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What You Need to Know About Cancer of the Uterus

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What You Need to Know About Cancer of the Uterus What You Need To Know About TM Cancer National Cancer Institute of the Uterus U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute Services This is only one of many free booklets for people with cancer. You may want more information for yourself, your family, and your doctor. NCI offers comprehensive research-based information for patients and their families, health professionals, cancer researchers, advocates, and the public. • Call NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) • Visit us at http://www.cancer.gov or http://www.cancer.gov/espanol • Chat using LiveHelp, NCI’s instant messaging service, at http://www.cancer.gov/ livehelp • E-mail us at [email protected] • Order publications at http://www.cancer.gov/ publications or by calling 1–800–4–CANCER • Get help with quitting smoking at 1–877–44U–QUIT (1–877–448–7848) Contents About This Booklet 1 The Uterus 2 Cancer Cells 3 Risk Factors 5 Symptoms 6 Diagnosis 7 Staging 9 Treatment 11 Second Opinion 20 Nutrition 22 Follow-up Care 22 Sources of Support 23 Taking Part in Cancer Research 25 Dictionary 27 National Cancer Institute Publications 37 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute About This Booklet This National Cancer Institute (NCI) booklet is about cancer* that starts in the uterus. Other names for this disease are uterine cancer and endometrial cancer. Each year in the United States, more than 43,000 women learn they have uterine cancer. Most are over 55 years old. Learning about medical care for uterine cancer can help you take an active part in making choices about your care. This booklet tells about: • Diagnosis and staging • Treatment and follow-up care • Taking part in research studies This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes. You may also want to have a family member or friend go with you when you talk with the doctor—to take notes, ask questions, or just listen. For the latest information about uterine cancer, visit NCI’s Web site at http://www.cancer.gov/ cancertopics/types/endometrial. Also, NCI’s Cancer Information Service can answer your questions about cancer. We can also send you NCI booklets and fact sheets. Call 1–800–4–CANCER (1–800–422–6237). Or chat using LiveHelp, NCI’s instant messaging service, at http://www.cancer.gov/livehelp. *Words in italics are in the Dictionary on page 27. The Dictionary explains these terms. It also shows how to pronounce them. 1 This booklet is not about uterine sarcoma. Uterine sarcoma is a different type of cancer. Women with sarcoma have different treatment options. For the latest information about uterine sarcoma, visit NCI’s Web site at http://www.cancer.gov/cancertopics/types/ uterinesarcoma or contact NCI’s Cancer Information Service. Also, this booklet is not about cancer that begins in the cervix. For the latest information about cervical cancer, visit NCI’s Web site at http://www.cancer.gov/ cancertopics/types/cervical or contact NCI’s Cancer Information Service. The Uterus The uterus is part of a woman’s reproductive system. It’s a hollow organ in the pelvis. The uterus has three parts: • Top: The top (fundus) of your uterus is shaped like a dome. From the top of your uterus, the fallopian tubes extend to the ovaries. • Middle: The middle part of your uterus is the body (corpus). This is where a baby grows. • Bottom: The narrow, lower part of your uterus is the cervix. The cervix is a passageway to the vagina. The wall of the uterus has two layers of tissue: • Inner layer: The inner layer (lining) of the uterus is the endometrium. In women of childbearing age, the lining grows and thickens each month to prepare for pregnancy. If a woman does not become pregnant, the thick, bloody lining flows out of the body. This flow is a menstrual period. • Outer layer: The outer layer of muscle tissue is the myometrium. 2 Fallopian tube Fallopian tube Ovary Ovary Uterus Endometrium Myometrium Cervix Vagina © 2009 Terese Winslow U.S. Govt. has certain rights This picture shows the uterus and nearby tissues. Cancer Cells Cancer begins in cells, the building blocks that make up tissues. Tissues make up the uterus and the other organs of the body. Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. 3 Tumors in the uterus can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors: • Benign tumors (such as a fibroid, a polyp, or endometriosis): —are usually not a threat to life —can be treated or removed and usually don’t grow back —don’t invade the tissues around them —don’t spread to other parts of the body • Malignant growths: —may be a threat to life —usually can be removed but can grow back —can invade and damage nearby tissues and organs (such as the vagina) —can spread to other parts of the body Cancer cells can spread by breaking away from the uterine tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lung, liver, bone, or brain. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section on page 9 for information about uterine cancer that has spread. 4 Risk Factors When you get a diagnosis of uterine cancer, it’s natural to wonder what may have caused the disease. Doctors usually can’t explain why one woman gets uterine cancer and another doesn’t. However, we do know that women with certain risk factors may be more likely than others to develop uterine cancer. A risk factor is something that may increase the chance of getting a disease. Studies have found the following risk factors for uterine cancer: • Abnormal overgrowth of the endometrium (endometrial hyperplasia): An abnormal increase in the number of cells in the lining of the uterus is a risk factor for uterine cancer. Hyperplasia is not cancer, but sometimes it develops into cancer. Common symptoms of this condition are heavy menstrual periods, bleeding between periods, and bleeding after menopause. Hyperplasia is most common after age 40. To prevent endometrial hyperplasia from developing into cancer, the doctor may recommend surgery to remove the uterus (hysterectomy) or hormone therapy with progesterone and regular follow-up exams. • Obesity: Women who are obese have a greater chance of developing uterine cancer. • Reproductive and menstrual history: Women are at increased risk of uterine cancer if at least one of the following apply: —Have never had children —Had their first menstrual period before age 12 —Went through menopause after age 55 5 • History of taking estrogen alone: The risk of uterine cancer is higher among women who used estrogen alone (without progesterone) for menopausal hormone therapy for many years. • History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of uterine cancer. • History of having radiation therapy to the pelvis: Women who had radiation therapy to the pelvis are at increased risk of uterine cancer. • Family health history: Women with a mother, sister, or daughter with uterine cancer are at increased risk of developing the disease. Also, women in families that have an inherited form of colorectal cancer (known as Lynch syndrome) are at increased risk of uterine cancer. Many women who get uterine cancer have none of these risk factors, and many women who have known risk factors don’t develop the disease. Symptoms The most common symptom of uterine cancer is abnormal vaginal bleeding. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal. These are common symptoms of uterine cancer: • Abnormal vaginal bleeding, spotting, or discharge • Pain or difficulty when emptying the bladder • Pain during sex • Pain in the pelvic area 6 These symptoms may be caused by uterine cancer or by other health problems. Women with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible. Diagnosis If you have symptoms that suggest uterine cancer, your doctor will try to find out what’s causing the problems. You may have a physical exam and blood tests. Also, you may have one or more of the following tests: • Pelvic exam: Your doctor can check your uterus, vagina, and nearby tissues for any lumps or changes in shape or size. • Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the pelvis. The echoes create a picture of your uterus and nearby tissues. The picture can show a uterine tumor. For a better view of the uterus, the device may be inserted into the vagina (transvaginal ultrasound). • Biopsy: The removal of tissue to look for cancer cells is a biopsy.
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