There are some pre-malignant changes that can occur in women, even young women who do not ovulate regularly and it is called endometrial hyperplasia. This is usually diagnosed by a biopsy of the endometrial lining. It is not cancer but the normal treatment is usually a hysterectomy or high dose progesterone therapy. In a young woman, the treatment for the pre-malignancy may include medication that will cause ovulation.

 The adenocarcinomas are graded.

• Grade I means that the cells are easily identified as coming from the glandular tissue and have easily identifiable glandular structures.

• Grade II are intermediate and moderately differentiated, meaning not as easily identified.

• Grade III is indicated when there is a loss of glandular structure and it appears as just solid cancer.

Grade I has the best prognosis and Grade III has the worst prognosis.

 There are two subtypes of uterine adenocarcinomas, papillary serous adenocarcinomas and clear cell adenocarcinoma, which are considered different because they have an increased potential to spread throughout the abdomen and they behave similar to ovarian cancer.

 There are several risk factors for uterine cancer.

• Age (considered most important risk factor) - This cancer can affect both post and peri menopausal women.

• Estrogen - Uterine cancer has been associated with estrogen as estrogen stimulates the endometrial glands to grow. If you do not ovulate, the ovary will continue to make estrogen and increase the risk of cancer. If a woman is post-menopausal and is taking estrogen, she will also have an increased risk of developing cancer of the uterus and is normally why progestin is also prescribed to post-menopausal women.

• Tamoxifen - If a woman is taking tamoxifen for breast cancer, she is also at an increased risk for uterine cancer because Tamoxifen is a type of estrogen. The increased risk is about five to twelve times more than the normal risk.

Other risk factors include early start of menstration, late menopause, no children, failure to ovulate and obesity.

Symptoms of Uterine Cancer

 There are several symptoms of uterine cancer but the most common symptom is abnormal bleeding. Other symptoms may include:

• abnormal vaginal discharge
• difficult/painful urination
• pain during intercourse or pain in the pelvic area

It is important to remember that these symptoms can be caused by conditions that are not cancer but it is always best to see your doctor if you have these symptoms to determine the cause.

 Any woman who is post-menopausal that has bleeding should be seen by her doctor and be checked for uterine cancer. This would be done by an endometrial biopsy. Sometimes a doctor will perform the procedure by using a scope that is inserted through the cervix so that the lining can be seen and biopsied and this is called a hysteroscopy. With uterine cancer, it is found that the abnormal bleeding is an early symptom and if it is not ignored, diagnosis can be made early, which is why the death rate for uterine cancer is low, despite that it is the most frequently diagnosed gynecologic cancer.

 At present there are no screening recommendations for uterine cancer. The only screening procedure is an endometrial biopsy and some do recommend that any woman taking estrogen only or taking Tamoxifen should have a biopsy yearly. The pap test is not adequate for finding uterine cancer though occasionally it can be found by a pap test.

 If you suspect that you might have uterine cancer, you can expect your dr to perform one or more of the following procedures. The first procedure would most likely be an endometrial biopsy or hysteroscopy (using a scope inserted in the cervix to view the lining and take a biopsy). It is also possible that your doctor may wish to do a D&C.

Staging

There are several stages of uterine cancer:

• Stage I - Cancer is just in the lining of the uterus.
• Stage Ia - There is no invasive into the uterine wall.
• Stage Ib - There is invasion of less than one-half of the uterine wall.
• Stage Ic - There is invasion of more than one-half of the uterine wall.

• Stage II - The cancer extends into the cervix.
• Stage IIa - The cancer only extends superficially along the endocervix
• Stage IIb - The cancer extends deep into the cervix.

• Stage III - The cancer has spread beyond the uterus.
• Stage IIIa - The cancer involes the tubes or ovaries.
• Stage IIIb - The cancer has spread to the vagina.
• Stage IIIc - The cancer has spread to the pelvic or aortic lymph nodes.

• Stage IV - There are distant metastases present.
• Stage IVa - There is cancer present inside the bladder or rectum.
• Stage IVb - Cancer is present throughout the abdomen or distant sites.

Treatment

 Uterine cancer is usually treated with a combination of surgery and radiation. Women in the early stage will first undergo the removal of their uterus, tubes and ovaries to confirm the stage. If there is just limited invasion into the wall and only grade I or II, radiation will not be recommended. Anything greater than that, the doctor will most likely advise radiation of the pelvis. The advanced stages of uterine cancer are sometimes treated by radiation (if possible) and chemotherapy and progesterone is a good chemotherapy drug for uterine cancer. The cure rate for uterine cancer does drop by 20% if a hysterectomy is not performed.

Prognosis

 The five year survival rate for uterine cancer varies according to the stage of the disease. There is an 80% five year survival rate for women with Stage I uterine cancer, 65% for those with Stage II, 30% for those with Stage III, and 10% for those with Stage IV. It is also stated that those who have Stage Ia, Grade I uterine cancer have a five year survival rate over 95%.

 Uterine Sarcomas are a rare cancer and there are several types that go from low grade to high grade malignancies. At present there are no standard treatments for uterine sarcomas. The other type of uterine cancer, leiomyosarcomas are graded according to the number of cells that are undergoing cell division. If there are not many dividing cells, it would be considered either low grade cancer or not cancer at all, but if the number is high, it would be considered an aggressive cancer. With leiomyosarcomas, stage I can still be very aggressive if it is high grade and most likely will recur. Research has not proved that radiation or chemotherapy is effective in preventing a recurrence of leiomyosarcomas.

 Uterine cancer is not an easily prevented cancer, but there are some recommendations. Women should try to maintain an ideal weight, make sure to get annual pelvic exams, and have endometrial biopsies after menopause if she is at high risk. Also the use of birth control pills or other progeterone therapies can reduce the risk of uterine cancer.