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 major 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 about 2% to 4% of uterine cancers.

Other, less common types of uterine cancer include carcinosarcoma and endometrial stromal sarcoma. Carcinosarcoma starts in the endometrium and is similar to both endometrial cancer and sarcoma. Endometrial stromal sarcoma starts in the connective tissue of the endometrium. Treatment for these types of uterine cancer is similar to the treatment of endometrial cancer.

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. Treatment also depends on the type of uterine cancer because some types may need more intense treatment. 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. Each treatment option is described below, followed by an outline of treatments based on the stage of the disease.

Surgery

Surgery is typically the first treatment given. 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 uterus, cervix, and the upper part of the vagina and nearby tissues). After a hysterectomy, a woman can no longer become pregnant. In addition, the surgeon will remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus. The surgeon will also perform a bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries) for patients who have been through menopause.

A hysterectomy may be performed as a traditional surgery (with one large incision) or by laparoscopy, which uses several smaller incisions. After surgery, the woman may remain in the hospital for several days to a week. Woman who received laparoscopic surgery often have a shorter hospital stay than women who received traditional surgery. 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 (if the woman has not already gone through menopause naturally.) 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 into the tumor.

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 is most often given after surgery to destroy any cancer cells remaining in the area. Radiation therapy is rarely given before surgery to shrink the tumor. If a woman cannot have surgery, the doctor may recommend radiation therapy as another option.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects usually go away soon after treatment is finished.

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 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 (a thin tube inserted into a vein).

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. 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.

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.

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 have changes in their menstrual cycle.