UTERINE CANCER

INTRODUCTION

 Cancer of the uterus occurs when abnormal cells develop in the uterus and begin growing
out of control. There are two main types of uterine cancer. Endometrial cancers begin in
the lining of the uterus (endometrium) and account for about 95% of all cases; and uterine
sarcomas, which develop in the muscle tissue (myometrium), and is a rarer form of uterine
cancer. Also called cancer of the uterus, it is the most diagnosed gynaecological cancer in
Australia. The risk of a woman in Australia being diagnosed with cancer of the uterus by the
age of 85 is 1 in 40. It is estimated that 3267 new cases of uterine cancer will be diagnosed
in Australia in 2021. Uterine cancer is often referred to as endometrial cancer as this is the
most common form.   The chance of surviving cancer of the uterus for at least five years is
83%.

CAUSES AND RISK FACTORS

CAUSES

being postmenopausal, or reaching menopause (after age 55)

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a thickened wall lining (endometrial hyperplasia)

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never having children

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starting periods early (before age 12)

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having high blood pressure or diabetes

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being overweight or obese

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family history of ovarian, uterine, or bowel cancer

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having a genetic condition such as Cowden syndrome or Lynch syndrome

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previous ovarian tumours, or polycystic ovary syndrome

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using oestrogen only hormone replacement therapy or fertility treatment

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previous radiation therapy to the pelvis

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taking tamoxifen to treat breast cancer (the benefits of treating breast cancer usually
outweigh the risk of uterine cancer - (talk to your doctor if you are concerned).

RISK FACTORS

 There are several risk factors for endometrial cancer. Many of them relate to the balance
between estrogen and progesterone. These risk factors include having obesity, a condition
 called polycystic ovarian syndrome (PCOS) or taking unopposed estrogen (taking estrogen
without taking progesterone, too). A genetic disorder known as Lynch syndrome is another
risk factor unrelated to hormones.

Risk factors include:

Age, lifestyle and family history:

 Age: As you get older, your likelihood of developing uterine cancer increases. Most
uterine cancers occur after age 50.
 Diet high in animal fat: A high-fat diet can increase your risk of several cancers,
including uterine cancer. Fatty foods are also high in calories, which can lead to obesity.
Extra weight is a uterine cancer risk factor.
 Family history: Some parents pass on genetic mutations (changes) for hereditary
nonpolyposis colorectal cancer (HNPCC). This inherited condition raises the risk for a
range of cancers, including endometrial cancer.

Other conditions:

 Diabetes: This disease is often related to obesity, a risk factor for cancer. But some
studies suggest a more direct tie between diabetes and uterine cancer as well.
 Obesity (having excess body weight): Some hormones get changed to estrogen by fat
tissue, raising uterine cancer risk. The higher the amount of fat tissue, the greater the
effect on estrogen levels.
 Ovarian diseases: People who have certain ovarian tumors have high estrogen levels
and low progesterone levels. These hormone changes can increase uterine cancer risk.

Menstrual and reproductive history:

 Early menstruation: If your period started before age 12, your risk for uterine cancer
might increase. That’s because your uterus gets exposed to estrogen for more years.
 Late menopause: Similarly, if menopause occurs after age 50, the risk also increases.
Your uterus gets exposed to estrogen longer.
 Long menstruation span: The number of years menstruating might be more important
than your age when periods started or ended.
 Not getting pregnant: People who haven’t been pregnant have a higher risk because of
the increased exposure to estrogen.

Previous treatments for other conditions:

  Earlier radiation therapy to the pelvis (between belly and legs): Radiation therapy to
treat other cancers can damage cell DNA. This damage may increase your risk of
developing a second type of cancer.
 Estrogen replacement therapy (ERT): Some people receive estrogen therapy to help
relieve menopause symptoms. Getting ERT without progesterone places you at a higher
risk for uterine cancer.
 Use of tamoxifen: People may receive this drug for breast cancer treatment. It acts like
estrogen in the uterus and can increase the risk of uterine cancer.

Symptoms

 Unusual vaginal bleeding is the most common symptom of uterine cancer, particularly any
bleeding after menopause. Other common symptoms may include:

heavier than usual periods or a change in your periods

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vaginal bleeding between periods

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periods that continue without a break.

Less common symptoms include:

 a watery discharge, which may have an unpleasant smell.

 unexplained weight loss
 difficulty urinating or a change in bowel habit
 abdominal pain.
While these symptoms may be caused by other reasons, check with your GP if you are
concerned.

PATHOPHYSIOLOGY

DIAGNOSIS

Tests to diagnose uterine cancer include:

Physical examination

The doctor may check your abdomen for swelling. To check your uterus, the doctor will place
two fingers inside your vagina while pressing on your abdomen, or they may use an instrument
(a speculum) that separates the walls of the vagina (similar to a cervical screening test).

Pelvic ultrasound

A pelvic ultrasound will use soundwaves to make a picture of your uterus and ovaries. The
soundwaves echo when they meet something dense such as a tumour or organ. A computer
then makes a picture from these echoes. A pelvic ultrasound can be done in two ways and you
often have both types at the same appointment. A pelvic ultrasound usually takes between 15
and 30 minutes. If anything appears unusual, the doctor may suggest a biopsy.

Abdominal ultrasound

In order to get good pictures of the ovaries and uterus in an abdominal ultrasound you will
need to have a full bladder so you will be asked to drink water before your appointment. A
technician called a sonographer will move a small device called a transducer over your
abdomen. 

Transvaginal ultrasound

For a transvaginal ultrasound you do not need a full bladder. The sonographer will insert a
transducer wand into your vagina. You may find the ultrasound uncomfortable, but it should
not be painful. 

If you feel uncomfortable or embarrassed about having the ultrasound, talk to the technician
beforehand. You can ask to have a female sonographer or have someone else in the room with
you.

Endometrial biopsy

An endometrial biopsy is done in the specialist’s office. A long, thin tube (pipelle) is inserted
into your vagina to gently suck cells from the uterine lining. The cells are sent to a pathologist
who examines them under a microscope. There may be some discomfort similar to period
cramps so your doctor may suggest taking non-steroidal anti-inflammatory drugs such as
ibuprofen, before the procedure.

Hysteroscopy and biopsy

A hysteroscope is a telescope-like device which is inserted through your vagina into your uterus
and allows a gynaecologist or gynaecological oncologist to see inside your uterus. During this
procedure, tissue can also be removed (biopsy) and sent for further testing in a laboratory.  
Blood and urine tests

Blood and urine tests may be used to assess your general health and inform treatment
decisions.

Other tests

If cancer is detected in your uterus, you may have other scans to see if the cancer has spread to
other parts of your body, such as an x-ray, CT scan or MRI scan. For particular types of uterine
cancer, such as sarcoma, a PET scan may be used.

MEDICAL MANAGEMENT

Treatment for endometrial cancer is usually with surgery to remove the uterus, fallopian tubes
and ovaries. Another option is radiation therapy with powerful energy. Drug treatments for
endometrial cancer include chemotherapy with powerful drugs and hormone therapy to block
hormones that cancer cells rely on. Other options might be targeted therapy with drugs that
attack specific weaknesses in the cancer cells and immunotherapy to help your immune system
fight cancer. Surgery Treatment for endometrial cancer usually involves an operation to remove
the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-
oophorectomy). A Hysterectomy makes it impossible for you to become pregnant in the future.
Also, once your ovaries are removed, you’ll experience menopause, if you haven’t aalready
During surgery, your surgeon will also inspect the areas around your uterus to look for signs
that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps
determine your cancer’s stage. Radiation therapy Radiation therapy uses powerful energy
beams, such as X-rays and protons, to kill cancer therapy in some instances, your doctor may
recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain
situations, radiation therapy may also be recommended before surgery, to shrink a tumor and
make it easier to remove. Radiation therapy can involve: • Radiation from a machine outside
your body. During external beam radiation, you lie on a table while a machine directs radiation
to specific points on your body. • Radiation placed inside your body. Internal radiation
(brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a
cylinder, inside your vagina for a short period of time.
Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or
two or more drugs can be used in combination. You may receive chemotherapy drugs by pill
(orally) or through your veins (intravenously). These drugs enter your bloodstream and then
travel through your body, killing cancer cells. Chemotherapy is sometimes recommended after
surgery if there’s an increased risk that the cancer might return. It can also be used before
surgery to shrink the cancer so that it’s more likely to be removed completely during surgery.
Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer
that as spread beyond the uterus. Hormone therapy Hormone therapy involves taking
medications to lower the hormone levels in the body. In response, cancer cells that rely on
hormones to help them grow might die. Hormone therapy maybe an option if you have
advanced endometrial cancer that has spread beyond the uterus. Targeted drug therapy
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking
these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug
therapy is usually combined with chemotherapy for treating advanced endometrial cancer.
Immunotherapy Immunotherapy is a drug treatment that helps your immune system to fight
cancer. Your body’s disease-fighting immune system might not attack cancer because the
cancer cells produce proteins that blind the immune system cells. Immunotherapy works by
interfering with that process. For endometrial cancer, immunotherapy might be considered if
the cancer is advanced and other treatments haven’t helped. Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other
symptoms of a serious illness. Palliative care specialists work with you, your family and your
Other doctors to provide an extra layer of support that complements your ongoing care.
Palliative care can be used while undergoing other aggressive treatments, such as surgery,
chemotherapy or Radiation therapy.

NURSING INTERVENTIONS

• Listen to the patient’s fears and concerns, and offer reassurance when appropriate.
• Encourage the patient to use relaxation techniques to promote comfort during the diagnostic
procedures.
• Monitor the patient’s response to therapy through frequent Pap tests and cone biopsies as
ordered.
• Watch for complications related to therapy by listening to and observing the patient
• Monitor laboratory studies and obtain frequent vital signs.
• Understand the treatment regimen and verbalize the need for adequate fluid and nutritional
intake to promote tissue healing.
• Explain any surgical or therapeutic procedure to the patient, including what to expect both
before and after the procedure.
• Review the possible complications of the type therapy ordered.
• Remind the patient to watch for and report uncomfortable adverse reactions.
• Reassure the patient that this disease and its treatment shouldn’t radically alter her lifestyle
or prohibit sexual intimacy.
• Explain the importance of complying with follow up visits to the gynecologist and Oncologist.
COMPLICATIONS

 The only potential complication of endometrial cancer symptoms is anemia, a low red
blood cell count. Symptoms of anemia include fatigue, weakness, cold hands and/or feet,
irregular heartbeat, headaches, shortness of breath, pale or yellow-tinged skin, chest
pain, and feeling dizzy or lightheaded.