Overview
Uterine cancer begins when cells in the uterus begin to change, grow uncontrollably, and eventually form a tumor, which can be benign (noncancerous) or malignant (cancerous).
The uterus, or womb, is the muscular organ in a woman's pelvis where fertilized eggs grow into babies. If a fertilized egg does not implant in the uterus then the lining of the uterus is shed every month. This is called menstruation. The cervix is the part of the uterus that connects to the vagina.
The endometrium is the lining of the inner surface of the uterus. This lining is a glandular epithelium, which is sensitive to hormonal stimulation and changes throughout the menstrual cycle and during pregnancy. It is supported by the structural or connective tissues called the endometrial stroma: together these are referred to as the endometrium. This is where most uterine or endometrial cancers occur. The myometrium is the muscle wall of the uterus.
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Tumor Types
Benign Tumors
Distinct from endometrial cancer are the benign tumors known as fibroids. These abnormal growths seldom cause pain, but can become large enough to be uncomfortable as they press on organs around the uterus and eventually produce bleeding. They rarely invade nearby tissues or organs and can be removed surgically. Endometrial hyperplasia — an abnormal increase in the cells of the endometrium — is common among women who are nearing menopause and who seldom ovulate. It also can be caused by overstimulation of the uterus by estrogen replacement therapy. It is not in itself cancerous, but can change progressively to become malignant.
Since endometrial hyperplasia can be a forerunner of endometrial cancer, your doctor will investigate it carefully. The type of treatment will depend on which of the three classes of hyperplasia is identified:
• Cystic hyperplasia is generally considered unlikely to become malignant, and will be monitored regularly.
• Adenomatous hyperplasia is more likely to progress to cancer in 25 percent of women who develop it, and generally requires some type of treatment.
• Atypical hyperplasia is considered a precancerous condition, and may be treated by surgical removal of the uterus.
Malignant Tumors
In uterine cancer the tissue most commonly involved is the inner lining of the uterus, or endometrium. When cancer cells arise among the cells of this lining, new cells develop faster than existing ones die. The excess cells continue trying to create tissue and perform their normal tasks, but have neither the room nor the ability to do it properly.
With the loss of orderly growth, they multiply, and eventually form extra tissue that has no function. As the tissue grows, it forms masses or tumors. Cancerous tumors can destroy normal uterine tissue and break away to spread or metastasize to other parts of the body.
Endometrial cancer is one of two major cancers that occur in the uterus. In most cases, it first develops in the glandular cells of the lining. Later, it may affect the supporting structure known as the stroma. It can spread by invading the muscle tissue or myometrium. It can also spread into the cervix at the mouth of the uterus, and into the bladder, bowel, and lower abdominal cavity. The lymph and blood systems may also allow it to spread to more distant areas of the body, such as the lung or the liver.
The second form of uterine cancer, called sarcoma, begins in the myometrium. It grows rapidly and may eventually reach the endometrium to also involve the surface cells of the uterine lining. While sarcoma currently accounts for only about five percent of uterine cancer, it is becoming more frequent.
In nearly three-quarters of all cases, uterine cancer establishes its initial foothold in the glandular cells that line the surface of the endometrium. Uncontrolled multiplication of these cells leads first to hyperplasia — an excessive number of cells — then to tumors formed by a large mass of abnormal cells. If an endometrial tumor is cancerous, it will penetrate deep into the uterine wall, destroying normal tissue as it goes and eventually spreading to nearby organs.
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Symptoms
Unfortunately, there is no sensitive, specific screening test for uterine cancer. The first sign of uterine cancer for most women is abnormal vaginal bleeding. But what does "abnormal" bleeding mean?
One sign of uterine cancer can be a relatively unalarming watery vaginal discharge that begins with some streaks of blood and may contain more blood later on. More commonly, women will have, new, unexpected or heavy bleeding. When a woman encounters any of these problems, she should see a physician promptly.
After menopause, when normal bleeding has stopped, any bleeding is considered "abnormal." Cancer of the endometrium — the lining of the uterus — occurs most commonly in postmenopausal women.
Endometrial cancer, however, also can begin with no symptoms. If the disease progresses unnoticed to a more advanced stage, the first warning sign could be pelvic pain or pressure as fluid accumulates in the abdomen.
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Treatment
The type of treatment selected will depend upon tumor grade and stage as well as your general health. Four types of treatment are commonly used for uterine cancer: hysterectomy, radiation therapy, chemotherapy, and hormonal therapy.
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