Uterine cancer is the most common female genital cancer in the United States and is the only genital cancer experiencing a continuous rapid increase in frequency.
In the U.S., 45,000 new cases are expected to be diagnosed in 2015, and of those, 8,000 will die.
Uterine cancer occurs later in life and in the majority of cases, the woman is in perimenopause. The risk increases from 3 to 10 times if the patient is obese (more than 30 pounds over ideal weight), two times more common if the patient was never pregnant, has Diabetes Mellitus, hypertension or took tamoxifen as adjunctive therapy after breast cancer.
There are three theoretical explanations regarding the increasing incidence of uterine cancer. First, the life span of American women has been expanded; second, the U.S. is experiencing the largest growth of postmenopausal sector in its history; and third, 35 percent of the population are obese.
Less than 10 percent of patients have a genetic high susceptibility for this cancer (Lynch II Syndrome) where a mutation predisposes to uterine, colorectal, stomach, biliary tract and ovarian cancer. For those patients, it is recommended to perform gynecologic risk-reducing surgery as soon as child bearing is completed. The procedure consists of a complete hysterectomy with the removal of both ovaries and both fallopian tubes with an effectiveness of 100 percent.
The symptoms of uterine cancer are bleeding or bloody discharge after menopause, irregular or unusual bleeding before menopause and/or presence of a pelvic mass. This usually prompts the gynecologist to order a pelvic ultrasound which will help decide if an endometrial biopsy can be performed in the office or as outpatient during a dilatation curettage hysteroscopy. Once the pathology report shows cancer, a CAT scan and/or MRI (magnetic resonance imaging) is ordered to stage the disease. The majority of patients are diagnosed in stage I-II (when the tumor is still in the uterus) with an excellent five-year survival rate of 74 to 90 percent for stage II and stage I cancers.
The mainstay of treatment is surgery with a hysterectomy, bilateral salpingo-oophorectomy and biopsies or excision of neighboring lymph nodes.
Once surgery is performed, the final pathology results categorize the patient into low/intermediate/high risk for recurrent cancer depending on several features, including grade or aggressiveness of the cancer cell, size and degree of invasion into the wall of the uterus, and status of the lymph nodes excised. Patients at higher risk of recurrence are treated with radiation therapy and/or chemotherapy. Advanced cancers where the tumor has traveled outside the uterus (stage III, IV) are treated with a combination of surgery, radiation and chemotherapy in a more individualized manner.
Unlike Pap smear screening for cervical cancer, there is no screening test for uterine cancer, but it is advised that women with genetic susceptibility, as well as patients with uterine cancer risk factors, visit their gynecologist frequently.
Dr. Moises Lichtinger specializes in gynecology, gynecology oncology, obstetrics and gynecology and robotic surgery at Holy Cross Hospital in Fort Lauderdale, Florida. He is one of the speakers at this week’s Conquering Cancer event.