Q+A: Uterine Cancer

The most common cancer of the female reproductive organs is uterine cancer, and its incidence is growing

Q What causes uterine cancer? 

A The most common type of uterine cancer is caused by an imbalance in the hormones estrogen and progesterone. Estrogen is produced during the first part of the menstrual cycle and causes the endometrium to grow. Progesterone is produced during the second half of the menstrual cycle, causing the endometrial lining to mature. If a woman does not get pregnant in a particular cycle, then both hormones briefly disappear and the endometrial lining is shed, resulting in a menstrual period. If there is constant stimulation by estrogen without progesterone to balance it out, then precancers or cancers of the uterine lining may occur. 

The risk of uterine cancer increases with age, peaking in the early 70s. However, even young women may develop uterine cancer. Women with polycystic ovarian syndrome have an increased risk of developing cancer of the uterus due to the hormonal imbalance that occurs with this syndrome. Although the usual treatment for uterine cancer is hysterectomy, there may be fertility-sparing options available for some young women. This usually involves treatment with progesterone to try to reverse the effects of unopposed estrogen. 

These cancers are more common in white women. However, they are more deadly in African American women. Overall, African American women may be less likely than white women to receive what’s considered standard treatment. However, they also appear to be more likely to develop aggressive forms of this cancer that are more difficult to treat.  

Q Are there genetic risk factors? 

A Uterine cancer can be hereditary. The most common genetic syndrome causing an increased risk of this cancer is Lynch syndrome, which is also associated with an increased risk of colon cancer. A woman with a family history of endometrial and colon cancer may want to consider testing to determine if she carries a gene that might predispose her to developing one of these cancers. If she does, then she may want to pursue more frequent colonoscopies for early detection or hysterectomy to reduce cancer risk. Women with a family history of uterine and colon cancer should consider being evaluated by an expert in cancer genetics. The diagnosis can be made by a simple blood test. 

Q What are the symptoms of uterine cancer? 

A The most common symptom is abnormal bleeding, either heavy or irregular menstrual bleeding, bleeding between periods or bleeding after menopause. Such bleeding is never normal and should prompt a visit to the gynecologist. Evaluation may include pelvic ultrasound, endometrial biopsy in the office or dilation and curettage (D & C). 

If a woman is diagnosed with endometrial cancer, she should be seen by a gynecologic oncologist to be sure that she is getting the most appropriate treatment for her case. Most patients can be treated with surgery, which can usually be performed laparoscopically. Biopsy of lymph nodes may be necessary to determine if the cancer has spread. Some patients will require radiation and/or chemotherapy. 

Q Can uterine cancer be prevented? 

A Obesity is an important risk factor for the development of uterine cancer. As with many cancers, maintaining a normal weight, eating a healthy diet and getting regular exercise may decrease a woman’s risk of developing this disease. 

Birth control pills decrease the risk of uterine cancer by 50% after five years of continuous use. Women who have irregular menstrual periods should talk to their gynecologists about medication to regulate their periods and prevent prolonged periods of the hormonal imbalance that can cause endometrial cancers.

For more information about uterine and other women’s cancers, check out the Foundation for Women’s Cancer website at www.foundationforwomenscancer.org, the American Cancer Society website at www.cancer.org or the National Cancer Institute website at www.cancer.gov.