Cancer of the Uterus: What Every Woman Should Know
Anu Gupta, MD
According to the American Cancer Society, an estimated 53,000 women in the United States will develop uterine cancer in the year 2014 and an estimated 9000 will die of the disease. These estimates include both endometrial cancers and uterine sarcomas. About 2% of uterine body cancers are sarcomas, so the actual numbers for endometrial cancer cases and deaths are slightly lower than these estimates.
Endometrial cancer is rare in women under the age of 45. Most (about 3 out of 4) cases are found in women aged 55 and over The average chance of a woman being diagnosed with this cancer during her lifetime is about one in 37. There are over 600,000 women who are survivors of this cancer. This cancer is slightly more common in white women, but black women are more likely to die from it.
The incidence of this malignancy varies throughout the world. It is more common in industrialized nations. Cancer of the uterus is the most common gynecologic malignancy among US women with the lifetime risk being 2%. It is the fourth most frequent cancer in women led by skin, lung, and breast.
Fortunately, the majority of cases of uterine cancer are diagnosed at an early stage, when surgery alone is an adequate cure. The survival rates for such early stage disease are as high as 95%. There have been many advances in the understanding of the development of uterine cancer. The protective benefit of birth control pills has been well established. Most of the risk factors for uterine cancer are associated with increased estrogen exposure. Obesity and infertility are significant risk factors for the development of this cancer. Family history also contributes to the risk of uterine cancer.
The hallmark symptom of uterine cancer is abnormal uterine bleeding. All postmenopausal women who develop bleeding unrelated to hormone therapy should be evaluated to exclude uterine carcinoma. Pre- and perimenopausal women with abnormal menstrual cycles, particularly if they have other risk factors, such as obesity or infertility, should be evaluated.
Screening has not proven to be effective in the early detection of uterine cancer. Pap smears sample the cervix but are inadequate for the uterus. Uterine biopsy is a less effective screening test in asymptomatic women and is uncomfortable. Other tests available for women at high risk include progesterone challenge test, transvaginal ultrasound, and dilatation and currettage. The progesterone challenge test involves giving progesterone for 10 days then checking for withdrawal bleeding. Women who have benign disease will bleed. The test has not been evaluated in women with known uterine cancer. Transvaginal ultrasound checks for increased uterine wall thickness. A thicker than normal lining should be evaluated further. Dilatation and curettage (“D & C”) is the gold standard of evaluation.
Early diagnosis is the key to cure. An abnormal uterine bleeding should be reported to your physician and evaluation should be done based on medical history and risk factors.