Uterine cancer

Uterine cancer occurs in over 40,000 America women each year and accounts for approximately 7,500.

The most common uterine cancers arise from the endometrial lining of the uterine cavity and are known as endometrial cancers. These are usually detected early and generally have good outcomes after appropriate treatment. Most are confined to the uterus. Approximately 20% spread to the lymph nodes or other sites in the pelvis.

Screening

There are no screening tests for uterine cancers.

Symptoms

Abnormal vaginal bleeding occurs as an early symptom in approximately 80% of patients.

Diagnosis

Endometrial sampling either by a biopsy or D & C, a procedure for scraping and collecting tissues, is required for diagnosis of endometrial cancer. A transvaginal ultrasound can measure the thickness of the endometrial lining. If it is thin then it is unlikely that there is a diagnosis of endometrial cancer. If it is thick then a sampling must be performed.

Staging Procedures

Like ovarian cancer, staging for endometrial cancer is surgical. The surgical procedure includes: an exploration of the peritoneal cavity, aspiration of fluid from the peritoneal cavity, total hysterectomy, removal of both fallopian tubes and ovaries, and a lymph node dissection. Additionally, the chest should be evaluated before surgery with a chest x-ray or chest CT scan.

Stages of Disease

Stage I: Confined to the uterus
Stage II: Extension from the uterus down to and including the cervix
Stage III: Spread to other structures within the pelvis or to the lymph nodes
Stage IV: Distant spread of disease outside of the pelvis

Treatment

Many women with Stage I endometrial cancer need no further therapy after surgery. Recommendations for all other patients include radiation and or chemotherapy based on the extent, location, and grade of disease spread.

Outcome

Long-term survival can be expected for approximately 85% of patients with Stage I disease. However, for the 20% with Stage III or IV disease long-term survival is less than 40%.

Unanswered questions and controversies about uterine cancer.