Uterine cancer, also known as endometrial cancer when it affects the lining of the uterus, is one of the most common gynecologic cancers. It primarily affects women after menopause but can occur at any age. Understanding its causes, symptoms, diagnosis, and treatment options can significantly improve outcomes and raise awareness for early intervention.

Overview

The uterus is a pear-shaped organ in the female pelvis where a fetus develops during pregnancy. Uterine cancer develops when abnormal cells grow uncontrollably in the tissue of the uterus, leading to the formation of tumors.

There are two primary types of uterine cancer:

  • Endometrial cancer: Arises in the inner lining (endometrium) of the uterus. It is the most common form.
  • Uterine sarcoma: A rarer, more aggressive type that forms in the muscle or supporting tissues of the uterus.

While endometrial cancer is more frequently diagnosed early due to noticeable symptoms like abnormal vaginal bleeding, uterine sarcomas are often found at later stages.

Types

Endometrial Carcinoma
This accounts for over 90% of uterine cancers. It typically grows slowly and is often detected early. Subtypes include:

  • Endometrioid adenocarcinoma (most common)
  • Serous carcinoma
  • Clear cell carcinoma

Uterine Sarcoma
Less than 10% of cases, but more aggressive. Types include:

  • Leiomyosarcoma
  • Endometrial stromal sarcoma
  • Undifferentiated sarcoma

Each subtype differs in behavior and treatment, making accurate diagnosis crucial.

Symptoms

Many women with uterine cancer experience noticeable symptoms, especially in early stages. The most common symptoms include:

  • Abnormal vaginal bleeding: The hallmark symptom, especially bleeding after menopause.
  • Pelvic pain or pressure
  • Pain during intercourse
  • Unusual vaginal discharge
  • Difficulty or pain during urination
  • Unexplained weight loss

Postmenopausal women should never ignore bleeding, even if it’s light. For premenopausal women, unusually heavy or prolonged menstrual bleeding may also be a warning sign.

Causes

Uterine cancer develops when mutations occur in the DNA of cells in the uterus, causing them to multiply uncontrollably. The exact cause is often unclear, but several factors increase the likelihood of these changes.

Estrogen plays a key role in the development of many cases of endometrial cancer. When estrogen levels are high and unopposed by progesterone, it can lead to the overgrowth of the endometrium, increasing cancer risk.

Risk Factors

Several risk factors can increase the likelihood of developing uterine cancer:

  • Age: Most common in women over 50.
  • Hormone imbalance: Excess estrogen without sufficient progesterone.
  • Obesity: Increases estrogen levels through fat tissue conversion.
  • Family history: Especially Lynch syndrome or colon cancer history.
  • Diabetes: Elevated insulin levels may contribute.
  • Polycystic ovary syndrome (PCOS): Hormonal imbalance raises risk.
  • Tamoxifen: A breast cancer drug that can affect the uterus.
  • Radiation therapy: Especially to the pelvis.

Not everyone with these factors will develop uterine cancer, but they increase the risk significantly.

Diagnosis

Detecting uterine cancer early improves outcomes significantly. Diagnosis often begins after a woman reports abnormal bleeding or other symptoms.

Pelvic Exam
A doctor may check for abnormalities in the uterus or other organs.

Transvaginal Ultrasound
This imaging test provides a clear view of the uterine lining. A thickened endometrium in postmenopausal women can signal cancer.

Endometrial Biopsy
A small tissue sample is collected from the uterine lining and sent to a lab to check for cancer cells.

Hysteroscopy
Involves inserting a small camera into the uterus to inspect the lining and collect targeted biopsies.

Dilation and Curettage (D&C)
A surgical procedure to remove tissue from inside the uterus for further testing.

Staging

Once diagnosed, uterine cancer is staged to determine how far it has spread:

  • Stage I: Cancer is limited to the uterus.
  • Stage II: Cancer has spread to the cervix.
  • Stage III: Spread beyond the uterus to nearby tissues (e.g., vagina, lymph nodes).
  • Stage IV: Spread to distant organs such as the bladder, rectum, or lungs.

Staging involves imaging tests like CT scans, MRIs, and sometimes PET scans, along with lymph node evaluation during surgery.

Treatment

Treatment depends on the type, stage, and overall health of the patient. A multidisciplinary team typically designs a personalized plan.

Surgery
The most common treatment is a hysterectomy—removal of the uterus. This may include removing the ovaries, fallopian tubes, and lymph nodes. For early-stage endometrial cancer, surgery alone may be curative.

Radiation Therapy
Used after surgery to reduce recurrence or in advanced cases to shrink tumors. Includes:

  • External beam radiation therapy (EBRT)
  • Brachytherapy: Internal radiation placed inside the uterus or vagina.

Hormone Therapy
For cancers that are hormone-receptor-positive, drugs like progestins or aromatase inhibitors may be used to slow cancer growth.

Chemotherapy
Used in aggressive or late-stage cancers. It can also follow surgery to eliminate remaining cancer cells.

Targeted Therapy & Immunotherapy
Advanced uterine cancers with specific genetic mutations may respond to targeted treatments like HER2 inhibitors or immune checkpoint inhibitors (e.g., pembrolizumab).

Prognosis

The outlook for uterine cancer is generally good when detected early. The 5-year survival rate varies by stage:

  • Stage I: ~95%
  • Stage II: ~70–80%
  • Stage III: ~50–60%
  • Stage IV: ~15–20%

Several factors influence survival, including cancer type, tumor grade, patient age, and general health.

Prevention

While not all cases can be prevented, certain steps can reduce risk:

  • Maintain a healthy weight
  • Exercise regularly
  • Control blood sugar and insulin levels
  • Treat hormonal imbalances promptly
  • Report unusual bleeding early
  • Discuss hormone therapy risks with your doctor

For women with genetic predispositions (e.g., Lynch syndrome), preventive surgery or more frequent screenings may be recommended.

Recurrence

Even after treatment, uterine cancer can return—most often within the first three years. Signs of recurrence may include:

  • Vaginal bleeding or discharge
  • Pelvic or abdominal pain
  • Swelling in the legs
  • Persistent cough or weight loss

Regular follow-up appointments are crucial to detect recurrence early.

Living With Uterine Cancer

Coping with a cancer diagnosis is emotionally and physically challenging. Support, both medical and emotional, is essential.

  • Follow-up care: Includes regular exams, imaging, and lab tests.
  • Fertility support: Younger women may explore fertility preservation before treatment.
  • Support groups: Talking with others facing similar experiences can help.
  • Mental health: Therapy and counseling may ease anxiety and depression.

Advancements in treatment have improved not only survival rates but also quality of life for survivors.