Uterine cancer Symptoms, Tests/screening/Diagnosis and Treatment

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

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. A thin tube is inserted through the vagina into your uterus. Your doctor uses gentle scraping and suction to remove samples of tissue. A pathologist examines the tissue under a microscope to check for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.

Uterine cancer Treatment

Most women with uterine cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormone therapy or chemotherapy. Another treatment option for women with uterine cancer is to take part in treatment studies (clinical trials). Such studies are designed to improve uterine cancer treatment. (See Treatment Studies for more information.) The following sections describe types of uterine cancer treatment.

Uterine cancer surgery to remove the uterus (hysterectomy) and the fallopian tubes and ovaries (bilateral salpingo-oophorectomy) is the treatment recommended for most women with uterine cancer. Lymph nodes near the tumor may also be removed during surgery to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean that the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the disease can usually be cured with surgery alone.

In radiation for uterine cancer (also called radiotherapy), high-energy rays are used to kill cancer cells. The rays may come from a small container of radioactive material, called an implant, which is placed directly into or near the tumor site (internal radiation). It may also come from a large machine outside the body (external radiation). Some patients with uterine cancer need both internal and external radiation therapy. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area.

Radiation therapy may be used in addition to surgery to treat women with certain stages of uterine cancer. Radiation may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, for a small number of women who cannot have surgery, radiation treatment is sometimes used instead.

In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The patient is hospitalized during this treatment. Patients may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, there is no radioactivity in the body. External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation.

Hormone therapy for uterine cancer treatment is the use of drugs, such as progesterone, that prevent cancer cells from getting or using the hormones they may need to grow. Hormone treatment is a systemic therapy. The drugs, which are usually taken by mouth, enter the bloodstream, travel through the body, and control cancer cells outside the uterus. Women who are unable to have surgery are sometimes treated with hormone therapy. Also, this form of treatment is often recommended for women who have metastatic or recurrent endometrial cancer.

Uterine cancer chemotherapy is the use of drugs to kill cancer cells. Anticancer drugs may be taken by mouth or given by injection into a blood vessel or a muscle. Like hormone therapy, chemotherapy is a systemic therapy; it can kill cancer cells throughout the body. Chemotherapy is being evaluated in treatment studies for patients with uterine cancer that has spread.