Uterine cancer, or cancer of the uterus (the womb) is the most common cancer of the female reproductive organs. Almost all cases start in the lining of the uterus, called the endometrium.
The uterus is where a fetus grows when a woman is pregnant. It is hollow and pear shaped with two main parts:
- The cervix, which is the bottom part and extends into the vagina (the birth canal)
- The body of the uterus is the upper part. It also may be called the corpus. It has two main parts -- the muscle wall, which contracts when a woman has a baby, and the inner lining (endometrium).
When a woman menstruates (has a period), the endometrium becomes thicker. If she does not become pregnant, the new endometrial tissue goes out of the body as menstrual flow (blood). This happens about every month until a woman stops having periods. When a woman stops having periods it is called menopause.
Uterine cancer types
There are three types of uterine cancer.
Endometrial cancer: Almost all uterine cancers start in the lining of the uterus (endometrium). The two main types of endometrial cancer are:
- Endometroid adenocarcinoma: This accounts for most cases of endometrium cancer.
- Uterine carcinosarcoma: The cancer cells look like endometrium cancer and sarcoma.
Uterine sarcomas: These are less common types of uterine cancer and start in the muscle wall of the uterus.
Uterine cancer statistics
Each year, about 63,000 women in the United States are diagnosed with uterine cancer. The average age for diagnosis of uterine cancer is 62. However, the number of younger women with endometrial cancer is going up.
Most uterine cancers develop over a period of years. They may start as less serious problems such as endometrial hyperplasia, which is an overgrowth of cells in the lining of the uterus.
Fortunately, many uterine cancers are found early because of warning signs such as abnormal or postmenopausal bleeding. If uterine cancer is found in the earliest stages, it often can be treated successfully.
Uterine cancer risk factors
Anything that increases your chance of getting uterine cancer is a risk factor. These include:
- Obesity: Being overweight raises your risk two to four times. A higher level of fat tissue increases your level of estrogen.
- Eating a diet high in fat
- Age: More than 95% of uterine cancers occur in women 40 and older.
- Tamoxifen: This breast cancer drug can cause the uterine lining to grow. If you take Tamoxifen and have changes in your menstrual period or bleeding after menopause, it is important to let your doctor know.
- Estrogen replacement therapy (ERT) without progesterone if you have a uterus. Birth control pills may lower your risk.
- Personal/family history of uterine, ovarian or colon cancer. This may be a sign of Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC). Learn more about hereditary cancer syndromes.
- Ovarian diseases, such as polycystic ovarian syndrome (PCOS)
- Complex atypical endometrial hyperplasia: This precancerous condition may become uterine cancer if not treated. Simple hyperplasia rarely becomes cancer.
- Diabetes
- Never having been pregnant
- Number of menstrual cycles (periods): If you started having periods before 12 years old or went through menopause late, your risk of uterine cancer may be higher.
- Breast or ovarian cancer
- Pelvic radiation to treat other kinds of cancer. The main risk factor for uterine sarcoma is a history of high-dose radiation therapy in the pelvic area.
Not everyone with risk factors gets uterine cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.
Behavioral and lifestyle changes can help prevent uterine cancer. Visit our prevention and screening section to learn how to manage your risk.
Some cases of uterine cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
What are the symptoms of uterine cancer?
Uterine cancer symptoms vary from woman to woman. If you have gone through menopause, see your doctor if you have any vaginal bleeding, spotting or unusual discharge.
If you have not gone through menopause, see your doctor if you have any of the following symptoms for more than two weeks:
- Unusual bleeding, such as between periods or heavier flow
- Abnormal vaginal discharge
- Pelvic pain or pressure
- Weight loss
These symptoms do not always mean you have uterine cancer. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.
Behavioral and lifestyle changes can help prevent uterine cancer. Visit our prevention and screening section to learn how to manage your risk.
Some cases of uterine cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
How is uterine cancer diagnosed?
Early and accurate diagnosis of uterine cancer can help increase the chance for successful treatment. MD Anderson uses the most advanced techniques and technology to diagnose uterine cancer and find out the exact extent of the disease. This helps your doctor choose the best type of treatment for you. Our staff includes pathologists, diagnostic radiologists and specially trained technicians who are highly skilled in diagnosing uterine cancer.
Uterine Cancer Diagnostic Tests
If you have symptoms that may signal uterine cancer, your doctor will examine you and ask you questions about your health; lifestyle, including smoking and drinking habits; and your family history.
If your doctor thinks you might have uterine cancer, the first step will be a biopsy. Your doctor will decide the best way to do the biopsy. Methods include:
Endometrial biopsy: A thin, flexible tube is inserted through the cervix and into the uterus. Using suction, a small amount of tissue is removed through the tube.
D&C (dilation and curettage): If an endometrial biopsy does not provide enough tissue or if a uterine cancer diagnosis is not definite, a D&C may be done. The cervix is dilated (enlarged) with a series of increasingly larger metal rods. A tool called a curette then is used to take cells from the uterus lining.
Hysteroscopy: A thin, telescope-like device with a light (hysteroscope) is put into the uterus through the vagina. The doctor then looks at the uterus and the openings to the Fallopian tubes. Small pieces of tissue can be removed. Hysteroscopy may be done with a D&C.
One or more of the following tests may be used to find out if you have uterine cancer and if it has spread. These tests also may be used to find out if treatment is working.
Surgery, which may include:
- Hysterectomy: Removal of the uterus
- Bilateral salpingo-oophorectomy: Removal of the uterus, ovaries and Fallopian tubes
- Lymph node dissection: Removal of lymph nodes in the pelvis and lower abdomen
Imaging tests, which may include:
- Ultrasound (link to definition)
- CT or CAT (computed axial tomography) scans (link to definition)
- MRI (magnetic resonance imaging) scans (link to definition)
- PET (positron emission tomography) scans (link to definition)
- Chest X-ray
Blood tests, which may include:
- Complete blood count (CBC)
- CA 125: Uterine cancers sometimes release this substance into the blood. This test, which is being studied at MD Anderson, measures levels of CA 125. High levels of CA 125 may mean the cancer has spread beyond the uterus or come back after treatment.
Genetic Testing
The Gynecological Cancer Genetics Clinic at MD Anderson offers genetic testing for some women with uterine cancer or who are at risk. Genetic counseling may be recommended if you:
- Were diagnosed with endometrium cancer before age 50
- Have had colon or rectal cancer
- Have any close relatives with colon, rectal or endometrium cancer
- Have a relative who has tested positive for a Lynch syndrome gene mutation (MLH1, MSH2, MSH6, PMS2 genes)
Behavioral and lifestyle changes can help prevent uterine cancer. Visit our prevention and screening section to learn how to manage your risk.
Some cases of uterine cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
What are the stages of uterine cancer?
If you are diagnosed with uterine cancer, your doctor will determine the stage of the disease.
Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.
Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.
There are two staging systems for uterine cancer, one for endometrial cancers and one for uterine sarcomas.
Endometrial cancer stages
(source: National Cancer Institute)
Stage I
In stage I, cancer is found in the uterus only. Stage I is divided into stages IA and IB, based on how far the cancer has spread.
- Stage IA: Cancer is in the endometrium only or less than halfway through the myometrium (muscle layer of the uterus).
- Stage IB: Cancer has spread halfway or more into the myometrium.
Stage II
In stage II, cancer has spread into connective tissue of the cervix, but has not spread outside the uterus.
Stage III
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis.
- Stage IIIA: Cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries, and ligaments of the uterus.
- Stage IIIB: Cancer has spread to the vagina and/or to the parametrium (connective tissue and fat around the uterus).
- Stage IIIC: Cancer has spread to lymph nodes in the pelvis and/or around the aorta (largest artery in the body, which carries blood away from the heart).
Stage IV
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread.
- Stage IVA: Cancer has spread to the bladder and/or bowel wall.
- Stage IVB: Cancer has spread to other parts of the body beyond the pelvis, including the abdomen and/or lymph nodes in the groin.
Uterine sarcoma stages
(source: National Cancer Institute)
Stage I
In stage I, cancer is found in the uterus only. Stage I is divided into stages IA and IB, based on how far the cancer has spread.
- Stage IA: Cancer is in the endometrium only or less than halfway through the myometrium (muscle layer of the uterus).
- Stage IB: Cancer has spread halfway or more into the myometrium.
Stage II
In stage II, cancer has spread into connective tissue of the cervix, but has not spread outside the uterus.
Stage III
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis.
- Stage IIIA: Cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries, and ligaments of the uterus.
- Stage IIIB: Cancer has spread to the vagina or to the parametrium (connective tissueand fat around the uterus).
- Stage IIIC: Cancer has spread to lymph nodes in the pelvis and/or around the aorta (largest artery in the body, which carries blood away from the heart).
Stage IV
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread.
- Stage IVA: Cancer has spread to the bladder and/or bowel wall.
- Stage IVB: Cancer has spread to other parts of the body beyond the pelvis, including the abdomen and/or lymph nodes in the groin.
What are the treatment options for uterine cancer?
Our treatment approach
At MD Anderson, your treatment for uterine cancer is customized just for you by some of the nation's leading experts. They work in teams, collaborating at every step, to be sure you receive comprehensive, yet highly specialized care.
We personalize your care to include the most advanced treatments with the least impact on your body. For uterine cancer, surgery often is one of the main treatments.
Surgical skill, experience
Like all surgeries, uterine cancer surgery is most successful when done by a specialist with a great deal of experience in the particular procedure. MD Anderson surgeons are among the most skilled and recognized in the world.
They perform a large number of uterine cancer surgeries each year, using the least-invasive and most-advanced techniques. For some patients, minimally invasive surgeries can mean faster healing and less time in the hospital.
And we're constantly researching newer, safer and more effective uterine cancer treatments. MD Anderson is one of the only cancer centers in the nation to house a $10 million federally funded uterine cancer SPORE (Specialized Program of Research Excellence) program. We're leading the way in uterine cancer research, which means we can offer a variety of clinical trials of new therapies.
Our uterine cancer treatments
If you are diagnosed with uterine cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. One or more of the following therapies may be recommended to treat uterine cancer or help relieve symptoms.
Surgery
Surgery is the main treatment for uterine cancer. Usually surgery for uterine cancer includes:
- Total hysterectomy (surgical removal of the uterus)
- Bilateral salpingo-oophorectomy (removal of both ovaries and Fallopian tubes)
- Biopsy of the omentum, a fat pad in the pelvis
- Removal of lymph nodes in the pelvis and lower abdomen
Sometimes a radical hysterectomy is done. This means removal of the:
- Uterus
- Cervix and surrounding tissue
- Upper vagina
Depending on your health and how far uterine cancer has spread, surgery may be:
- Minimally invasive: After making several small incisions (cuts) in the abdomen, the doctor uses a laparoscope or robotic surgery to remove the organs. The uterus often is removed through the vagina.
- Open: A large incision is made in the abdomen.
Surgery for uterine cancer may include:
- Pelvic washings: The surgeon puts saline (salt water) into the pelvic area after the uterus has been removed. The saline is then examined under a microscope.
- Tumor debulking: If the cancer has spread into the abdomen, it may be debulked. This means the surgeon removes as much of the cancer as possible before other types of treatment.
Radiation therapy
Radiation therapy may be used to treat uterine cancer after a hysterectomy or as the main treatment when surgery is not possible. Depending on the stage and grade of the cancer, radiation therapy also may be used at other points of treatment.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target uterine cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson provides the most advanced radiation treatments for uterine cancer, including:
- Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
- 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
- Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor
Talk to your doctor about possible side effects of radiation treatment for uterine cancer. Some women get lymphedema in their legs. This is caused by blockage of the lymph fluid. Lymphedema may not start until months after treatment, but it usually does not go away. However, there are treatments to help.
Chemotherapy
MD Anderson offers the most up-to-date and advanced chemotherapy options for uterine cancer.
Hormone therapy
Some hormones can cause certain uterine cancers to grow. If tests show the cancer cells have receptors where hormones can attach, drugs can be used to reduce hormones or block them from working.
Hormones that may be used to treat uterine cancer include:
- Progestins
- Tamoxifen
- Aromatase inhibitors
Our uterine cancer clinical trials
MD Anderson is proud to be one of the only cancer centers in the nation to house a prestigious federally funded SPORE (Specialized Program of Research Excellence) program. We’re studying new ways to prevent and treat uterine cancers to give patients everywhere futures filled with hope.
Because of our status as one of the world’s premier cancer centers, MD Anderson participates in many clinical trials (research studies) for uterine cancer. Sometimes they are a patient’s best option for treatment. Other times, they help researchers learn how to treat cancer and improve the future of cancer treatment.
Why come to MD Anderson for uterine cancer care?
MD Anderson's Gynecologic Oncology Center focuses an incredible level of expertise and experience on each patient with uterine cancer. From diagnosis through treatment and follow-up, your care is personalized and designed especially for you.
Teams of some of the nation's top endometrial cancer experts consider all the options, and then they recommend the most-advanced therapies with the least impact on your body. They have at their fingertips the latest technology and techniques, backed by one of the leading uterine cancer research programs in the United States.
Personalized uterine cancer treatment
Your treatment team, which may include medical, surgical and radiation oncologists; gynecologists; pathologists; and diagnostic radiologists, collaborates and communicates each step of the way. A specially trained staff with experience in caring for women with uterine cancer supports the team.
Surgery often is part of the treatment for uterine cancer. At MD Anderson, our highly specialized surgeons are among the most experienced and skillful in the country. In many cases, they are able to perform minimally invasive surgeries and use robotic surgery for uterine cancer. These procedures may help lessen the time it takes you to heal and the time you need to spend in the hospital.
Specialized care, research
At MD Anderson, we go beyond treating disease. We are dedicated to helping women who have been treated for endometrial cancer get back to a healthy life. For instance, we offer special support groups just for women with uterine cancer.
In addition, we are working toward a better understanding of uterine cancer on a molecular basis. Our Gynecologic Genetics Clinic provides genetic counseling for women at risk of inherited cancer syndromes.
MD Anderson is proud to be one of the only cancer centers in the nation to house a $10 million federally funded uterine cancer SPORE (Specialized Program of Research Excellence) program. We're leading the way in uterine cancer research, which means we offer a variety of clinical trials of new therapies.
My doctors say that I'm a miracle, but I know miracles happen every day at MD Anderson.
Jan de Chambrier had always envisioned herself as a mother to several children. In 1990, she and her husband were on their way to fulfilling that desire when they found out they were expecting twins. Then she suffered a miscarriage. And the news got worse from there.
“They discovered a tumor behind the uterus,” says Jan, who was 37 at the time. “It was unusual because at that age, women are not diagnosed with uterine cancer. I was told that it was a miracle that I conceived given that I had this type of cancer in my body.”
Losing the ability to bear children after uterine cancer treatment
As part of her uterine cancer treatment, Jan had to undergo a complete hysterectomy.
“I went overnight from being pregnant to being menopausal,” she says. “It kind of rocked our world.”
Jan struggled with the emotional impact of her treatment for a year and a half. Then her husband helped her gain a new perspective: Her story wasn’t a tragedy; it was a miracle because if it wasn’t for her pregnancy, no one would’ve discovered the tumor until it was too late.
“That’s really what turned the corner for me,” Jan says.
Eventually, she and her husband adopted a son, Paul, and in 1994, the family moved to The Woodlands, Texas from Denver, Colorado.
A rare uterine cancer recurrence
After more than two decades in remission, Jan noticed a lump in her lower abdomen in January 2016. “I thought it was a hernia because it had been 26 years since my diagnosis,” she says.
Jan’s family doctor examined the lump during her annual physical and told her it wasn’t a hernia.
“I just felt a jolt,” Jan recalls. “I remember going out to my car, and I thought, you know, I have a choice here. I can give into fear, or I can choose to remember what God did 26 years ago.”
Jan met with Douglas Nelson, M.D., at MD Anderson in The Woodlands, and the results of her staging studies caught everyone by surprise.
“It was a very unusual recurrence of the original cancer,” she says.
A second miracle
Jan’s scans indicated her tumor was aggressive, so Michael Bevers, M.D., said she needed to undergo a 6-hour surgery to remove the mass, along with half of her stomach muscles, and have her small intestine restructured with the help of plastic surgeon Victor Hassid, M.D. But on April 14, 2016, Jan awoke from surgery to see Bevers smiling at her.
“He said, ‘You probably won’t remember this, but it went very well. We learned that all we had to do was remove the tumor,’” she recalls. “It was so encapsulated and so contained that they didn’t have to remove any muscles. Dr. Hassid just consolidated all the scars in my abdomen into one beautiful line.”
A new purpose after uterine cancer treatment
Cancer has inspired Jan to help others who are dealing with their own diagnoses.
“You have to grieve,” she advises, adding, “Just because we have experienced deep loss, it doesn’t mean that we no longer have a purpose. Sometimes we have to look deeper to find our purpose.”
This introspection led Jan to volunteer with myCancerConnection, MD Anderson’s one-on-one support program for cancer patients and caregivers.
“I felt that I had been so blessed to go through that whole process and emerge healthy and joyful and able to live a strong and vibrant life,” she says. “I have a wonderful family and a great career, so it’s been great to give back to help others.”
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