Uterine Cancer Program

Symptoms, Causes & Risk Factors

Symptoms of Uterine Cancer

The symptoms of uterine cancer can be similar to lots of other conditions, especially those that affect the reproductive organs. If you have an unusual pain, discharge or bleeding, always talk to your doctor. A timely and accurate diagnosis is very important to ensure you get the right treatment.

Common symptoms include:

• Bleeding between menstrual periods
• Spotting or bleeding after the menopause
• Pain in the lower abdomen or a cramping feeling in the pelvis
• Any unusual vaginal discharge in postmenopausal women
• Very long, very heavy or frequent bleeding in women over the age of 40

Causes & Risk Factors of Uterine Cancer

The exact cause of uterine cancer is not yet known, but there are a number of risk factors that put you at an increased risk.

Most risk factors for uterine cancer are related to the balance of the hormone's estrogen and progesterone. Things such as morbid obesity, polycystic ovarian syndrome or some estrogen therapies can affect this balance. Lynch syndrome, a genetic disorder, is also a risk factor but is not related to hormones.

Other risk factors can include:

• Age: The risk of uterine cancer increases with age, with most cases occurring in women over 50.
• High fat diet: A diet that is high in fat may increase the risk of uterine cancer, as well as other types of cancer. A high fat diet can also lead to obesity, another risk factor for uterine cancer.
• Family history: A genetic mutation for something called hereditary nonpolyposis colorectal cancer (HNPCC) may be inherited which increases the risk of several cancers, including uterine cancer.

Other conditions that increase risk:

• Diabetes
• Obesity
• Diseases of the ovaries

Gynecology history

• Early menstruation age
• Late menopause
• No pregnancy

Treatment for other conditions

• Radiation therapy to the pelvis
• Estrogen replacement therapy (ERT)
• Tamoxifen

If you think you may be at risk, talk to your doctor to find out what you can do to decrease your risk.

Prevention & Screening

Uterine cancer can’t be prevented but there are things you can do to reduce your risk. These include maintaining a healthy weight and controlling diabetes properly. Oral contraceptives might also offer protection against uterine cancer.

There is no screening test for uterine cancer, but if you think you are at high risk, talk to your doctor about regular checks.

Endometrial cancer is usually diagnosed at an early stage, as women notice the symptoms such as unusual bleeding. If diagnosed early, and the cancer hasn’t spread to other organs, it can be cured by removing the uterus.

If you notice anything unusual, such as bleeding or spotting, always talk to your doctor.

Diagnosis & Treatment

Diagnosis of Uterine Cancer

If you visit your doctor with any of the symptoms of uterine cancer, they will discuss the symptoms with you in details, and ask about any risk factors that you may have, including family history. They will then perform a physical exam, including an exam of your pelvic area. 

Diagnostic tests

There are a number of tests that your doctor may perform to confirm a diagnosis of uterine cancer. These include: 

• Blood test: This will look for the presence of a protein called CA-125, which can indicate cancer 
• CT scan: A CT scan allows doctors to obtain pictures of the affected area 
• MRI scan: Using radio waves and a strong magnet, doctors can obtain detailed images 
• Transvaginal ultrasound: A smooth, rounded probe is placed inside the vagina to obtain images of the uterus 
• Endometrial biopsy: A thin, flexible tube is inserted through the cervix, into the uterus, where a small amount of the endometrium is removed for analysis 
• Hysteroscopy: A long, thin tube with a light and camera, called a hysteroscope, is inserted through the cervix to take images of the uterus 
• Dilation and curettage (D&C): A more complex procedure that is done in the operating room, to remove tissue from the uterus. The tissue is then analyzed for signs of cancer 

Please note, a pap test can detect abnormal cells on the cervix only. It cannot screen for, or be used to diagnose, uterine cancer.  If endometrial cancer is diagnosed, your doctor will need to know which type it is, so they can decide on the best possible treatment. 

• Type 1 endometrial cancer: Is less aggressive and doesn’t usually spread to other tissues very quickly 
• Type 2 endometrial cancer: Generally, is more aggressive and more likely to spread to tissue outside of the uterus. It usually requires stronger treatment.

Treatment for Uterine Cancer

The exact treatment plan for uterine cancer will depend on the type of cancer you have and your overall health. Treatments might include: 

• Chemotherapy: The use of strong drugs that kill cancer cells 
• Radiation therapy: The use of targeted radiation beams that can destroy cancer cells 
• Hormone therapy: Either adding hormones or blocking them to treat the cancer 
• Immunotherapy: A treatment that helps your own immune system to fight cancer 
• Targeted therapy: The use of medication(s) that target specific cancer cells and stop them from multiplying. 

Most women diagnosed with endometrial cancer will need surgery. This is usually a hysterectomy, which involves a surgeon removing the uterus and cervix. The main types of hysterectomy procedures are: 

• Total abdominal hysterectomy: A surgeon makes a cut in the abdomen so that the uterus can be removed 
• Vaginal hysterectomy: The uterus is removed through the vagina 
• Radical hysterectomy: A radical hysterectomy may be needed if the cancer has spread to the cervix. This involves removing the uterus, tissues next to the uterus, and the top of the vagina, next to the cervix.

At the same time as a hysterectomy, a surgeon may also perform two other procedures: 

• Bilateral salpingo-oophorectomy (BSO): This procedure removes the ovaries and fallopian tubes, to ensure all the cancer is removed. Removing the ovaries is usually necessary but it means you will go through the menopause (if this hasn’t happened already). If you are under the age of 45, your doctor may discuss keeping your ovaries 
• Lymph node dissection: A surgeon will remove the lymph nodes to see if the cancer has spread to them. 

The side effects of surgery for uterine cancer might include infertility and the menopause, along with the symptoms associated with it.