Uterine Cancer

While there are several risk factors for endometrial cancer, a hormonal imbalance is considered one of the main risk factors. An excess of the hormone estrogen can increase the risk of endometrial cancer. Some risk factors like age and family history are out of your control, but there are many risk factors that you can control through your lifestyle.

Some endometrial cancer risk factors include:

• Estrogen replacement therapy – women may use menopausal hormone therapy to ease symptoms of menopause; however, if estrogen is not given along with progesterone a hormonal imbalance will occur, increasing a women's risk of endometrial cancer
  
• Endometrial hyperplasia – this condition thickens the endometrial layer of the uterus, and the excess growth can become cancerous
• Past breast or ovarian cancer – previous history of breast cancer or ovarian cancer can increase the risk of developing uterine cancer
• Family history – a family history of cancer, especially gynecological cancer or colorectal cancer
• Age – over 50 and have been through menopause
• A larger number of menstrual cycles – early menstruation (before age 12) and/or late menopause
• Pregnancy – women who have never been pregnant have a higher risk of endometrial cancer than those who have had one or multiple pregnancies
• Obesity – hormonal balance is disrupted when you’re obese
• Diabetes/metabolic syndrome – an imbalanced metabolism can increase risk, as well as cause obesity
• Hypertension – high blood pressure can increase risk

There are no uterine cancer screening exams for women with average risk and no symptoms. If you have some of the factors that put you at a higher risk, talk with your doctor about other procedures to help identify endometrial cancer early. You can help lower the risk of endometrial cancer by:

• Maintaining a healthy weight
• Managing diabetes
• Discussing hormone replacement therapy with your doctor
• Visiting your gynecologist for regular check-ups
• Taking oral contraceptives long-term

In addition to a physical exam, screening tests may include the following.

• Pelvic Exam –  performed to detect lumps which may be cysts or tumors
• CA-125 Blood Test - although this type of blood test is not typically used for uterine cancer screening, it can be used to monitor response to therapy
• Gynecologic Ultrasound Imaging - a transvaginal ultrasound is used to decide where a biopsy is needed
• CT & MRI Scans
• Biopsy – there are two types of biopsies used to detect uterine cancer - endometrial biopsy and sentinel lymph node biopsy
• Dilation & Curettage (D&C) - a D&C is a procedure to remove tissue samples from the uterus. A D&C is often performed with hysteroscopy.

Surgery is usually the first treatment for endometrial cancer. It's performed to remove as much of the tumor as possible, also called debulking, as well as to determine how far cancer may have spread. Depending on how far the cancer has spread in the uterus, different surgical treatments may be used.

Simple or Total Abdominal Hysterectomy 

During a simple abdominal hysterectomy, the uterus is removed through an incision in the abdomen. This type of hysterectomy is often performed using minimally-invasive robotic-assisted techniques.

Vaginal Hysterectomy

In a vaginal hysterectomy, the uterus is removed through the vagina. This type of hysterectomy may be an option for women who are not healthy enough to undergo other types of surgery.

Radical Hysterectomy

When endometrial cancer has spread to the cervix or the area around the cervix, a radical hysterectomy is performed. During this surgery, the entire uterus, the tissues next to the uterus (parametrium & uterosacral ligaments) and the upper part of the vagina (next to the cervix) are removed. This is most often done through the abdomen but can be done through the vagina as well.

Oophorectomy

An oophorectomy is the removal of the fallopian tubes and both ovaries, using minimally invasive laparoscopic techniques. This procedure can also be done as part of a hysterectomy.

Lymphadenectomy

Lymphadenectomy is the removal of lymph nodes from the pelvic region and lower abdomen to see if the cancer has spread beyond the uterus.

Hormone therapy is mostly used in advanced or recurrent endometrial cancer. A few different kinds of hormones are used, but each is intended to slow the growth of cancer. This type of therapy may be used as part of treatment or post-treatment and is often used alongside chemotherapy.

There are a few different kinds of radiation therapy that may be used in endometrial cancer treatment. Depending on the stage and type of cancer, your Mercy provider may recommend a different kind of radiation therapy.

External Beam Radiation Therapy (EBRT)

External beam radiation may be provided in combination with chemotherapy to treat uterine cancer. This type of radiation therapy focuses a beam of X-ray energy on a specific area of the body to eliminate cancer cells.

Internal Radiation Therapy

Some patients may receive internal radiation or brachytherapy, a type of radiation therapy where small sources of radiation in the form of capsules, pellets or ribbons are placed inside your body within or near the tumor.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT is similar to external beam radiation therapy but targets your tumor more directly. This type of therapy uses smaller particles of energy to create a beam that is generally the same size and shape as your tumor.

Chemotherapy can be part of a treatment plan to attack cancer that has spread from the uterus, since chemotherapy targets all quickly-dividing cells throughout the body.  A combination of chemotherapy medications may be part of a treatment plan for endometrial cancer.

Immunotherapy is designed to stimulate the immune system to boost its natural ability to fight cancer and to make cancer cells easier for the immune system to recognize. Immunotherapy can be used to treat certain types of endometrial cancer that have spread or returned. Oral, topical or intravenous medication may be given as part of immunotherapy treatment.