Uterine cancer (also known as uterine adenocarcinoma and endometrial cancer) is the most common cancer of a woman's reproductive system. The pear-shaped uterus is hollow and located in a woman's pelvis between her bladder and rectum. The uterus is also known as the womb, where a baby grows when a woman is pregnant. It has three sections: the cervix (the narrow, lower section), the corpus (the broad, middle section), and the fundus (the dome-shaped, top section). The wall (the inside of the uterus) has two layers of tissue: endometrium (an inner layer), and myometrium (the outer layer), which is muscle tissue.
Every month during a woman's childbearing years, the lining of the uterus grows and thickens in preparation for pregnancy. If the woman does not get pregnant, this thick, bloody lining passes out of her body through her vagina during menstruation. This process continues until menopause.
Uterine cancer begins when cells in the uterus begin to change, grow uncontrollably, and eventually form a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). Noncancerous conditions of the uterus include fibroids (benign tumors in the muscle of the uterus), endometriosis (endometrial tissue on the outside of the uterus or other organs), and endometrial hyperplasia (an increased number of cells in the uterine lining).
There are two types of uterine cancer:
Adenocarcinoma. This type of cancer makes up more than 95% of uterine cancers. It develops from cells in the lining of the uterus, the endometrium. This cancer is also commonly called endometrial cancer.
Sarcoma. This form of uterine cancer develops in the uterine muscle, the myometrium. Sarcoma accounts for only 2% to 4% of uterine cancers. For more information on this type of cancer, visit Cancer.Net's Sarcoma section.
Statistics
In 2008, an estimated 40,100 women in the United States will be diagnosed with uterine cancer. It is estimated that 7,470 deaths from this disease will occur this year. Uterine cancer is the fourth most common cancer and the eighth most common cause of cancer death in women in the United States. Although uterine cancer rates are higher among white women than black women, black women are nearly twice as likely to die from uterine cancer as white women.
The one-year relative survival rate (percentage of patients who survive at least one year after the cancer is detected, excluding those who die from other diseases) for uterine cancer is 92%. The five-year relative survival rate (percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) for a woman with a local (without spread) uterine cancer at diagnosis is about 95%. If the cancer is diagnosed with regional spread, the five-year relative survival rate is about 67%, and if diagnosed after the cancer has spread more distantly, it is 23%.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with uterine cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2008.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices
The following factors can raise a woman's risk of developing uterine cancer:
Age. Uterine cancer most often occurs in women over 50; the average age is 60.
Race. White women are more likely to develop uterine cancer than black women.
Genetics. Uterine cancer may run in families where colon cancer is hereditary. For more information, read The Genetics of Colorectal Cancer.
Other health conditions. Women may be at increased risk for uterine cancer if they have had endometrial hyperplasia or if they have diabetes.
Other cancers. Women who have had breast, colon, or ovarian cancers are at increased risk for uterine cancer.
Tamoxifen. Women taking the drug tamoxifen (Nolvadex) to prevent or treat breast cancer are at increased risk for developing uterine cancer. However, the benefits of tamoxifen may outweigh the risk of developing uterine cancer, so women should discuss the benefits and risks of tamoxifen with their doctor.
Radiation therapy. Women who have had previous radiation treatment in the pelvic area (the lower part of the abdomen between the hip bones) for another cancer are at increased risk for uterine cancer.
Diet. Women who eat a diet high in animal fat may be at an increased risk for uterine cancer.
Estrogen. Exposure to estrogen and/or an imbalance of estrogen is relevant to many of the following risk factors:
Women who started having their periods before age 12 and/or go through menopause later in life
Women who take hormone replacement therapy (HRT) after menopause, especially if they are only taking estrogen; estrogen with progesterone poses a lower risk.
Women who have never had children
Obesity. Fatty tissue in overweight women produces additional estrogen, which can increase the risk of uterine cancer.
Prevention
Research has shown that certain factors can lower the risk of uterine cancer:
Taking birth control pills, especially over a long period of time
Assessing the risk of uterine cancer before considering HRT, especially estrogen replacement therapy
Maintaining a healthy weight
If diabetic, maintaining good self-care, such as regularly monitoring blood glucose levels
Women with uterine cancer may experience the following symptoms. Sometimes, women with uterine cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
The most likely time for uterine cancer to occur is after menopause. The most common symptom is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding during or after menopause is not normal and is always a sign of a problem.
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
As with all types of cancer, early detection and treatment is important. In addition to a physical examination, the following tests may be used to diagnose uterine cancer:
Pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. A Pap test, usually done with a pelvic examination, neither finds nor diagnoses uterine cancer.
Transvaginal ultrasound. In this procedure, an ultrasound wand is inserted in the vagina and aimed at the uterus. An ultrasound uses sound waves to produce images of the uterus, including healthy tissues, cysts, and tumors. If the endometrium looks too thick, the doctor may decide to perform a biopsy.
Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). An endometrial biopsy is a procedure performed in the doctor's office, where the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes about one minute. Afterward, the woman may have cramps and vaginal bleeding. These symptoms will go away and can be reduced by taking a nonsteroidal anti-inflammatory drug under a doctor's direction.
Dilation & curettage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure.
Once endometrial tissue has been removed either during a biopsy or D&C, the sample is checked for cancer cells, endometrial hyperplasia, and other conditions.
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines those images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a woman's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe a woman's condition in more detail. (Roman numerals in parentheses are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO.)
TX: The primary tumor cannot be evaluated due to lack of information. More tests may be needed.
T0 (T plus zero): There does not seem to be a primary tumor in the uterus.
Tis: This condition is called carcinoma (cancer) in situ, which means that the cancer is found only in the layer of cells lining the uterus and has not invaded deeper tissues of the uterus.
T1/FIGO I: The tumor is found only in the corpus uteri (the body of the uterus).
T1a/FIGO IA: The tumor is found only in the endometrium.
T1b/FIGO IB: The tumor has invaded less than one-half of the myometrium.
T1c/FIGO IC: The tumor has invaded more than one-half of the myometrium.
T2/FIGO II: The tumor has invaded the cervix but has not grown beyond the uterus.
T2a/FIGO IIA: The tumor has invaded glands near the cervix.
T2b/FIGO IIB: The tumor has invaded the cervical stroma (the connective tissue of the endometrium).
T3/FIGO III: The tumor has spread to the following areas:
T3a/FIGO IIIA: The tumor involves the serosa (the layer of tissue that covers the outer surface of some parts of the large intestine) and/or adnexa; and/or cancer cells were found in the ascites (abnormal fluid in the abdomen) or peritoneal fluid (fluid from the inner lining of the pelvis and abdomen).
T3b/FIGO IIIB: The tumor has spread to the vagina.
T4/FIGO IVA: The tumor has spread to the lining of the bladder mucosa (lining of the bladder) and/or the bowel mucosa (lining of the bowel).
FIGO IVB (M1): There is distant metastasis to other parts of the body.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the uterus are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be assessed.
N0 (N plus zero): There is no regional lymph node metastasis.
N1: The cancer has invaded the regional lymph node(s).
Distant metastasis. The "M" in the TNM system describes whether the cancer has spread to other parts of the body (to areas such as the lungs or the bones).
MX: The distant metastasis cannot be evaluated.
M0 (M plus zero): The cancer has not metastasized.
M1: There is distant metastasis.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage 0: The tumor is called carcinoma in situ, which means it is very early stage cancer. It is found only in one layer of cells and has not spread (Tis, N0, M0).
Stage I: The cancer is found only in the uterus or womb and has not spread to other parts of the body (T1, N0, M0).
Stage IA: The cancer is found only in the endometrium (T1a, N0, M0).
Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area.
Stage IIIA: The cancer has spread to the serosa of the uterus (the layer of tissue on the outer surface of the uterus) or to the tissue immediately around the uterus. Or, cancer cells were found in the peritoneal fluid (T3a, N0, M0).
Stage IV: The cancer has spread to the mucosa (inner surface) of the bladder or rectum (the lower part of the large intestine); and/or it has spread to lymph nodes in the groin; and/or it has spread to distant organs of the body, such as the lungs or bones.
Stage IVA: The cancer has spread to the mucosa of the rectum or bladder (T4, any N, M0).
Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs (any T, any N, M1).
After identifying the type of uterine cancer, the tumor's grade is determined. The grade is based on how the tumor cells appear under the microscope. If they look much like normal tissue, the cancer is called a low-grade tumor. If the cells look very little like normal cells, the cancer is classified as a high-grade tumor. A high-grade tumor usually grows faster and spreads more quickly than a low-grade tumor.
Recurrent uterine cancer
Recurrent disease means that the cancer has recurred (come back) after it has been treated. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. Approximately 70% of recurrent uterine cancer happens within three years of initial treatment. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.
Vaginal bleeding or discharge
Pain in the pelvic area, abdomen, or back of the legs
Difficulty or pain when urinating
Weight loss
Chronic cough
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of uterine cancer depends on the size and location of the tumor, whether the cancer has spread, the grade (how fast the tumor might grow), and the woman's overall health. In many cases, a team of doctors will work with the woman to determine the best treatment plan.
Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, and hormone therapy.
Surgery
Surgery is the first line of treatment. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the body of the uterus and cervix) or a radical hysterectomy (removal of the entire uterus). After a hysterectomy, a woman can no longer have children. The surgeon may also perform a bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries). The surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus.
After surgery, the woman may remain in the hospital for several days to a week. The most common side effects include pain and extreme tiredness. If a woman is experiencing pain, her doctor will prescribe appropriate medicine. Other immediate side effects may include nausea and vomiting, as well as difficulty emptying the bladder and having bowel movements. The woman's diet may be restricted to liquids, followed by a gradual return to solid foods.
If the ovaries are removed, this ends the body's production of sex hormones, resulting in premature menopause. Soon after surgery, the woman is likely to experience menopausal symptoms, including hot flashes and vaginal dryness. A woman should to talk with her doctor about ways to cope with these side effects.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy for uterine cancer is given by injecting a small amount of radioactive material directly to the tumor. Intraperitoneal radiation therapy is given by delivering radioactive liquid directly into the abdomen through a catheter, a thin tube temporarily put into a large vein to make injections easier.
Side effects from radiation therapy depend on the dosage and the area of the body being treated. Common side effects include tiredness, mild skin reactions (such as dry or reddened skin at the site of radiation treatment), loss of appetite, nausea, vomiting, urinary discomfort, and diarrhea. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away after treatment is finished.
Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.
Some women with uterine cancer need both radiation therapy and surgery. The radiation therapy may take place before surgery (to shrink the tumor) or after (to destroy any cancer cells remaining in the area). If a woman cannot have surgery, the doctor may recommend radiation therapy as another option.
For more information about radiation therapy, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects. Although chemotherapy can be given orally (by mouth), most drugs used to treat uterine cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a catheter.
Other potential side effects of chemotherapy for uterine cancer include the inability to become pregnant and early menopause. Rarely, some drugs cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.
Advances in chemotherapy during the last 10 years include the development of new drugs for the prevention and treatment of side effects, such as antiemetics for nausea and vomiting, and hormones to prevent low white and red blood cell counts.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Hormone therapy
Hormone therapy is used to slow the growth of uterine cancer cells. Hormone therapy for uterine cancer involves the sex hormone, progesterone, given in a pill form. It may be used for women who cannot have surgery or radiation therapy.
Side effects of hormone therapy include fluid retention, increase in appetite, and weight gain. Women in their childbearing years may experience changes in their menstrual cycle.
Treatment options by stage
Stage I
Surgery
Surgery and radiation therapy
Hormone therapy
Stage II
Surgery and radiation therapy
Stage III
Surgery and radiation therapy
Surgery and chemotherapy
Stage IV (advanced)
Surgery
Radiation therapy
Hormone therapy
Chemotherapy
Recurrent cancer(cancer that comes back after treatment)
Hormone therapy
Radiation therapy
Chemotherapy
Treatment for advanced uterine cancer includes radiation therapy, especially for recurrent cancer in the pelvis. Hormone therapy may be used for a cancer that has spread to distant parts of the body. A cancer that is high grade or that does not respond to hormone therapy is treated with chemotherapy. Women with stage IV uterine cancer are encouraged to consider participating in clinical trials.
Doctors and scientists are always looking for better ways to treat women with uterine cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Women who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Women decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that this is the only way to make progress in treating uterine cancer, such as finding new drugs. Even if they do not benefit directly from the clinical trial, their participation may benefit future women with uterine cancer.
To join a clinical trial, women must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so that she understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to uterine cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Anemia. Anemia is common in people with cancer, especially those receiving chemotherapy. Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin (an iron protein) that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue (tiredness) associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects.
Appetite loss. Appetite changes are common with cancer and cancer treatment, including chemotherapy. Individuals with a poor appetite or appetite loss may eat less than usual, not feel hungry at all, or feel satiated (full) after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition, and loss of muscle mass and strength. The combination of weight loss and loss of muscle mass, also called wasting, is referred to as cachexia.
Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of certain chemotherapy and radiation therapy to the pelvis. It may also be caused by certain types of cancer such as pancreatic cancer.
Fatigue. Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously affect family and other daily activities, can make patients avoid or skip cancer treatments, and may even affect the will to live.
Fluid in the abdomen (ascites). Ascites is the buildup of fluid in the abdomen, in the area around the organs known as the peritoneal cavity. Ten percent of all ascites is caused by cancer and is called malignant ascites. Most cancer-related ascites appears in patients with cancers of the ovary, endometrium, breast, colon, gastrointestinal (GI) system, or pancreas. These cancers can cause fluid to build up in the body. People with ascites may experience weight gain, abdominal swelling, a sense of fullness or bloating, a sense of heaviness, indigestion, nausea and/or vomiting, changes to the navel, hemorrhoids (a condition that causes painful swelling near the anus), or ankle swelling.
Fluid in the arms or legs (lymphedema). Lymphedema is the abnormal buildup of fluid in the lymphatic system, the series of channels and nodes (small sacs that hold fluid) that carries lymph (fluid) through the body and helps fight infection. When cancer metastasizes, cancer cells first move to the lymph nodes and then to other parts of the body. Lymphedema can develop immediately after cancer surgery or radiation therapy, or it can develop months or years later. The most common causes of lymphedema includes surgery to remove the lymph nodes; radiation therapy to the lymph nodes; metastatic cancer; bacterial or fungal infection; injury to the lymph nodes; and other diseases involving the lymph system.
Hair loss (alopecia). Radiation therapy and chemotherapy may cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Menopausal symptoms in women. Up to 40% of women experience menopausal symptoms as a result of uterine cancer or its treatments. Menopausal symptoms may depend on the type of therapy and may include hot flashes; night sweats; vaginal dryness, itching, irritation, or discharge; painful sexual intercourse; difficulties with bladder control; depressed feelings; and insomnia.
Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy treatments. Mucositis can be caused by chemotherapy directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment, but it is preventable. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Nervous system disturbances. Nervous system disturbances can be caused by many different factors, including cancer, cancer treatments, medications, or other disorders. Symptoms that result from a disruption or damage to the nerves caused by cancer treatment (such as surgery, radiation treatment, or chemotherapy) can appear soon after treatment or many years later. See Managing Side Effects: Nervous System Disturbances for the most common symptoms.
Pain. Depending on the stage of disease, 30% to 75% of all patients experience pain from cancer. About 85% to 95% of cancer pain can be treated successfully. Pain can make other aspects of cancer seem worse, such as fatigue (tiredness), weakness, sleep disturbance, and confusion. Pain can come from the tumor itself or may be a result of cancer treatment. Pain from a tumor can be a result of the tumor growing and spreading to the bones or other organs and putting pressure on and damaging nerves. Pain from surgery is normal and may persist for months or years. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the chest, breast, or spinal cord. Chemotherapy may cause pain along with numbness in the fingers and toes. Usually this pain goes away when treatment is finished, but sometimes the damage is permanent.
Sexual dysfunction. Sexual dysfunction is common in all people, affecting up to 43% of women and 31% of men. It may be even more common in patients with cancer, as a result of treatments, the tumor, or stress. Many people, with or without cancer, find it intimidating to discuss sexual problems with their doctors. Sexual problems are most commonly caused by body changes from cancer surgery, chemotherapy or radiation therapy, hormone changes, fatigue (tiredness), pain, nausea and/or vomiting, medications that reduce libido (desire for sex), fear of recurrence, stress, depression, and anxiety. Symptoms of sexual dysfunction generally fall into four categories: desire disorders, arousal disorders, orgasmic disorders, and pain disorders.
Skin problems. Skin contains many nerves, making skin problems painful. Skin protects the inside of the body from infection, and skin problems can often lead to other serious problems. Because the skin is on the outside of the body and visible to others, many patients have difficulty coping with skin problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapy leaking out of the intravenous (IV) tube or burned skin caused by radiation therapy.
After treatment for uterine cancer ends, talk with your doctor about developing a plan for follow-up care. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.
Follow-up care may include a physical examination, pelvic examination, blood tests, yearly Pap test, and x-rays. These tests may be done more frequently in the first and second year after treatment. Tell your doctor about any new symptoms, especially a loss of appetite, bladder or bowel changes, pain, vaginal bleeding, or weight changes. These symptoms may be signs that the cancer has come back or signs of other medical conditions.
Women recovering from uterine cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Research involving more advanced diagnostic procedures and treatment for uterine cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
There are several recent developments in the screening and treatment of uterine cancer.
Genetics. Advances in DNA technology have enabled scientists to understand how genetic mutations of tumor suppressor genes (genes that prevent tumor growth), such as PTEN, p53, and Rb, can result in cancer. A uterine cancer with these mutations seems to be less responsive to conventional treatment and have a greater chance of recurring. By testing for these genetic changes, doctors may be able to decide which course of treatment is appropriate for each woman.
Targeted treatments. These drugs target specific growth signals that are present in cancer cells. A number of these drugs are being evaluated in clinical trials. Erlotinib (Tarceva) is a drug that blocks a protein needed for a cancer cell to grow and is being tested in women with uterine cancer. Trastuzumab (Herceptin) is a monoclonal antibody, which is a drug designed to attach to and block a growth factor protein called HER2. Researchers think that HER2 helps cancer cells grow.
Radiation therapy after chemotherapy. For advanced uterine cancer, doctors are exploring the use of radiation therapy after chemotherapy.
Multiple drug combinations. Different types of drugs kill cancer cells in different ways. Using a combination of drugs may increase the chance that the tumor will be destroyed.
Hyperthermia therapy and chemotherapy. Hyperthermia therapy kills cancer cells by increasing body temperature; it also may make cancer cells respond better to chemotherapy.
Improved drug delivery. Chemotherapy is incorporated into fat molecules called liposomes to improve how the drug works.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What type of uterine cancer do I have?
What is the stage of the cancer, and what does this mean?
What is the grade of the tumor, and what does this mean?
What are my options for treatment?
Is hormone therapy one of the treatment options for this type and stage of uterine cancer?
What treatment do you recommend? Why?
What is the goal of this treatment?
What are the possible side effects of this treatment, both in the short-term and long-term?
Will this treatment affect my ability to become pregnant? Should I talk with a fertility specialist before treatment begins?
[If applicable] If I take tamoxifen to prevent breast cancer and later develop cancer of the uterus, are my chances for successful treatment less than for someone who develops uterine cancer and has never taken tamoxifen?
What follow-up tests will I need, and how often will I need them?
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