Uterine Cancer: Symptoms, Causes, Diagnosis, and Treatment

Uterine cancer is a group of cancers that begin in the tissues of the uterus. Endometrial cancer is the most common type and starts in the lining of the uterus, while less common types include uterine sarcoma, which begins in the muscle of the uterus or the supporting tissues around it.

Cancer develops when some cells begin to grow and divide abnormally and uncontrollably, potentially forming a tumor. The causes and risk factors for uterine cancer vary from one woman to another, and treatment depends on the type and stage of the tumor, its characteristics, and the patient’s overall health.

Endometrial cancer is more common after menopause, but it can affect women at different ages. Therefore, unusual vaginal bleeding, especially bleeding after menopause, should always be medically evaluated and should not be ignored.

What Are the Types of Uterine Cancer?

When discussing uterine cancer, it is important to distinguish between the main types:

Endometrial Cancer

This type begins in the endometrium, the inner lining of the uterus that changes throughout the menstrual cycle.

It is the most common type of uterine cancer and often presents with abnormal vaginal bleeding, which may help lead to an early diagnosis in many cases.

Uterine Sarcoma

Uterine sarcoma is a less common type of uterine cancer that develops in the muscle of the uterus or the tissues that support it.

Its nature, behavior, and appropriate treatment may differ from those of endometrial cancer. Therefore, diagnosis requires careful evaluation of the tumor type, grade, and stage.

Who Is at Risk of Uterine Cancer?

Uterine cancer can affect any woman, but certain factors are associated with an increased risk, including:

• Older age, particularly after menopause.
• Overweight or obesity.
• Lack of physical activity.
• Type 2 diabetes.
• Polycystic ovary syndrome (PCOS) in some cases.
• Use of estrogen-only hormone therapy after menopause in women who have a uterus.
• Use of Tamoxifen to treat or prevent certain types of breast cancer.
• Starting menstruation at an early age or reaching menopause at a later age.
• Never having been pregnant.
• A family history of endometrial cancer.
• Certain inherited syndromes, particularly Lynch syndrome.

Having one or more risk factors does not mean that a woman will definitely develop uterine cancer. Likewise, some women may develop the disease without having any obvious risk factors.

Symptoms of Uterine Cancer

Symptoms vary depending on the type and stage of cancer, but abnormal vaginal bleeding is one of the most important and most common symptoms of endometrial cancer.

Symptoms may include:

• Vaginal bleeding between menstrual periods.
• Unusually heavy menstrual bleeding.
• Bleeding or spotting after menopause.
• Unusual vaginal discharge, which may or may not contain blood.
• Pelvic pain or pressure.
• A feeling of fullness or a mass in the pelvic or abdominal area in some cases.
• Pain during sexual intercourse.
• Pain or difficulty urinating in some cases.
• Unintentional weight loss, particularly in advanced stages.

Bleeding After Menopause

Any vaginal bleeding that occurs after menopause should be medically evaluated.

Bleeding does not necessarily mean that cancer is present. It can have other causes, such as changes in the uterine lining, polyps, hormonal causes, and other conditions. However, it should not be ignored because bleeding after menopause can be an early sign of endometrial cancer.

Can Uterine Cancer Be Prevented?

There is no way to completely guarantee prevention of uterine cancer, but certain measures may help reduce the risk.

Some of the most important include:

Maintaining a Healthy Weight

Being overweight or obese is associated with an increased risk of endometrial cancer. This is partly related to hormonal changes associated with increased body fat.

Staying Physically Active

Regular physical activity and maintaining a healthy weight may help reduce some of the risk factors associated with endometrial cancer.

Consulting a Doctor Before Starting Hormone Therapy

Using estrogen alone as hormone therapy after menopause can increase the risk of endometrial cancer in women who have a uterus.

Therefore, the appropriate type of hormone therapy should be determined by a doctor according to the individual medical condition. Hormones should not be used without medical supervision.

Hormonal Contraceptives

Evidence suggests that some combined hormonal contraceptives containing estrogen and progestin may reduce the risk of endometrial cancer, and part of this protective effect may continue after stopping their use.

Are There Routine Screening Tests for Uterine Cancer?

It is important to correct a common misconception: there are currently no standard routine screening tests recommended for the early detection of endometrial cancer in average-risk women who have no symptoms.

However, this does not mean that symptoms should be ignored.

The appearance of abnormal bleeding, especially bleeding after menopause, requires medical evaluation to determine the appropriate diagnostic approach.

Women with a high inherited risk, such as those with Lynch syndrome, may require a different monitoring plan determined by their doctor based on their risk factors and family history.

How Is Uterine Cancer Diagnosed?

Diagnosis is based on symptoms, medical history, physical examination, and the results of diagnostic tests.

The evaluation may include:

Gynecological Examination

The doctor reviews the patient’s medical history, discusses symptoms and risk factors, and may perform a pelvic examination when appropriate.

Transvaginal Ultrasound

Transvaginal ultrasound is used to evaluate the uterus and endometrial lining. It may help identify a thickened endometrium or other changes that require further investigation.

Ultrasound alone is usually not sufficient to confirm cancer. Therefore, an endometrial tissue sample may be required.

Endometrial Biopsy

An endometrial biopsy is one of the most important tests used to diagnose endometrial cancer.

The doctor takes a small sample of tissue from the uterine lining. The sample is then sent to a laboratory, where it is examined under a microscope to determine whether cancerous cells are present and identify the type of abnormality.

Hysteroscopy

The doctor may use hysteroscopy to directly examine the inside of the uterus.

A thin scope is inserted through the cervix into the uterus. During the procedure, a sample may be taken from an area that appears abnormal when necessary.

Dilation and Curettage (D&C)

Dilation and curettage (D&C) may be used to obtain a sample of the uterine lining when a previous biopsy is insufficient or when the doctor needs a larger amount of tissue for examination.

This procedure is not performed for every patient. The decision depends on the results of previous tests and the patient’s clinical condition.

Tests Used to Determine the Stage of Uterine Cancer

After cancer has been confirmed, the medical team needs to determine the cancer stage, meaning how far the tumor has spread.

Depending on the type of cancer and the individual condition, tests may include:

• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET/CT) in selected cases.
• Additional tests determined by the doctor based on the type of tumor and the suspected extent of spread.

Determining the stage is very important because it helps the medical team select the most appropriate treatment and assess how far the disease has spread.

Treatment of Uterine Cancer

There is no single treatment that is suitable for every case of uterine cancer.

The treatment plan depends on several factors, including:

• The type of cancer.
• The stage of the disease.
• The tumor grade.
• The characteristics of the cancer cells.
• The patient’s age and overall health.
• Whether the patient wishes to preserve fertility in certain cases.
• Molecular or biological test results of the tumor when necessary.

Treatment may include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, or immunotherapy. More than one treatment approach may be combined.

1. Surgery

Surgery is the primary treatment for most cases of endometrial cancer, particularly when the cancer can be surgically removed.

Surgery may include:

Hysterectomy

The uterus is removed, usually along with the cervix.

The procedure may be performed through:

• Open surgery.
• Laparoscopic surgery.
• Robotic-assisted surgery at centers where it is available.

Removal of the Ovaries and Fallopian Tubes

In many cases of endometrial cancer, the fallopian tubes and ovaries may be removed along with the uterus. This is known as a hysterectomy with bilateral salpingo-oophorectomy.

Lymph Node Evaluation

The surgical team may take samples from the lymph nodes or remove certain lymph nodes depending on the type and stage of cancer to determine whether the disease has spread to them.

2. Radiation Therapy

Radiation therapy uses high-energy radiation to destroy cancer cells or limit their ability to grow.

It may include:

• External beam radiation, which is delivered from a machine outside the body.
• Internal radiation (brachytherapy), in which a radiation source is placed near the tumor or inside the area being treated.

Radiation therapy may be used after surgery or as part of the treatment for certain stages and types of uterine cancer.

3. Chemotherapy

Chemotherapy uses medications that work by killing cancer cells or stopping their growth and division.

It may be used when there is a high risk of the disease spreading, in certain advanced stages, or when cancer returns.

Medications can be administered in different ways, most commonly through a vein or by mouth, depending on the medication and treatment plan.

4. Hormone Therapy

Hormone therapy used to treat endometrial cancer is not the same as hormone therapy used to relieve symptoms of menopause.

Hormone therapy may be used in certain cases of endometrial cancer, particularly for tumors that respond to hormones. It may also be used in some advanced or recurrent cases and, in selected situations, when preserving fertility is an important goal.

5. Targeted Therapy and Immunotherapy

As the diagnosis and understanding of endometrial cancer have advanced, certain targeted therapies and immunotherapies have become treatment options for some patients.

Their use depends on the type and stage of the tumor, the characteristics of the cancer cells, and molecular testing. Therefore, these treatments are not suitable for every patient.

Side Effects of Uterine Cancer Treatment

Side effects vary significantly depending on the type and dose of treatment and the patient’s condition.

Possible side effects may include:

• Fatigue and tiredness.
• Nausea.
• Changes in appetite.
• Hair loss with some types of chemotherapy.
• Skin changes.
• Changes in bowel or bladder function.
• Low blood cell counts.
• Side effects related to radiation therapy.
• Symptoms associated with hormonal changes after removal of the ovaries.
• Effects on fertility depending on the type of treatment.

Not every patient will experience all of these symptoms. The medical team explains the expected side effects and ways to manage them before treatment begins.

Can Uterine Cancer Be Treated?

The chances of treating and controlling uterine cancer depend on the type of cancer, the stage at which it is diagnosed, its characteristics, and the body’s response to treatment.

Cases diagnosed at an early stage are generally more treatable. Therefore, paying attention to symptoms, particularly abnormal vaginal bleeding or bleeding after menopause, and seeking medical evaluation without delay is important.

When Should You See a Gynecologist?

You should see a gynecologist if you experience:

• Unusual bleeding between menstrual periods.
• Unexplained increase in menstrual bleeding.
• Bleeding or spotting after menopause.
• Unusual vaginal discharge.
• Persistent pelvic pain.
• Pain during sexual intercourse.
• Persistent changes in urination or bowel movements accompanied by other symptoms.

These symptoms do not necessarily mean that cancer is present, but they should be evaluated to determine the cause and rule out conditions that may require treatment.

Frequently Asked Questions About Uterine Cancer

What Is the First Symptom of Uterine Cancer?

Abnormal vaginal bleeding is one of the most important symptoms, particularly bleeding or spotting after menopause. Unusual vaginal discharge or pelvic symptoms may also occur.

Does Bleeding After Menopause Mean Uterine Cancer?

Not necessarily. There are many non-cancerous causes of bleeding after menopause. However, it should be medically evaluated because it may be an early sign of endometrial cancer.

Is Uterine Cancer the Same as Endometrial Cancer?

Not exactly. Endometrial cancer begins in the lining of the uterus and is the most common type of uterine cancer, while uterine sarcoma begins in the muscle of the uterus or the tissues that support it.

Are There Routine Screening Tests for Uterine Cancer?

There is no standard routine screening test recommended for average-risk women who have no symptoms. However, symptoms such as abnormal bleeding require medical evaluation. Women with a high inherited risk may need a specialized monitoring plan.

Can a Woman Develop Uterine Cancer Before Menopause?

Yes. Uterine cancer can occur before menopause, although the risk increases with age and the disease is more common after menopause.

Can Uterine Cancer Be Treated?

There are several treatment options, and treatment depends on the type and stage of cancer, its characteristics, and the patient’s overall health. Treatment may include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, or immunotherapy when appropriate.

Conclusion

Uterine cancer is not a single type of cancer. Endometrial cancer is the most common type, while uterine sarcoma represents a different group of tumors that begin in the muscle of the uterus or its supporting tissues.

Abnormal vaginal bleeding, particularly bleeding after menopause, is one of the most important signs that requires consultation with a gynecologist.

The presence of these symptoms does not necessarily mean that cancer is present, but early evaluation can help identify the cause and allow appropriate treatment to begin when necessary.

Treatment for uterine cancer is selected according to the type of tumor, its stage, and its characteristics. It may include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, or immunotherapy.

If you experience unusual symptoms or have a family history or risk factors associated with uterine cancer, an evaluation by a gynecologist can help determine the appropriate tests and the next steps.