Uterine Cancer

Melissa Moffitt, M.D., with patient.
Dr. Melissa Moffitt is a gynecologic oncologist who treats patients who have cervical, ovarian or other women's reproductive cancers. She is also a researcher whose focus areas include finding ovarian cancer earlier.

The OHSU Knight Cancer Institute offers advanced care for ovarian cancer, including:

  • The latest diagnostic imaging, with results often available within two days.
  • Advanced genetic testing to guide treatment for every patient.
  • Fellowship-trained doctors who focus on treating patients with gynecologic cancers.
  • Team-based care, with a treatment plan tailored to your needs and wishes.
  • A welcoming environment at the OHSU Center for Women’s Health.
  • A wide range of support services, including options to protect your fertility.

Go to our Gynecologic Cancers page to:

  • See illustrations of women’s reproductive anatomy.
  • Learn more about our gynecologic cancer care.

Understanding uterine cancer

What is uterine cancer?

Cancer can begin in different parts of the uterus, the small, pear-shaped organ where a fetus grows. By far, the most common uterine cancer is endometrial cancer, which forms in the endometrium, the inner lining of the uterus. A rarer form, uterine sarcoma, starts in the muscles of the uterus or in the tissues that support the uterus.

Who gets uterine cancer?

Endometrial cancer is the most common type of gynecologic cancer in the United States, making up about 6 percent of cancers in women. More than 63,000 patients are expected to be diagnosed in 2018. Anyone with a uterus, regardless of gender identity, has some risk.

Age: This cancer affects mostly postmenopausal women. The average age at diagnosis is 60, and it's rare in women under 45. This cancer is slightly more common in white women. Black women, however, are more likely to be diagnosed later, when it's more difficult to treat.

Family history: It can run in families. You have a higher chance of getting endometrial cancer if your mother, sister or daughter had it. OHSU offers genetic counseling, risk assessment and testing for those who have or may have an inherited genetic defect linked to a higher risk of endometrial cancer. 

Survival rates: Endometrial cancer can often be cured because it is usually diagnosed early. More than 80 percent of patients survive at least five years after being diagnosed. This is only an average, though, and can't predict the outcome for any one patient.

Uterine sarcomas: These are much rarer, making up no more than 5 percent of uterine cancers. They are twice as common in black women as they are in white or Asian women, though doctors don't know why. They are harder to find early, making them tougher to treat.

What causes uterine cancer?

Doctors don't yet know what causes these cancers, but they have identified risk factors.

For endometrial cancer, they include:

  • Obesity
  • Having something called metabolic syndrome, a cluster of conditions that include high blood pressure, high blood sugar and excess fat around the waist
  • Never having given birth
  • Beginning menstruation at an early age
  • Reaching menopause at a later age
  • Taking tamoxifen for breast cancer
  • Taking estrogen without progesterone
For uterine sarcoma, they include:
  • Radiation therapy to the pelvic region
  • Taking tamoxifen for breast cancer
  • Being exposed to X-rays

Symptoms of uterine cancer

Signs and symptoms of endometrial cancer include:

  • Unusual vaginal bleeding not related to menstruation
  • Vaginal bleeding after menopause
  • Painful urination
  • Pain during intercourse
  • Pain in the pelvic region
  • Losing weight without trying
Signs and symptoms of uterine sarcoma include:
  • Unusual vaginal bleeding not related to menstruation
  • Vaginal bleeding after menopause
  • A mass in the vagina
  • Pain or a feeling of fullness in the abdomen
  • Frequent urination

Diagnosing uterine cancer

Melissa Moffitt M.D. examining a patientDoctors and specialists may conduct similar tests to look for endometrial cancer or uterine sarcoma. A Pap test, used to screen for cancer of the cervix, often fails to detect these cancers.

If you have symptoms of either cancer, your doctor will talk with you about your health history and conduct a physical exam. Your doctor will also most likely do a pelvic examination, which allows the doctor to feel and look for anything abnormal in your uterus, ovaries or cervix. These are other tests your care team may recommend:

Transvaginal ultrasound: A small wandlike device is inserted into your vagina. The device produces sound waves that allow a computer to create a video image of your uterus. This can show something unusual in the lining.

Hysteroscopy: Your doctor inserts a thin, flexible tube through your vagina and cervix into your uterus. The device has a light and small camera so the doctor can see the uterus lining on a video screen.

Endometrial biopsy: A thin, flexible tube is inserted into the uterus through the vagina and cervix. Suction is used to extract a tiny bit of the endometrium. A type of doctor called a pathologist examines the tissue under a microscope to look for cancer cells.

Dilation and curettage: This procedure, also called D&C, is sometimes needed if a biopsy sample doesn’t provide clear results. The opening of the cervix is enlarged and an instrument is used to scrape tissue from inside the uterus.

Uterine sarcoma tests: Your doctor may do the same tests used for endometrial cancer, with one exception. A rare type called leiomyosarcoma, or LMS, begins in the uterus wall’s muscle layer, outside the lining. Often the only way to diagnose an LMS is to analyze it after removing it with surgery.

Genetic testing: Your doctor may recommend a blood test for gene mutations linked to some uterine cancers to help guide your care plan.

Types of uterine cancer

About 95 percent of endometrial cancers are adenocarcinomas. This type of cancer starts in glandular cells, which release fluids into the body. These cells are found in epithelial tissue, which lines organs and other parts of the body.

  • Endometrioid cancer: This is the most common type of uterine adenocarcinoma. This cancer is made up of cells in glands that look like the normal uterine lining. Endometrioid cancer is linked to excess estrogen and is generally slower-growing. It is commonly detected early and has a high survival rate.
  • Clear cell carcinoma and papillary serous adenocarcinoma: These types are more likely to spread to lymph nodes and other parts of the body, requiring more aggressive treatment. They tend to grow quickly and have often spread outside the uterus when diagnosed.

Types of uterine sarcomas include:

  • Endometrial stromal sarcomas: These rare cancers develop in the supporting connective tissue of the endometrium. They tend to grow slowly, making them easier to treat.
  • Undifferentiated sarcomas: These are rare, making up less than 1 percent of uterine cancers. They are more aggressive.
  • Uterine leiomyosarcomas: These rare cancers start in the muscle wall of the uterus known as the myometrium.

Staging uterine cancer

Staging determines whether and how much cancer has spread. This helps your care team plan the best treatment. Staging also takes the grade of your cancer (how normal or abnormal the cancer cells look under a microscope) and other factors into account. This is the system for adenocarcinomas, the vast majority of endometrial cancers:

Stage I: Cancer is only in the uterus.

  • Stage IA: Cancer is only in the endometrium or endocervix (an opening in the cervix, linking the vagina and uterus).
  • Stage IB: The tumor has spread to less than half of the myometrium (the uterus’s muscle layer).
  • Stage IC: The tumor has spread to more than half of the myometrium.

Stage II: The tumor has spread outside the uterus but remains inside the pelvis.

  • Stage IIA: Cancer has spread to tissue attached to the uterus, such as the ovaries or ligaments.
  • Stage IIB: Cancer has spread to other pelvic tissues.

Stage III: The tumor has spread to other tissue in the abdomen.

  • Stage IIIA: Cancer has spread to one site.
  • Stage IIIB: Cancer has spread to more than one site.
  • Stage IIIC: Cancer has spread to nearby lymph nodes. The tumor ranges from being only in the uterus to having spread to abdominal sites.

Stage IV:

  • Stage IVA: Cancer has spread to the bladder or rectum.
  • Stage IVB: Cancer has spread to distant parts of the body.

Treatments

Your care team will work with you to develop a treatment plan for your unique condition. Recommendations may include:

Surgery

Surgery to remove the cancer is the most common treatment. Our doctors use minimally invasive and precise robotic surgical techniques. This allows for less pain, smaller incisions and quicker recovery.

Options include:

  • Total hysterectomy, which removes the uterus and cervix.
  • Bilateral salpingo-oophorectomy, which removes ovaries and fallopian tubes on both sides.
  • Radical hysterectomy, which removes the uterus, cervix, part of the vagina and possibly the ovaries, fallopian tubes and nearby lymph nodes.
  • A lymph node dissection, which removes lymph nodes so they can be checked for cancer cells.

Radiation therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. The two types of radiation therapy for uterine cancer are:

  • External beam radiation, which uses a machine outside the body to target the cancer.
  • Brachytherapy, a form of internal radiation therapy, which allows for a higher dose in a smaller area. For uterine cancer, you might receive vaginal brachytherapy. In the most common form, a radiation source is placed in a tube that’s inserted into the vagina for a short time. Patients may receive several doses in a series of outpatient visits.

Chemotherapy

Medications are used to kill or stop the growth of cancer cells nearly anywhere in the body. The medications either kill the cells or stop them from dividing. Chemotherapy is usually given in a series of infusions — slow intravenous drips.

Hormone therapy

Hormone therapy removes, blocks or stimulates hormones to stop certain cancer cells from growing.

With endometrial cancer, medicine that increases the amount of progesterone in your body can help stop the growth of cancer cells.

Medicine that reduces the amount of estrogen in your body can help kill endometrial cancer cells that rely on estrogen to grow. These medications may be given as a pill, liquid or shot.

Targeted therapy

Medications given as pills or intravenously can target specific molecules within cancer cells with little damage to normal cells. For endometrial cancer, targeted therapy may:

  • Use antibodies from an immune system cell.
  • Use antibodies that can carry toxins or radioactive material to the cancer cells.
  • Use inhibitors that block a certain type of protein to keep cancer cells from growing.

Targeted therapy is used less often in uterine sarcoma.

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