The uterus, also called the womb, is a crucial organ in the female reproductive system. However, it can be susceptible to cancer, particularly in postmenopausal women. Uterine cancer is a disease in which cells in the uterus grow out of control. The two main types are endometrial cancer, which forms in the uterine lining and accounts for about 90 percent of cases, and uterine sarcoma, which develops in the muscles or supporting tissues1.
Early detection is vital, as the five-year survival rate for localized endometrial cancer is 96 percent, compared to only 20 percent for distant cases2. This article will explore the causes, risk factors, diagnosis, methods, and screening options for uterine cancer.
Types of Cancer in the Uterus
As mentioned above, uterine cancer primarily manifests in two main types: endometrial cancer and uterine sarcoma.
Endometrial cancer is the most common form, originating in the uterine lining (endometrium). Accounting for about 90 percent of uterine cancers, it is further classified into various subtypes, including endometrioid adenocarcinoma, the most prevalent form3.
Uterine sarcoma is rarer but more aggressive, developing in the uterine muscle (myometrium) or supporting tissues. It comprises around 4 percent of uterine cancer and includes subtypes like leiomyosarcoma, endometrial stromal sarcoma, and undifferentiated sarcoma4,5.
Carcinosarcoma, once classified as a sarcoma, is now considered a type of carcinoma with sarcomatous elements (cells within a tumor that resemble those found in sarcomas)6. It’s highly aggressive and associated with poor prognosis.
Clear cell carcinoma is a rare, aggressive subtype of endometrial cancer7. It’s often linked to worse outcomes compared to more common endometrial cancer types and may require specific treatment approaches.
Symptoms of Cancer in the Uterus
Early Symptoms of Cancer in the Uterus
The most common and often earliest symptom of uterine cancer is abnormal vaginal bleeding, particularly in postmenopausal women. This may include heavier than usual periods, bleeding between periods, or any bleeding after menopause. Other early signs include8,9:
- Unusual vaginal discharge, which may be watery, pink, or white.
- Pelvic pain or discomfort.
- Pain during sexual intercourse.
- Changes in urination frequency.
It’s important to note that while these symptoms can indicate uterine cancer, they may also be caused by other conditions. Consulting a healthcare professional for proper evaluation is crucial.
Symptoms of Advanced Cancer in the Uterus
As uterine cancer progresses, more severe symptoms can develop due to metastases, including10,11:
- Persistent pelvic or lower abdominal pain.
- Unexplained weight loss and fatigue.
- Changes in bowel or bladder habits.
- Swelling or bloating in the lower abdomen.
- Weakness and pain in the lower back or legs.
- Difficulty emptying the bladder completely.
- A new cough.
Advanced uterine cancer may also cause anemia due to chronic bleeding12. These symptoms often indicate that the cancer has spread beyond the uterus, potentially affecting nearby organs or lymph nodes.
Leg pain from uterine cancer can feel like a dull ache, pressure, or weakness in the legs. It occurs when the tumor grows and presses against the nerves in the pelvic wall, causing pain that radiates down the leg. It can be intermittent or constant and may be accompanied by leg swelling (lymphedema)13.
Causes of Cancer in the Uterus
Uterine cancer development is influenced by several factors, with hormonal imbalances playing a significant role. Increased estrogen levels without sufficient progesterone can stimulate excessive endometrial growth, leading to cancer14,15. This imbalance can occur naturally or due to certain medical conditions.
Genetic mutations in uterine cells can trigger uncontrolled cell growth, leading to cancer formation. Some inherited gene mutations, like BRCA1 and BRCA2, increase the risk of uterine cancer16.
Obesity is a major risk factor, as excess fat tissue produces additional estrogen. Women who are overweight or obese have higher estrogen levels, which can increase their risk of developing uterine cancer.
Diabetes and metabolic syndrome contribute to increased inflammation and hormonal changes that may promote cancer development14. A history of tamoxifen use for breast cancer treatment or previous pelvic radiation therapy can also increase the risk of uterine cancer.
Risk Factors of Cancer in the Uterus
Is Cancer in the Uterus Hereditary?
While most cases of uterine cancer are not inherited, certain genetic factors can increase the risk. Lynch syndrome, an inherited condition, significantly raises the likelihood of developing uterine cancer. Women with Lynch syndrome have a 40 to 60 percent lifetime risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer17.
A family history of uterine, ovarian, or colorectal cancer can increase personal risk. Women with a first-degree relative (mother, sister, or daughter) who has had endometrial cancer have a 1.82 times higher risk of developing the disease themselves18.
For individuals with a strong family history or other risk factors, genetic testing can help assess cancer risk and guide preventive measures16.
What Affects the Prognosis of Cancer in the Uterus?
Cancer prognosis depends on several key factors:
- Staging: Catching cancers at an early stage significantly improves survival rate above 90 percent, while advanced stages have poorer outcomes19.
- Tumor grade: More aggressive tumors grow and spread quickly, leading to worse outcomes. Grade 1 or 2 tumors have a better prognosis and are less likely to recur than Grade 320.
- Treatment response: Individual response to treatment, including chemotherapy, radiation, or surgery, significantly affects prognosis21.
- Overall health and age: Pre-existing conditions and older age may limit treatment options or increase complication risks.
Other factors include lymph node involvement, depth of myometrial invasion, and specific genetic mutations22. An oncologist's personalized assessment provides the most accurate prognosis.
What Happens if You Leave Uterine Cancer Untreated?
Untreated uterine cancer has a poor prognosis, with the disease progressing and significantly reducing survival rates. The 5-year survival rate drops dramatically as the cancer spreads, from ~95 percent for localized cancer to as low as 17 percent for cancer that has spread20.
What Are Signs That Uterus Cancer Has Spread?
As the cancer spreads, symptoms like abnormal bleeding, pain, and fatigue will likely worsen. The cancer may spread to other organs, which further complicates treatment and reduces survival rates.
How Is Cancer in the Uterus Staged?
Cancer staging is important for determining treatment and prognosis. The FIGO (International Federation of Gynecology and Obstetrics) system, recently updated in 2023, is commonly used23,24.
Stage 1: Cancer is limited to the uterine corpus and ovary. It is subdivided based on the depth of myometrial invasion and histological depth.
Stage 2: Involves cervical stromal invasion, extensive lymphovascular space invasion, or aggressive histological type with myometrial invasion.
Stage 3: Indicates local or regional spread, including involvement of the serosa, adnexa, vagina, parametrium, or lymph nodes.
Stage 4: Signifies bladder or bowl mucosal involvement, extrapelvic peritoneal spread, or distant metastases.
Staging tests may include transvaginal ultrasound, Magnetic Resonance Imaging (MRI), Computed tomography (CT) scans, and surgical exploration with tissue sampling25.
How Is Cancer in the Uterus Diagnosed?
Uterine cancer diagnosis typically involves multiple steps:
- Pelvic exam and medical history assessment.
- Endometrial biopsy: Most common and accurate test for postmenopausal women.
- Transvaginal ultrasound: Measures endometrial thickness and detects abnormalities.
For further evaluation:
- CT scan: Useful for detecting tumor spread and staging.
- MRI scan: Provides detailed soft tissue imaging, often preferred for uterine cancer.
Both CT and MRI may use contrast agents to enhance visibility. MRI is typically favored for uterus cancer due to better soft tissue resolution and lack of radiation. CT scans can be valuable for staging but use ionizing radiation, which can slightly increase cancer risk26.
How Much Does It Cost to Image the Uterus?
The cost of scanning the uterus varies depending on the type of scan and location across the US27–29. Average prices include:
MRI
- Pelvis: $550 to $1,450.
- Abdomen: $350 to $750.
CT
- Pelvis: $1,700 - $10,200.
- Abdomen: $1,750 - $9,500.
Ultrasound
- Transvaginal: $235 - $1,435.
If you are at increased risk of endometrial cancer, it is recommended by some that you receive a screening test once yearly30.
At Ezra, potential abnormalities can be caught with a Full-Body Flash covering the head, neck, pelvis, and abdomen. The cost is $1495.
See More:
How Much Does an MRI Cost Without Health Insurance?
How much is a CT scan With and Without Insurance? National Averages and How To Pay Less
Abdominal and Pelvic MRI: What You Need to Know
Summary: Uterus Cancer: Symptoms, Causes, Risk Factors, Diagnosis
Uterus cancer is a serious illness most common in postmenopausal women. Early symptoms can include abnormal bleeding, pelvic pain, and unusual discharge. Risk factors include hormonal imbalances, obesity, and genetic predisposition. Early diagnosis through biopsy, ultrasound, CT, or MRI is vital for effective treatment. Proactive steps, including regular check-ups and screenings, can significantly improve patient outcomes and survival rates.
If you want to be proactive about your uterus health, why not book an Ezra full-body MRI? Our annual scan catches potential cancer earlier, leveraging AI through the screening process to make it more efficient, affordable, and faster
