, such as Lynch syndrome^[6][8]
• Having endometrial hyperplasia^[6][8]
• Previous radiation therapy to the pelvis^[8]

With age, menopause quiets the uterus, but that’s when the increased incidence of uterine cancer is noticed because abnormal cell changes can happen^[23].

Signs and symptoms

The most common symptom of uterine cancer is abnormal vaginal bleeding^[6][8]. If you notice unusual pain or irregular vaginal bleeding, it’s important to talk to your healthcare provider^[11].

Symptoms of uterine cancer include:

• Vaginal bleeding after menopause — any amount of blood is considered abnormal^[5][11][23]
• Vaginal bleeding between periods before menopause^[11]
• Extremely prolonged, heavy, or frequent vaginal bleeding if you’re older than 40^[11]
• Unusual discharge or bleeding that is not related to normal menstruation^[8]
• Pelvic pain or lower abdominal pain or cramping in the pelvis, just below the belly^[5][8][11]
• Thin white or clear vaginal discharge if you’re postmenopausal^[11]
• Pain during sexual intercourse^[8]
• Difficulty or pain while urinating^[8]
• Frequent urination^[8]
• Pain or bloated feeling in abdomen^[8]
• Weight loss without known reason^[8]

If you have gone through menopause and no longer have a monthly menstrual cycle, any amount of blood is considered abnormal. If you have any bleeding after menopause, it’s important to get checked out quickly^[23].

How is uterine cancer diagnosed?

If you develop symptoms such as post-menopausal bleeding or abnormal vaginal discharge, visit your gynecologist^[8]. Your doctor will ask about your medical history and family health history, and conduct a thorough pelvic exam^[6][8].

During a pelvic exam, a doctor inserts one or two gloved fingers inside the vagina while pressing down on the abdomen at the same time to check the uterus, ovaries, and other organs^[9].

To diagnose uterine cancer, your doctor will need to conduct one or more diagnostic tests:

• Transvaginal ultrasound: This test uses sound waves to produce an image of the tissues of the uterus and pelvic area. A wandlike device called a transducer is inserted into the vagina^[8][9].
• Endometrial biopsy: In this procedure, a doctor removes a small piece of tissue from the endometrium. A specialist called a pathologist then examines the tissue under a microscope to check for the presence of cancer cells^[8].
• Dilation and curettage (D&C): Also known as uterine scraping, a doctor inserts an instrument called a curette into the vagina and uterus and uses it to scrape part of the endometrium. In a lab, a pathologist examines the tissue sample to see if cancer cells are present^[8].
• Hysteroscopy: This procedure allows a doctor to visually examine the endometrium. A thin tube called a hysteroscope, equipped with a light and camera, is inserted into the vagina and uterus, allowing the doctor to view the lining of the uterus. If abnormal tissue is detected, the doctor can also take a small tissue sample through the hysteroscope^[8][9].

If uterine cancer is diagnosed, your doctor may order additional tests to learn more about the type of cancer and determine whether the cancer has spread beyond the uterus. This is known as staging^[8]. Uterine cancers are staged on a scale from I to IV. In some cases, the stage may not be known until surgery to remove the cancer has been performed^[8].

The stages are defined as follows: Stage I means cancer hasn’t spread beyond the uterus; Stage II means it has spread to the cervix; Stage III means it has spread to the vagina, ovaries, and/or lymph nodes; and Stage IV means it has spread to the bladder or other organs far away from the uterus^[19]. Stages I and II are sometimes called early stage, while Stages III and IV are referred to as advanced, late-stage, or metastatic^[19].

Treatment options

If your doctor says you have uterine cancer, ask to be referred to a gynecologic oncologist — a doctor who has been trained to treat gynecologic cancers, including uterine cancer^[10][19]. This doctor will work with you to create a treatment plan^[10].

Uterine cancer is treated in several ways, depending on the type of uterine cancer and how far it has spread^[10]. The treatment plan can be complex, and some patients require care from more than one doctor^[12]. Treatment options include:

• Surgery: An operation in which doctors cut out the cancer^[10]. Surgery is the most common treatment for uterine cancer^[8][12]. The minimum surgical procedure is hysterectomy, which is the removal of the uterus and cervix, usually along with both fallopian tubes and ovaries^[12]. Surgery can be performed through a traditional incision in the abdomen or with minimally invasive techniques, including standard laparoscopy or robotic surgery^[12]. Patients treated with minimally invasive techniques may have a quicker recovery and experience less pain after surgery^[12].
• Radiation therapy: Use of high-energy rays (similar to x-rays) to kill the cancer^[10]. Radiation therapy may be used to kill any cancer cells that remain after surgery or in place of surgery if a patient is not well enough to undergo a surgical procedure^[14].
• Chemotherapy: Use of special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both^[10]. Chemotherapy might be recommended after surgery to ensure cancer cells are completely eliminated, to treat disease that has spread, or to treat uterine cancer that has returned^[14].
• Hormone therapy: This treatment affects hormones that cancer cells need to grow^[13]. For women who wish to preserve their fertility, certain types of uterine cancer may be treated with a hormone, though this method is not curative^[14]. Hormonal therapy may also be used to prevent certain types of advanced or recurrent uterine cancers from growing or spreading^[14].
• Targeted therapy: Use of drugs to block the growth and spread of cancer cells. The drugs can be pills you take or medicines given in your veins^[10]. As of 2024, lenvatinib is the only targeted therapy approved to treat endometrial cancer, usually in combination with an immune checkpoint inhibitor like pembrolizumab^[16].
• Immunotherapy: This treatment helps strengthen the immune system to fight cancer^[13]. In 2024, three immune checkpoint inhibitors were approved to treat advanced endometrial cancer: dostarlimab, durvalumab, and pembrolizumab^[16]. These drugs work by blocking proteins that stop the immune system from attacking cancer cells^[16].

Your doctor can explain the risks and benefits of each treatment and the side effects^[10]. Sometimes people get an opinion from more than one cancer doctor, which is called a “second opinion.” Getting a second opinion may help you choose the treatment that is right for you^[10].

If you have cancer, you may also want to take part in a clinical trial, which uses new treatment options to see if they are safe and effective^[10]. Clinical trials may offer access to the latest treatments not available at other cancer centers^[14].

Living with uterine cancer

Living with uterine cancer can mean changes in your lifestyle and finding the quality of life that suits you best^[21]. While radiation therapy itself may be painless, it impacts your body in ways that you can’t always see^[21].

During treatment, there are ways to help your body stay strong:

• Listen to your body and get extra rest when needed. It’s typical to need more sleep at night and naps during the day^[21].
• Don’t push yourself too hard^[21].
• Eat a healthy diet and drink plenty of fluids^[21].
• Treat your skin in the treatment area with care. Clean the area with warm water and mild soap, avoid hot or cold packs, and check with your care team before using lotions or ointments^[21].
• Talk to your doctor about any medications or supplements you are taking to make sure they are safe to use during treatment^[21].
• Find a support group or seek out help to cope with the stress of your cancer diagnosis and treatment^[21].

After you’ve completed treatment, you’ll have follow-up visits with your care team, especially in the first few months after treatment, to make sure there is no progression or recurrence^[21]. During this time, it’s important to report any new symptoms to your doctor right away so the cause can be found and treated^[10][21].

Being diagnosed with cancer often comes with a range of emotions. It’s important to understand your diagnosis and treatment options, and get answers to questions such as: Has the cancer spread? What stage is the cancer? What are the most common treatment options?^[19] Your care team, which may include gynecologic oncologists, medical oncologists, oncology nurses, radiation oncologists, social workers, patient navigators, registered dietitians, and genetic counselors, can help you throughout your journey^[19].