The uterus, or womb, is part of a woman’s reproductive system. It is about the size and shape of a hollow, upside-down pear. The uterus sits low in the abdomen between the bladder and rectum and is held there by muscle. It is joined to the vagina by the cervix, which is the neck of the uterus. The uterus is where a foetus grows.
The uterus is made up of two layers:
- Myometrium: the outer layer of muscle tissue. This makes up most of the uterus.
- Endometrium: the inner layer or the lining of the uterus. In a woman of child-bearing age, the endometrium changes in thickness each month to prepare for pregnancy.
When a woman releases an egg (ovum) from her ovary (ovulates), the egg travels down her fallopian tube into the uterus. If the egg is fertilised by a sperm, it will implant itself into the lining of the uterus and grow into a baby. If the egg is not fertilised by a sperm, the lining is shed and flows out of the body through the vagina. This flow is known as a woman’s period (menstruation).
Menopause occurs when the levels of hormones in a woman’s body that cause ovulation and menstruation decrease. A menopausal woman’s periods stop, and she is not able to become pregnant. The uterus becomes smaller and the endometrium becomes thinner and inactive.
Cancer of the uterus is cancer that begins from abnormal cells in the lining of the uterus (endometrium) or the muscle tissue (myometrium). This cancer can affects the female reproductive system. And It's also called uterine cancer and endometrial cancer. Vaginal bleeding, during or after menopause, is often a sign of a problem.
- Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, menorrhagia, or abnormal uterine bleeding (AUB).
- Difficulty or pain when urinating
- Pain during sexual intercourse
- Pain in the pelvic area
If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.
If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.
Types of uterine cancer
The vast majority of womb cancers begin in the cells that make up the lining of the womb (called the endometrium), which is why cancer of the womb is often called endometrial cancer.
In rare cases, womb cancer can start in the muscles surrounding the womb. This type of cancer is called uterine sarcoma and may be treated in a different way from endometrial cancer.
This article uses the term womb cancer, and mostly includes information about endometrial cancer. Read more information about soft tissue sarcomas.
Womb cancer is separate from other cancers of the female reproductive system, such as ovarian cancer and cervical cancer.
Uterine cancer causes
It's not clear exactly what causes womb cancer, but certain things can increase your risk of developing the condition.
A hormone imbalance is one of the most important risks for womb cancer. Specifically, your risk is increased if you have high levels of a hormone called oestrogen in your body.
A number of things can cause this hormone imbalance, including obesity, diabetes, and hormone replacement therapy (HRT). There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen.
It's not always possible to prevent womb cancer, but some things are thought to reduce your risk. This includes maintaining a healthy weight and the long-term use of some types of contraception.
Treatment Overview of Uterine Cancer
In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Your health care team should include a gynecologic oncologist, which is a doctor who specializes in the cancers of the female reproductive system.
Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy. Combinations of treatments are often recommended. Each treatment option is described below, followed by an outline of treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the woman’s overall health, and her age and her personal preferences, including whether or how treatment will affect the ability to have children. Women with uterine cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is typically the first treatment used for uterine cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Learn more about the basics of cancer surgery.
- Hysterectomy. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, the upper part of the vagina, and nearby tissues). For patients who have been through menopause, the surgeon will also perform a bilateral salpingo-oophorectomy, which is the removal of both fallopian tubes and ovaries.
- Lymph node dissection. At the same time as a hysterectomy, the surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus.
- Sentinel lymph node biopsy. Sometimes a sentinel lymph node biopsy is performed. A sentinel lymph node biopsy is a procedure that helps the doctor find out whether cancer has spread to the lymph nodes. This procedure is proven to be useful for breast and other cancers, and doctors are researching its usefulness in uterine cancer.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist or gynecologic oncologist, a doctor who specializes in treating women’s reproductive cancer with medication. When recommended for endometrial cancer, chemotherapy is given usually after surgery, either with or instead of radiation therapy. Chemotherapy is also considered if the endometrial cancer returns after initial treatment.
Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them. These tumors are generally adenocarcinomas and are grade 1 or 2 tumors. Hormone therapy for uterine cancer often involves a high dose of the sex hormone progesterone, given in a pill form. Other hormone therapies include the aromatase inhibitors (AIs) often used for the treatment of women with breast cancer, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin). An AI is a drug that reduces the amount of the hormone estrogen in a woman's body by stopping tissues and organs other than the ovaries from producing it. Hormone therapy may also be used for women who cannot have surgery or radiation therapy or in combination with other types of treatment.