Uterine Cancer Overview

Uterine cancer originates in the tissue layers of the uterus, a hollow, pear-shaped organ in a woman’s pelvis. After receiving a fertilized egg from a fallopian tube, the uterus will protect and nourish the developing fetus.

Although uterine cancer primarily affects postmenopausal women, it can occur at any age. It is also the most common type of gynecologic cancer. For reasons not fully understood, its incidence is currently on the rise in the United States and other developed countries.

Uterine Cancer Types

Uterine cancer is classified based on its cellular origin:

Endometrial cancer – Develops in the inner lining of the uterus (endometrium) (most common)
Uterine sarcoma – Forms in the muscular wall of the uterus (myometrium) (extremely rare)

Uterine Cancer Causes and Factors

Uterine cancer develops when cells in the uterus undergo harmful genetic mutations that disrupt the normal cellular life cycle, leading to unregulated cell division and an accumulation of abnormal cells. Over time, the abnormal cells can invade nearby tissues and spread to distant parts of the body. The exact cause is often unknown.

Scientists have identified certain risk factors for uterine cancer, including:

Advanced age – Most cases are diagnosed after age 50.
Prolonged exposure to estrogen without progesterone – This type of hormone exposure can affect women who start menstruating early (before age 12), enter menopause late (after age 55), use hormone replacement therapy (HRT) for menopause symptoms or have never been pregnant.
Obesity – Excess fatty tissue can increase estrogen levels, a known risk factor for uterine cancer.
Lifestyle factors – An unhealthy diet high in animal fats and a sedentary lifestyle can lead to obesity.
Family history – Women with a first-degree biological relative (mother, sister or daughter) who was diagnosed with uterine cancer are at heightened risk.
Inherited cancer predisposition syndromes – Certain genetic conditions, such as Lynch syndrome, can elevate the risk.
Certain medical conditions – A history of endometrial hyperplasia is associated with an increased risk of uterine cancer.

Uterine Cancer Signs and Symptoms

The first noticeable warning sign of uterine cancer may be abnormal vaginal bleeding, such as bleeding in between menstrual periods, heavy or prolonged menstrual bleeding or postmenopausal bleeding. Uterine cancer can also cause unusual vaginal discharge, which may be watery or blood-tinged.

What Does Uterine Cancer Feel Like?

In addition to abnormal vaginal bleeding or discharge, uterine cancer can cause pelvic pain or cramping, which may be persistent or intermittent. Some women also experience an uncomfortable feeling of fullness or a mass that can be felt in the pelvic area. As the tumor progresses, it may begin to cause pain during sexual intercourse, unexplained weight loss and fatigue.

What Does Uterine Cancer Look Like?

In medical imaging studies, such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans, uterine cancer may appear as a thickened endometrium or mass within the uterus.

Uterine Cancer Diagnosis

To diagnose uterine cancer, a physician will typically perform a pelvic examination to check for abnormalities in the uterus. If uterine cancer is suspected, the physician may order a transvaginal ultrasound to visualize the uterus and check for unusual thickening of the endometrium and masses.

A diagnosis of uterine cancer can be confirmed with an endometrial biopsy, which involves taking a small sample of cells from the uterine lining for microscopic examination by a pathologist, who can identify cancerous cells. In some cases, the biopsy may be guided by a hysteroscopy, which involves inserting a thin, lighted tube into the vagina and uterus to gain a direct view of the endometrium. If cancer is found, the physician may order imaging tests, such as CT or MRI scans, to assess the extent of the cancer.

Uterine Cancer Stages

Uterine cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) system or the American Joint Committee on Cancer (AJCC) TNM staging system. Both systems classify the tumor based on its spread. The stages range from 1 to 4; a higher number indicates a more advanced tumor.

Stage 1 Uterine Cancer

At stage 1, the cancer is confined to the uterus; it has not spread to nearby lymph nodes, structures in the abdominal cavity or distant organs or tissues. Stage 1 uterine cancer can be further classified as:

Stage 1A – The cancer is limited to the endometrium or extends less than halfway through the myometrium.
Stage 1B – The cancer extends more than halfway through the myometrium.

Treatment for early-stage uterine cancer typically involves surgery, such as a hysterectomy to remove the uterus and possibly the ovaries and fallopian tubes. Surgery may be followed by radiation therapy or hormone therapy to help reduce the risk of recurrence.

Stage 2 Uterine Cancer

At stage 2, the cancer has spread from the uterus to the cervix. Treatment typically involves surgery, such as a radical hysterectomy to remove the uterus, cervix, surrounding tissues and possibly some nearby lymph nodes. Post-surgical radiation therapy and/or chemotherapy may be considered to eliminate any remaining cancer cells and reduce the risk of recurrence.

Stage 3 Uterine Cancer

At stage 3, the cancer has spread beyond the uterus and cervix to surrounding pelvic structures. Stage 3 uterine cancer can be further classified as:

Stage 3A – The cancer has spread to the outer layer of the uterus, fallopian tubes or ovaries.
Stage 3B – The cancer has spread to the vagina or connective tissues around the uterus (parametrium).
Stage 3C – The cancer has reached the pelvic or para-aortic lymph nodes.

Treatment typically involves surgery to remove the affected organs and tissues. Surgery may be followed by radiation therapy and/or chemotherapy to address any remaining cancer cells.

Stage 4 Uterine Cancer

At stage 4, the cancer has spread beyond the pelvis to distant organs. Metastatic uterine cancer can be further classified as:

Stage 4A – The cancer has invaded the bladder or rectum.
Stage 4B – The cancer has metastasized to distant organs, such as the lungs, liver or bones.

Treatment for advanced-stage uterine cancer typically involves a combination of surgery, if feasible, to remove as much of the tumor as possible, followed by chemotherapy, radiation therapy, and/or targeted therapy to manage the progression of the cancer and alleviate the symptoms.

Uterine Cancer Treatment

The treatment options for uterine cancer can vary depending on the stage of the tumor and the patient’s age and preferences. Many patients receive a combination of:

Benefit from World-Class Care at TGH

Tampa General Hospital is a nationally recognized cancer center designated by U.S. News & World Report as One of the Nation's Best Hospitals for Cancer Care for 2024-25 and is named one of America's Best Cancer Hospitals by Newsweek. Our multidisciplinary team diagnoses and treats all types and stages of gynecologic cancer, including uterine cancer.

If you would like to learn more about uterine cancer, contact TGH at (813) 844-7585 to request an appointment with a gynecologic oncologist at the TGH Cancer Institute in Tampa, FL.

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