Top questions about uterine cancer

What you should know about uterine cancer

When meeting with your gynecologic oncologist, you may want to bring a friend or relative to help you remember your questions and to take notes. From your first visit, having a better understanding of uterine cancer may help you feel confident in your decisions and prepared for whatever may come next.

At City of Hope, you are encouraged to ask questions and be an active participant in your treatment decisions. Our uterine cancer experts are committed to providing thorough, easy-to-understand answers.

Here are answers to some common questions uterine cancer patients ask their doctors:

What is uterine cancer?

Uterine cancers may form in various areas of the uterus (also called the womb), the hollow pelvic organ where a fetus grows in women. Uterine cancer that forms in the inner lining of the uterus is considered endometrial cancer, which is the most common form of the disease. Most endometrial cancers are adenocarcinomas, or cancers that begin in glands that secrete mucus and other fluids.

Uterine sarcoma is an uncommon form of uterine cancer that forms in the muscle and tissue that support the uterus. Uterine sarcoma is typically treated differently than endometrial cancer.

Research has shown that certain factors may help lower the risk of uterine cancer, including:

• Maintaining a healthy weight
• Taking birth control pills, especially over a long period of time
• Regularly monitoring blood sugar levels if you are diabetic

Why does obesity increase the risk for cancer of the uterus?

Fat tissue may change some hormones into estrogen. Being obese and having excess fat tissue may increase a woman's estrogen levels, which raises her endometrial cancer risk. Endometrial cancer is twice as common in overweight women as in women who maintain a healthy weight, and the disease is more than three times as common in obese women. Obese women who experience early menopause may be at an even greater risk.

Questions about uterine cancer treatment

Here are answers to some common questions uterine cancer patients ask their gynecologic oncologists about diagnosing and treatments for cancers of the uterus:

How is uterine cancer diagnosed?

Cancers of the uterus are not typically detected by a Pap test. For this reason, an endometrial tissue sample must be removed and examined under a microscope to look for cancer cells and procedures to diagnose cancers of the uterus include:

Pelvic examination: This is typically the first test performed to check for uterine cancer. During a pelvic exam, your doctor checks the abdomen and pelvic area for signs of disease, including nodules, bumps or other abnormalities. of disease, including nodules, bumps or other abnormalities.

Biopsy: This test involves removing tissue from the uterine lining for analysis under a microscope. An endometrial biopsy procedure is typically performed in the doctor’s office.

Ultrasound: A transvaginal ultrasound examines the vagina, uterus, fallopian tubes and bladder. A wand-like device is inserted into the vagina. The wand interprets sound waves, projecting a video image of the uterus on a monitor. This test helps the doctor look for abnormalities in the uterine lining.

CT scan: A CT scan creates a three-dimensional image of organs, tissues and cells inside the body using X-rays taken from different angles. A computer combines the images into a detailed, cross-sectional view that may reveal tumors or other abnormalities.

Dilation and curettage: If a sufficient tissue sample cannot be obtained during a biopsy or if the biopsy results are inconclusive, a dilation and curettage (D&C) may be necessary. During D&C, tissue is scraped from the lining of the uterus and examined under a microscope for cancer cells. This procedure is typically performed in an operating room.

Hysteroscopy: During this procedure, a thin, tube-like instrument called a hysteroscope is inserted through the vagina and cervix into the uterus. The end of the hysteroscope is fitted with a light and lens for viewing. It may also be fitted with a tool to remove tissue samples, which are checked under a microscope for signs of cancer. Frequently, hysteroscopy is performed at the time of a D&C.

Magnetic resonance imaging (MRI): An MRI uses magnetic fields to create detailed images of the body. This test uses a special dye called a contrast medium, given before the scan, to create a clearer picture. MRIs may also be used to measure the tumor’s size.

Sentinel lymph node biopsy: During this procedure, a surgeon removes sentinel lymph nodes, which are considered the first one or few lymph nodes draining fluid from a tumor. A pathologist later examines the lymph nodes under a microscope for cancer cells. Sentinel lymph node biopsy may help determine whether the cancer has spread beyond the uterus. Removing only one or two lymph nodes also may help avoid complications from surgery to remove a larger number of lymph nodes.

Why does the stage of my tumor matter?

Staging is used to determine the severity or extent of the cancer. Knowing the cancer’s stage will help your care team recommend a personalized treatment plan specific to your disease. Cancer that has spread to other organs is called metastatic cancer. A cancer’s stage is typically denoted by a Roman numeral. The higher the number, the more advanced the cancer has become.

How is uterine cancer treated?

Treatment options for cancers of the uterus depend on several factors, including the type and stage of the disease, potential side effects, as well as the patient’s overall health and age. The patient’s personal preferences, such as whether or how treatment may affect her ability to have children, may also be considered. Uterine cancer may be treated with one or a combination of approaches, including surgery, radiation therapy, chemotherapy and hormone therapy. Some treatments remove or destroy the disease in the uterus and in nearby tissues, such as lymph nodes.

The typical first-line treatment for most uterine cancer patients is surgery. Common surgical procedures to treat uterine cancer include:

Hysterectomy: A hysterectomy is surgery to remove the uterus and cervix.

Radical hysterectomy: This procedure, which is only recommended for a small percentage of uterine cancer patients, removes the uterus, cervix, ovaries, upper part of the vagina and surrounding tissue.

Lymphadenectomy: This procedure, which removes lymph nodes in the pelvis and lower abdomen, may be performed as part of a hysterectomy to stage the cancer and develop a more targeted treatment plan.

Pelvic exenteration: During this surgery, the uterus, cervix, vagina, ovaries, bladder, rectum and nearby lymph nodes are removed. Tissue from elsewhere in the body is used to reconstruct the vagina, and urine and stool are passed into external bags. This may be an option for women with recurrent or advanced uterine cancer.

The goal of other treatments is to destroy or control cancer cells. These treatments include:

• Chemotherapy: This treatment uses anti-cancer drugs targeted to a specific location, to kill cancer cells. Chemotherapy may be administered by mouth or injected into a vein.
• Hormone therapy: These drugs are used to slow the growth of cancer by reducing estrogen levels in the body.
• Radiation therapy: This conventional technique uses targeted, high-energy X-rays to destroy or shrink tumors. It may be administered in two ways to treat cancer of the uterus:
• Brachytherapy, an internal radiation treatment that implants radioactive material inside the body using a cylinder
• External beam radiation therapy, which uses a machine that focuses a beam of radiation at the tumor

In some cases, brachytherapy and external beam radiation therapy are administered in combination. In such instances, the external beam radiation is typically given first, followed by the brachytherapy.

If your treatment plan includes radiation therapy after surgery, you will be given time to heal from the operation before starting radiation.

What are the possible side effects of each treatment option?

Nearly all treatments for cancers of the uterus have potential side effects. Some side effects are mild; others may be more severe. Not every patient has the same side effects or experiences them to the same degree. Some side effects are temporary, while others may last longer or appear after treatment ends. Here is a brief summary of the side effects associated with treatment for cancers of the uterus:

Surgery: Women undergoing a hysterectomy may experience lower abdominal incisional pain, bleeding or infection. Bladder damage is a rare side effect. Women of childbearing age should understand that a hysterectomy makes future childbirth impossible since the uterus and both ovaries are removed. Once the ovaries are removed, menopause will develop, if it hasn’t already. This may lead to symptoms such as hot flashes, night sweats and vaginal dryness. Removing lymph nodes in the pelvis may lead to a build-up of fluid in the legs, a condition called lymphedema.

Radiation therapy: Common side effects of radiation include fatigue, upset stomach and diarrhea. Nausea and vomiting may also occur, but they may be managed with medication. Skin irritation is another possibility.These side effects are more common with pelvic radiation than with vaginal brachytherapy. Side effects tend to be worse when chemotherapy is administered along with radiation.

Long term side effects may include changes to the lining of the vagina, which may in turn lead to vaginal dryness. This is more common after vaginal brachytherapy than following external beam radiation to the pelvis.

Chemotherapy: Tolerance to chemotherapy treatments varies from woman to woman. The drugs used and the interval between treatments also vary with each patient. Some women receiving chemotherapy for gynecologic cancer lose their hair, typically two to three weeks after the first treatment.

Hormone therapy: Side effects of hormone therapy for endometrial cancer may include hot flashes, weight gain and night sweats, as well as increased blood sugar levels in women with diabetes.

How can I manage treatment-related side effects?

The side effects of uterine cancer treatment may be managed with supportive care services designed to help you stay strong throughout treatment. The therapies are designed to help you maintain your strength and stamina, so you are better able to continue treatment without interruption. Nutrition therapy, naturopathic medicine, pain management and mind-body medicine are some examples of supportive therapies that may help reduce the impact of uterine cancer treatment side effects.

How will uterine cancer affect my fertility?

Uterine cancer treatment may affect your ability to conceive. The uterus, also called the womb, is a critical component of a woman’s reproductive system and houses the growing fetus during pregnancy. Sometimes the ovaries are removed as part of uterine cancer treatment. Ovarian cortex cryopreservation may be an option for women of childbearing age who want to get pregnant via a surrogate after treatment.

Does it matter how much experience a doctor has in treating my type and stage of uterine cancer?

Gynecologic oncologists who are experienced in treating cancer of the uterus may be better equipped to explain and deliver the full range of treatment options. You should feel comfortable asking your doctor about his or her experience. If you are not satisfied with the answers you receive, you may want to consider getting a second opinion.

Next topic: What are the facts about uterine cancer?