Uterine cancer

Uterine cancer
Other names	Womb cancer
Specialty	Gynecology, oncology
Symptoms	Endometrial cancer: vaginal bleeding, pelvic pain[1] Uterine sarcoma: vaginal bleeding, mass in the vagina[2]
Types	Endometrial cancer, uterine sarcoma[3]
Risk factors	Endometrial cancer: obesity, metabolic syndrome, type 2 diabetes, family history of the condition[1] Uterine sarcoma: radiation therapy to the pelvis[2]
Treatment	Surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy[1][2]
Prognosis	81% 5 year survival (US)[4]
Frequency	3.8 million (2015)[5]
Deaths	90,000 (2015)[6]

Uterine cancer, also known as womb cancer, includes two types of cancer that develop from the tissues of the uterus.^[3] Endometrial cancer forms from the lining of the uterus, and uterine sarcoma forms from the muscles or support tissue of the uterus.^[1][2] Symptoms of endometrial cancer include changes in vaginal bleeding or pain in the pelvis.^[1] Symptoms of uterine sarcoma include unusual vaginal bleeding or a mass in the vagina.^[2]

Risk factors for endometrial cancer include obesity, metabolic syndrome, type 2 diabetes, taking pills that contain estrogen without progesterone, a history of tamoxifen use, late menopause, and a family history of the condition.^[7][1] Risk factors for uterine sarcoma include prior radiation therapy to the pelvis.^[2] Diagnosis of endometrial cancer is typically based on an endometrial biopsy.^[1] A diagnosis of uterine sarcoma may be suspected based on symptoms, a pelvic exam, and medical imaging.^[2]

Endometrial cancer can often be cured while uterine sarcoma typically is harder to treat.^[3] Treatment may include a combination of surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy.^[1][2] Just over 80% of people survive more than 5 years following diagnosis.^[4]

In 2015 about 3.8 million people were affected globally and it resulted in 90,000 deaths.^[5][6] Endometrial cancer is relatively common while uterine sarcoma is rare.^[3] In the United States they represent 3.6% of new cancer cases.^[4] They most commonly occur in women between the ages of 55 and 74.^[4]

Types[]

The terms uterine cancer and womb cancer may refer to several different types of cancer that occur in the uterus, namely:

Endometrial cancer:[]

• Endometrial carcinomas originate from cells in the glands of the endometrium (uterine lining). These include the common and readily treatable well-differentiated endometrioid adenocarcinoma, as well as the more aggressive uterine papillary serous carcinoma and uterine clear-cell carcinoma.
• Endometrial stromal sarcomas originate from the connective tissues of the endometrium, and are far less common than endometrial carcinomas.
• Malignant mixed Müllerian tumors are rare endometrial tumors which show both glandular (carcinomatous) and stromal (sarcomatous) differentiation – carcinosarcoma behaves similar to a high grade carcinoma, and it is felt to be of epithelial origin rather than true sarcoma.

Uterine sarcomas[]

• Sarcomas of the myometrium, or muscular layer of the uterus, are most commonly leiomyosarcomas. (Of note, leiomyosarcomas are distinct from uterine leiomyoma, which are a benign tumor of the uterus).

Signs and Symptoms[]

Causes and Risk Factors[]

It is not known with certainty what the causes for uterine cancer may be, though hormone imbalance is speculated as a risk factor. Estrogen receptors, known to be present on the surfaces of the cells of this type of cancer, are thought to interact with the hormone causing increased cell growth, which can then result in cancer. The exact mechanism of how this occurs is not understood.^[8]

Diagnosis[]

To evaluate for uterine cancer, a clinician might perform a pelvic exam to visually inspect internal pelvic organs and to feel the size and position of the uterus and ovaries, a “pap smear” to collect cells to look at under a microscope, and a Dilatation & Curettage to sample uterine tissue. An ultrasound is often done to look for tumors.^[9]

Treatment[]

Treatment of uterine cancer may differ depending on the type of cancer and staging of the tumor.^[10]

For endometrial cancer, five main types of treatments are used, including surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. The most common treatment modality for endometrial cancer is surgery, whereby the uterus is removed via a total hysterectomy.^[10] Hysterectomies may also be accompanied by removal of ovaries and fallopian tubes, called a salpingo-oophorectomy. Additionally, hormone therapy which seeks to block the growth of cancer cells may also be used in the treatment of endometrial cancer. Targeted therapy may include monoclonal antibodies, mTOR inhibitors, and signal transduction inhibitors which all act to target cancer cells specifically. Of note, bevacizumab targeting VEGF can be used to limit the vascular growth of tumor blood vessels and is currently used to treat Stage III, IV, and recurrent endometrial cancer.^[10]

As of 2021, treatment options for uterine sarcoma include surgery, radiation therapy, chemotherapy, and hormone therapy.^[10]

Prognosis[]

Epidemiology[]

Age-standardized death from cancer of the uterine body per 100,000 inhabitants in 2004.^[11]

  no data

  less than 0.5

  0.5–1

  1–1.5

  1.5–2

  2–2.5

  2.5–3

  3–3.5

  3.5–4

  4–4.5

  4.5–5

  5–8

  more than 8

Uterine cancer effects approximately 3.1% of females during their lifetime.^[4] Uterine cancer resulted in 45,000 deaths worldwide in 1990, with this number increasing to 58,000 deaths in 2010.^[12] North America and Northern Europe have the highest rates of uterine cancer. Asia, Southern Europe, Australia and South America have moderate rates, with the lowest rates in Africa and Eastern Asia.^[13] About 81% of females with uterine cancer surviving for five years. This rate is higher with more localized cancer at 95% survival rate for five years and lower for a distant spread of the cancer, at a 16.8% survival rate for five years.^[4]

United Kingdom[]

Uterine cancer is the fourth most common cancer in females in the UK (around 8,500 women were diagnosed with the disease in 2011), and it is the tenth most common cause of cancer death in females (around 2,000 people died in 2012).^[14]

United States[]

Uterine cancer has a high prevalence in the United States, with approximately 772,247 people with the disease in 2016.^[15]

In the United States, uterine cancer is the most common invasive gynecologic cancer.^[13] The number of people diagnosed with uterine cancer has been steadily increasing, with 35,040 people diagnosed in 1999 and 56,808 people diagnosed in 2016. The age-adjusted rate of new cases in 1999 was 23.9 per 100,000 and has increased to 27.3 per 100,000 in 2016.^[16] The incidence of uterine cancer increased even more in 2019, with an approximated 61,880 new cases.^[15]

The rates of incidence and death for uterine cancer differ depending on race. The rate of diagnosis is highest for white females, with 28.1 new cases per 100,000 persons. Black females have a similar incidence with 27.4 new cases per 100,000 persons. Other ethnic groups had lower incidences, Hispanic females had 24.1 new cases per 100,000 persons, Asian/Pacific Islander females had 20.8 new cases per 100,000 persons, and American Indian/Alaska Native females had 19.7 new cases per 100,000 persons. For the death rates of uterine cancer, black females had the highest rates, 8.5 deaths per 100,000 persons. The death rates for the other ethnic groups were dramatically lower. White females had 4.4 deaths per 100,000 persons, Hispanic females had 3.9 deaths per 100,000 persons, American Indian/Alaska Native females had 3.5 deaths per 100,000 persons, and Asian/Pacific Islander females had 3.1 deaths per 100,000 persons.^[4]

References[]

External links[]

• Clinically reviewed uterine cancer information for patients
• UK uterine cancer statistics