Brief overview
- Disease progression and prognosis: Depends on tumor stage at time of diagnosis; prognosis is good in early stages, unfavorable in late diagnosed tumors and higher stages
- Prevention: There is no vaccination against uterine cancer.
- Treatment: Surgery, radiotherapy, chemotherapy and hormone therapy if necessary.
- Diagnosis: Physical examination with palpation, ultrasound, uterus endoscopy, if metastases are suspected also bladder and colonoscopy, magnetic resonance imaging (MRI), computed tomography (CT)
- Causes and risk factors: Cause not exactly known, probably hormonal disturbances (dysfunction of estrogen); increased risk in old age, due to genetic predisposition, with radiation therapy, with administration of the antiestrogen tamoxifen
What is uterine cancer?
The uterus is a hollow muscular organ. The upper part is called the uterine body (corpus); the two fallopian tubes open into it. The lower short and tubular section is called the cervix. It connects the corpus with the vagina.
Until menopause, the lining of the uterus renews itself regularly. Every month, the upper layers are shed and expelled with menstruation. During menopause, changes occur in the mucous membrane. Under certain circumstances, individual cells develop into cancer cells due to genetic changes (mutation) – an endometrial carcinoma develops.
Doctors usually distinguish between two types of endometrial carcinoma: Type I carcinomas make up the majority of uterine cancers, accounting for about 80 percent. They are estrogen-dependent – cancer cell formation only under the influence of estrogen – and usually have a good prognosis. Type II cancers, on the other hand, have a poorer prognosis and develop without the influence of estrogen.
Uterine cancer should not be confused with cervical cancer. The latter develops from the lower part of the uterus. Both types of cancer differ in terms of early detection, diagnosis and treatment.
Uterine cancer: facts and figures
What is the life expectancy for uterine cancer?
The prognosis for uterine cancer depends on various factors. In addition to the general state of health, the stage in which the corpus carcinoma is at the time of diagnosis has a particular influence on the chances of cure and life expectancy.
If the uterine cancer is detected early and therapy is started immediately, the prognosis is good. However, it is more difficult if the uterine tumor has already formed metastases. These prefer to settle in the lungs or in the bones and are more difficult to treat. Therefore, it is important that every woman with possible symptoms of uterine cancer (bleeding outside of menstruation or after menopause) immediately see the doctor and have the cause clarified.
Approximately 80 percent of patients are still alive five years after diagnosis (five-year survival rate).
Fear of relapse
After surviving uterine cancer, some women are very afraid that the tumor will recur. This psychological burden often significantly impairs the performance and quality of life of those affected. Regular check-ups, psychological support and discussions in a self-help group for women with uterine cancer offer support here.
The tumor can be divided into four stages – according to the so-called FIGO classification (Fédération Internationale de Gynécologie et dʼObstétrique):
- FIGO I: The tumor is limited to the endometrium or affects less or more than half of the uterine muscles (myometrium).
- FIGO II: The tumor affects the stroma (connective tissue framework) of the cervix (neck of the uterus) but remains within the uterus.
- FIGO III: The tumor metastasizes outside the uterus, e.g., to the fallopian tubes, vagina, pelvic lymph nodes.
- FIGO IV: The tumor affects the mucosa of the bladder and/or rectum, and there are other distant metastases.
In addition to staging according to FIGO, the tumor is classified according to the TNM system (tumor-nodus-metastases). It is consistent with the FIGO classification. It classifies the extent of the tumor and also assesses the involvement of lymph nodes (nodus) and the presence of daughter tumors.
Is it possible to get vaccinated against uterine cancer?
There is no vaccination against uterine cancer as a preventive measure. Uterine cancer is not to be confused with cervical cancer, for which there is indeed a vaccine. The latter form of cancer is caused by human papillomavirus (HPV), against which the vaccine is directed. However, this is not effective against cervical cancer.
You can read everything important about the typical signs of uterine cancer in the article Uterine cancer – symptoms.
What therapies are available for uterine cancer?
The most important treatment for uterine cancer is surgery. Depending on the aggressiveness and stage of the cancer, other treatments are used in addition, such as radiation therapy and/or chemotherapy. Another option for the treatment of uterine cancer is hormone therapy in certain cases.
Surgery
In most cases of endometrial cancer, surgery is the best treatment option, in which doctors remove the tumor tissue (resection). How much tissue is removed depends on the stage of the cancer. If the uterine cancer has not yet spread too much, the uterus (hysterectomy), fallopian tubes and ovaries (together called an adnectomy) are usually removed.
In more advanced stages, it may also be necessary to excise the lymph nodes in the pelvic area and along the abdominal aorta, the tissue around the uterus, and part of the vaginal vault. If the tumor has already spread to the bladder or intestines, even more tissue is removed.
Radiotherapy
Radiation therapy after uterine cancer surgery is indicated if the vaginal vault is also affected by the cancer. This usually prevents the tumor from recurring. In addition, radiation is given if the uterine cancer is too advanced for surgery or could not be completely removed.
Chemotherapy
If the uterine cancer is inoperable, there is a high risk of recurrence after surgery, or a new tumor has already developed, chemotherapy is given. Patients receive the appropriate drugs (cytostatics) through an infusion. In some cases, a combination of chemotherapy and radiation therapy is useful.
Hormone therapy
As part of hormone therapy for uterine cancer, patients receive artificial corpus luteum hormones (progestins), usually in tablet form. They are intended to counteract the estrogen effect to such an extent that the growth of the estrogen-dependent tumor is inhibited – but the disease often progresses anyway. Hormone therapy therefore does not provide a cure.
How is uterine cancer diagnosed?
Endometrial cancer can be diagnosed in several ways.
The first method of choice is ultrasound examination through the vagina (vaginal sonography). In addition, the gynecologist feels changes in the mucosa by palpation. It is often necessary to take a tissue sample (biopsy). This is examined in the laboratory. This determines whether a benign or malignant change is present and at what stage the uterine cancer is.
The suspicion of uterine cancer can be confirmed with a hysteroscopy. This procedure is performed on an outpatient basis. A small rod (hysteroscope) is inserted into the uterus through the vagina. If necessary, a sample of the mucous membrane is also taken without difficulty.
Imaging procedures are used to assess the spread of the uterine cancer. Magnetic resonance imaging (MRI) and computer tomography (CT) are available for this purpose. These examinations are performed in the hospital.
If there is a suspicion that the uterine cancer is no longer confined to the uterus, further examinations are performed. For example, a cystoscopy (examination of the bladder) and a rectoscopy (examination of the rectum) are performed to check whether the tumor has spread to the bladder or the intestine.
What triggers uterine cancer?
It is likely that the development of uterine cancer is essentially dependent on the female sex hormones, especially estrogen – almost every endometrial carcinoma is estrogen-dependent in its growth. Before menopause, the hormone ensures that the mucous membrane renews itself regularly. It is produced in the ovaries and in fatty tissue.
The corpus luteum hormone progesterone (a progestogen) is also produced in the ovaries. It counteracts the build-up effect of estrogen and also ensures that the mucous membrane is shed with menstruation. Thus, if the effects of estrogen predominate, there may be excessive growth of the endometrium and subsequently endometrial carcinoma.
Therefore, especially overweight women have an increased risk of developing uterine cancer after menopause: Their ovaries no longer produce “protective” progesterone, but the large amount of fatty tissue continues to produce estrogen.
Women who had their first menstrual period early or went through menopause late also have a slightly increased risk of endometrial cancer. The same applies to women who have not had children or have never breastfed.
Age is also a risk factor for uterine cancer.
Genetic factors also appear to play a role in the development of uterine cancer. A single gene is responsible, which is passed on to the next generation with a probability of 50 percent. In affected families, the risk of uterine cancer is increased, as is the risk of ovarian cancer and colon cancer.
Certain hormonal disorders are further risk factors for uterine cancer. In some women, the endometrium builds up, but there is no ovulation and thus no subsequent progestin formation.
Or, for other reasons, the influence of the progestin is too weak to ensure expulsion of the thickened mucosa. Such unusual thickening of the endometrium, which is not related to the menstrual cycle, is called endometrial hyperplasia. It occurs before and after menopause and sometimes leads to endometrial carcinoma.
