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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Illustration
Cancer of the Uterus (Endometrial Cancer)
What is cancer of the uterus (endometrial cancer)?
Cancer of the uterus is a malignant growth of cells in the
endometrium, the lining of the uterus. The uterus (womb) is
the muscular organ at the top of the vagina. Babies develop
in the uterus, and menstrual blood comes from the uterus.
This type of cancer is also called uterine or endometrial
cancer.
Uterine cancer is one of the most common cancers among
women. It occurs most often in women between the ages of 50
and 70.
How does it occur?
The cause of cancer of the uterus is not known. However,
you are at greatest risk of having this type of cancer if
you have a condition that causes your body to produce a lot
of the hormone estrogen and you have gone through menopause.
Having a high level of estrogen in your body does not create
a high risk of cancer by itself. It is a risk only when
your body also does not have enough of another hormone
called progesterone. After you go through menopause, the
progesterone in your body decreases or disappears. Usually
estrogen levels also drop quite a bit.
Conditions in which you may have a high level of estrogen
without enough progesterone are:
- obesity
- a history of infertility
- late menopause
- polycystic ovary syndrome
- long-term use of estrogen hormones without the addition
of progesterone.
Other factors related to an increased risk of uterine cancer
are:
- radiation treatment of the pelvic area
- a combination of high blood pressure, diabetes, and
obesity
- start of menstrual periods at an early age
- previous breast or ovarian cancer.
What are the symptoms?
Symptoms include:
- vaginal bleeding after menopause
- bleeding after sexual intercourse
- bleeding between periods in premenopausal women.
Abnormal bleeding is the first symptom in 90% of endometrial
cancers. Many women ignore this bleeding or blame it on
menopause.
How is it diagnosed?
Rarely uterine cancer is found as a result of a Pap smear.
For the Pap smear, your provider takes a sample of cells
from the opening of the uterus (the cervix). The cells are
then examined in a lab. A Pap smear may miss cancers that
develop higher up in the uterus.
Your health care provider will examine the condition and
size of your uterus. Your provider may remove a small
sample (biopsy) of your endometrium to be examined under a
microscope. The biopsy can usually be done in your
provider's office. It causes only a little discomfort. You
may have cramps or pain for a short time after the
procedure.
You may also have a D&C (dilation and curettage) to remove
tissue for examination. This procedure is done under local
or general anesthesia. Your cervix is widened (dilated) and
a sharp tool called a curette is used to scrape the walls of
the uterus. These tissue scrapings are checked for cancer
cells. After a D&C, your uterus will bleed for a couple of
days and you may have some low back and pelvic pain.
However, this procedure often reduces or stops any abnormal
bleeding you were having.
An ultrasound scan can be used when your health care
provider cannot perform an endometrial biopsy. If the scan
shows that the inner lining of the uterus is a certain
thickness, it may be a sign of endometrial cancer. More
tests will then need to be performed.
If you have cancer, your provider may also want you to have
some blood tests, a urine test, a CT scan, and x-rays to see
if the cancer has spread to other parts of your body.
How is it treated?
If the cancer is diagnosed early, the uterus is usually
removed (hysterectomy), along with the ovaries, fallopian
tubes (tubes from the ovaries to the uterus), and some lymph
nodes.
Other treatment will depend on the type of cancer cells
present and the extent of spread. Besides surgery, hormone
therapy, radiation therapy, or (rarely) chemotherapy may be
used alone or in combination.
How long will the effects last?
With early treatment, more than 80% of women with uterine
cancer survive more than 5 years and most are completely
cured. The longer the condition goes untreated, the lower
the survival rate.
How can I prevent it?
Because the cause of uterine cancer is unknown, there is no
way to prevent it. However, the following may help lower
your risk:
- Eat a diet low in animal fat.
- Control your weight by eating healthy foods and
exercising.
- Control your blood pressure by decreasing stress and
eating a diet low in salt.
- Report abnormal vaginal bleeding promptly to your health
care provider.
- Have an annual pelvic exam and Pap smear.
- If you are taking estrogen replacement, you should take
progesterone with the estrogen and follow your provider's
advice for regular exams.
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