Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Uterus


Related Terms

  • Cancer of the Uterus
  • Endometrial Cancer
  • Endometrial Carcinoma
  • Uterine Cancer
  • Uterine Sarcoma

Differential Diagnosis

Specialists

  • General Surgeon
  • Gynecologist
  • Oncologist
  • Radiology Oncologist

Comorbid Conditions

Factors Influencing Duration

Factors influencing the length of disability include the woman's age, the type and stage of disease at initial presentation, the presence of concurrent infection, the woman's overall health, type of treatment, the woman's response to treatment, any side effects of treatment modalities, and the presence of complications. Older women, women in poor health, and women with cancer that has spread outside the uterus will require the longest time for recovery and may become permanently disabled. Chemotherapy and radiation therapy will extend the period of disability as much as 6 additional months. Early return to heavy and very heavy work may not be possible after abdominal surgery.

Medical Codes

ICD-9-CM:
179 - Malignant Neoplasm of Uterus, Part Unspecified
182 - Malignant Neoplasm of Body of Uterus
182.0 - Malignant Neoplasm of Body of Uterus; Corpus Uteri, except Isthmus; Cornu; Endometrium; Fundus; Myometrium
182.1 - Malignant Neoplasm of Body of Uterus; Isthmus, Lower Uterine Segment
182.8 - Malignant Neoplasm of Body of Uterus; Other Specified Sites of Body of Uterus
198.82 - Secondary Malignant Neoplasm of Other Specified Sites; Other Specified Sites, Genital Organs
233.2 - Carcinoma in Situ of Other and Unspecified Parts of Uterus
236.0 - Neoplasm of Uncertain Behavior of Genitourinary Organs, Uterus

Overview

Uterine cancer is a tumor that develops in the body of the uterus (uterine corpus). It occurs when cells in some part of the uterus divide and reproduce uncontrollably until a cancerous (malignant) lesion or tumor is formed. When the cancer arises from the lining of the uterus (endometrium), it is referred to as endometrial carcinoma. When the cancer arises in the smooth muscle or other supporting tissues of the uterus (connective tissue), it is referred to as uterine sarcoma. Uterine sarcomas can be endometrial stromal sarcomas that develop in the endometrial connective tissue (stroma), or uterine leiomyosarcomas that develop in the muscular uterus wall. Uterine sarcomas account for only about 3% of uterine cancer ("Detailed Guide: Uterine Sarcoma"). A rapidly growing pelvic mass is often indicative of uterine sarcoma. Endometrial cancer accounts for more than 95% of cancers of the uterus ("Detailed Guide: Endometrial Cancer"); endometrial adenocarcinoma develops during women's reproductive and menopausal years, but most endometrial cancer (75%) is found in postmenopausal women (Creasman). A third type of uterine cancer, a combination of sarcoma and carcinoma called carcinosarcoma (also called mixed mesodermal tumors) can also develop in the endometrium. Benign tumors of the uterus are commonly called fibroid tumors, although they may be referred to clinically as leiomyomas, adenofibromas, or adenomyomas.

The uterus is a pear-shaped, hollow organ located behind the bladder. It is about 3 inches long and 2 inches wide at its widest point. The uterus is made up of three layers: the inner layer (endometrium), the middle layer (myometrium), and the external covering for the two other layers (perimetrium). The area where the lower part of the uterus protrudes into the vaginal cavity is called the cervix.

Some endometrial cancers develop slowly over many years and may have spread (metastasized) within the pelvis or to distant organs by the time of diagnosis. However, the majority of individuals are diagnosed at early stages of the disease, allowing early treatment and explaining why endometrial cancer accounts for a low 3% of female cancer deaths (Chiang).

Based on clinical and diagnostic evidence, endometrial cancer is staged as follows: stage I, cancer is confined to the body of the uterus (corpus); stage II, cancer has reached the cervix but not the lymph nodes or distant sites; stage III, cancer has spread outside the uterus and possibly to nearby lymph nodes but remains in the pelvic area and has not spread to distant sites; and stage IV, cancer has metastasized to the lymphatic system and distant organs.

Incidence and Prevalence: Uterine cancer is the most common cancer of the female reproductive system, accounting for 15% of gynecologic cancers and 6% of all cancers in women after breast, lung, and colorectal cancer (Chiang). In the US, the American Cancer Society estimated that about 43,470 women would be diagnosed with uterine cancer in 2010, and about 7,950 women would die from the disease (“Cancer Facts”). The incidence of endometrial cancer increased markedly prior to 1998 but has stabilized in recent years. About 1,200 new cases of uterine sarcoma were predicted for 2010, accounting for 3% of all uterine cancer (“Detailed Guide: Uterine Sarcoma”).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Conditions that increase the risk of developing uterine cancer include those associated with increased estrogen exposure, such as early menarche, late menopause, never having been pregnant, infertility, obesity, tamoxifen use, and estrogen replacement therapy (ERT). Additional risk factors include age, family history of uterine cancer, history of breast or ovarian cancer, diabetes, hypertension, pelvic radiation therapy, polycystic ovary syndrome (PCOS), and endometrial hyperplasia (an abnormal increase in the number of cells lining the uterus). Evidence also suggests that women who eat a diet high in fat increase their risk of developing uterine cancer.

As a woman ages, the risk of developing uterine cancer increases. Ninety-five percent of endometrial cancers occur in women age 40 or older; the average age at which uterine cancer is diagnosed is 60 (“Detailed Guide: Endometrial Cancer”).

Factors associated with a lower risk of uterine cancer include having multiple children (multiparity), the use of oral contraceptives with combined estrogen and progestin, and taking ERT combined with progesterone during menopause. Because smoking may result in earlier menopause, women who smoke have a reduced likelihood of developing uterine cancer, even though the risk for other cancers (e.g., lung, bladder, colorectal cancer) is increased (Creasman).

An increased risk is found among premenopausal women who have hereditary nonpolyposis colorectal cancer (HNPCC) caused by mutations in DNA mismatch repair genes (MMR) found in both diseases. About 9% of uterine cancer patients younger than age 50 have developed endometrial cancer in conjunction with colorectal cancer (Chiang).

Source: Medical Disability Advisor



Diagnosis

History: Early symptoms of uterine cancer include abnormal vaginal bleeding that can be postmenopausal bleeding, spotting, or discharge. Pelvic pain, bloating, purulent vaginal discharge, a pelvic mass, or weight loss may occur at later stages. Changes in bowel and bladder habits may also be reported in metastatic disease. About 5% of women have no symptoms and are diagnosed only during work-up of an abnormal Pap test (Papanicolaou smear) (Chiang).

Physical exam: The doctor performs a pelvic exam to check the vagina, uterus, ovaries, bladder, and rectum for lumps or changes in shape or size. A complete physical exam will be done to look for indications of metastasis of a primary uterine cancer.

Tests: No standard tests are used to screen for early-stage uterine cancer. Screening by endometrial sampling (in-office biopsy) or transvaginal sonography is not recommended for asymptomatic women.

Also, since endometrial cancer begins inside the uterus, it rarely is detected on a Pap test, which screens for cancer of the cervix (the lower part of the uterus).

If uterine cancer is suspected by history and exam, a tissue sample is obtained by biopsy (endometrial biopsy) and examined under the microscope. A histologic grade of 1 to 3 is assigned to the tumor based on types of cells found (e.g., squamous, papillary, or clear cells); the grade points to the likely prognosis. The tissue may also be tested for progesterone receptors. If enough tissue cannot be obtained by biopsy, or if examination of the biopsy tissue is inconclusive, a procedure in which tissue is scraped from the lining of the uterus (dilation and curettage, or D&C) is required to examine cells and confirm the diagnosis.

Blood chemistries that assess liver and kidney function may be performed if metastasis is suspected, and a blood test to measure CA-125, a substance released into the bloodstream by many endometrial cancers, may be performed in advanced stage cancers, primarily as a baseline for monitoring the individual's response to treatment.

Additional tests may be performed to determine if the cancer has spread to other organs, including transvaginal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) scans of the pelvis and abdomen, intravenous pyelogram (IVP), skeletal x-rays, barium enema, cystoscopy, proctoscopy, sigmoidoscopy, and lymphangiography. Chest radiography may be done to assess for lung metastasis.

Source: Medical Disability Advisor



Treatment

The choice of treatment depends on the size of the tumor, the stage of the disease, whether female hormones such as progesterone affect tumor growth, and tumor grade. (The tumor grade tells how closely the cancer resembles normal cells and suggests how fast the cancer is likely to grow.) Other factors considered when planning treatment are the woman's age, general health, and childbearing plans.

Most women with uterine cancer are treated with surgery in which the cancerous tumors are removed. Two types of common surgery are removal of the body of the uterus, cervix, ovaries, and fallopian tubes (complete hysterectomy), or removal of the uterus, along with the cervix, the upper vagina, and most of the tissue around the cervix (radical hysterectomy). Lymph nodes near the tumor will also be removed and examined to see if they are cancerous. After examination of the surgically removed tumor and other affected organs and tissues, surgical staging is done to determine whether the cancer has spread and, if it has, to determine what other parts of the body are affected. If pathology tests (histopathologic staging) show the cancer has not spread (metastasized) beyond the mucous lining of the uterus (endometrium), surgery may be the only treatment needed for an effective cure.

After surgery, many women whose cancer has spread are treated with radiation therapy directed at the affected area. Vaginal brachytherapy is sometimes administered, which involves placing a cylindrical applicator directly into the pelvic cavity to deliver radioactive pellets; the pellets stay in place for up to 1 day, and several treatments may be given. In some cases, radiation is used before surgery to shrink the tumor. For a small number of women who, for reasons of general health status or advanced stage, are not candidates for surgery, radiation therapy is the mainstay of the treatment process.

Some women may also receive chemotherapy. Chemotherapeutic drugs are most often administered intravenously (IV) and less frequently by mouth or by injection. A smaller number of women are given hormone therapy, such as progesterone-based therapy. Progesterone is a hormone that is produced by the corpus luteum of the ovary and by the placenta; either natural or synthetic forms may be used. It is given orally and prevents cancer cells from obtaining the hormones they need to grow. Both chemotherapy and hormone therapy are referred to as systemic treatments because the therapeutic agent travels through the body via the bloodstream. Newer therapeutic agents are being evaluated in clinical trials for treatment of uterine sarcoma, including trabectedin and temozolomide, which have successfully treated other types of tumors. Patients with advanced stage cancer are sometimes advised to enroll in clinical trials of experimental drugs.

Psychiatric or psychological counseling or intervention may be required because of the severity and life-threatening nature of this disease.

Source: Medical Disability Advisor



Prognosis

The most significant predictor of outcome is the stage of the cancer at the time of diagnosis. The 5-year survival rates calculated by the American Cancer Society for the stages of endometrial cancer are as follows: stage 0, nearly 100%; stage I, 99%; stage II, 80%; stage III, 66%; and stage IV, 30% (“Detailed Guide: Endometrial Cancer”). Mortality associated with endometrial cancer is higher among black women than white women, indicated by 7.3 deaths per 100,000 black women compared to 3.8 deaths per 100,000 white women (Creasman).

The predicted outcome in stages 0 and I, when the cancer and the uterus have been surgically removed (hysterectomy), is good, and full recovery is anticipated in a majority of cases due to early detection and treatment. If cancer recurs in another location in the body, it usually happens within 3 years. Uterine cancer results in only 3% of female cancer deaths (Chiang).

The prognosis for uterine sarcoma depends on the type of sarcoma, its stage, and its grade. Five-year survival rates for leiomyosarcoma are as follows: stage I, 60%; stage II, 35%; stage III, 28%; and stage IV, 15% (“Detailed Guide: Uterine Sarcoma”). For endometrial stromal sarcoma, 5-year survival rates are stage I, 90%; stage II, 40% (inaccurate due to few study subjects in this group); stage III, 64%; and stage IV, 37% (“Detailed Guide: Uterine Sarcoma”).

Surgical removal of the uterus, with or without removal of the ovaries and fallopian tubes, is used to treat most stages of uterine sarcoma. Even with adjuvant therapies such as chemotherapy and radiation, the outcome of surgical treatment of uterine sarcomas is not as good as that of endometrial carcinoma. In addition, uterine sarcoma tends to recur in other places in the body, most commonly the lungs.

When uterine carcinoma and uterine sarcoma are considered together, survival rates for uterine cancer are generally quite high, especially if the disease is detected in an early stage. The overall 5-year survival rate, regardless of stage at detection, is 84% (“Detailed Guide: Uterine Sarcoma”).

Source: Medical Disability Advisor



Rehabilitation

Women who have been diagnosed with uterine cancer may require physical therapy and occupational therapy. The amount of therapy required depends on the stage of cancer and the treatment used.

Women who have had a hysterectomy but who do not require radiation or chemotherapy may require a few sessions of physical therapy before leaving the hospital to adjust to weakened abdominal muscles. Women who require chemotherapy or radiation may require more intensive physical and occupational therapies, both in the hospital as well as at home or in an outpatient clinic. Physical therapists will teach general strengthening exercises. Occupational therapists may need to address activities of daily living, such as dressing and bathing techniques.

Women with uterine cancer may benefit from psychological counseling, either individually or through support groups. It can help women deal with depression due to perceptions of decreased sexual function, fear of death, and the impact of cancer treatments. Counseling can help women maintain a positive outlook, which can promote physical healing.

Source: Medical Disability Advisor



Complications

Complications of uterine cancer result from the spread (metastasis) of the cancer to other organs and progressive functional loss of the affected organs. Related complications include bowel obstruction, urinary obstruction, and fluid collection in the abdominal area (ascites). Bowel and urinary obstructions may require surgical removal of the obstructed section of the bowel and/or of the urinary tract. The symptoms of ascites depend on the amount of fluid in the abdominal cavity; the symptoms will increase as more fluid accumulates.

Surgery, radiation therapy, and chemotherapy treatments create additional complications. In addition, there may be psychological complications such as loss of self-esteem, depression, loss of a woman's sense of sexuality, fear of pain, and fear of dying. Early detection and treatment of uterine cancer minimize complications. However, women with advanced stage disease and/or generally poor health before treatment are likely to experience more serious complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Women recovering from surgery or undergoing chemotherapy and/or radiation therapy may require a place to rest periodically at the work site. Workplace responsibilities should initially be mostly sedentary. Accommodations for women undergoing chemotherapy and/or radiation therapy may include leave time from work to receive necessary treatments, as well as additional leave to permit adequate recovery time following treatment.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a history of early menstruation and/or late menopause? Pelvic radiation therapy? Diabetes, high blood pressure, colorectal or other cancers, or no menstruation for extended periods?
  • Does individual have few or no children?
  • Has individual taken estrogen replacement therapy (ERT) without supplemental progestin? Is individual taking tamoxifen?
  • Does individual report abnormal (i.e., postmenopausal) uterine bleeding, ranging from minor, watery, blood-tinged discharge or spotting to heavy hemorrhage?
  • Does individual complain of painful or difficult urination or pain during intercourse? Weight loss, general weakness, changes in bowel and bladder habits, or pain in the pelvic area, back, or legs? Is individual bloated or aware of an abdominal mass?
  • Was a transvaginal ultrasound done? Were blood tests for liver and kidney function done? Were CT and MRI of the pelvis and abdomen done? Did individual require tests to determine possible cancer spread (metastasis) such as intravenous pyelogram (IVP), chest and skeletal x-rays, barium enema, cystoscopy, sigmoidoscopy, and lymphangiography?
  • Was CA-125 measured prior to treatment?
  • Was an endometrial biopsy obtained, or did individual have a dilation and curettage (D&C)?
  • Was cancer staged by a pathologist after biopsy sample was examined? What stage was the cancer at diagnosis?

Regarding treatment:

  • What type of surgery did individual undergo? Complete or radical hysterectomy?
  • Has the cancer spread (metastasized)? If so, how extensive are the metastases?
  • Does individual require pre- or postoperative radiation therapy?
  • Does individual require chemotherapy or hormone therapy, such as progesterone-based therapy?
  • Was CA-125 measured to monitor response to therapy?
  • Does individual require psychological counseling or intervention to understand and cope with the nature of this disease?

Regarding prognosis:

  • Of stages 0 to IV for uterine cancer, in what stage is individual's cancer classified (according to whether cancer cells are localized or have spread beyond the uterus)?
  • How are distant metastases being addressed?
  • Have complications occurred as a result of surgery, radiation therapy, or chemotherapy? As a result of the cancer metastasizing? Are there any psychological complications?
  • What is the treatment plan for complications? How will complications affect individual's activities of daily living?
  • Would individual benefit from additional treatment? Psychological counseling?

Source: Medical Disability Advisor



References

Cited

"Detailed Guide: Endometrial Cancer." American Cancer Society. 15 Oct. 2008. 3 Sep. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_endometrial_cancer_staged.asp?sitearea=>.

American Cancer Society. "Cancer Facts & Figures 2010." American Cancer Society. 24 May 2011 <http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010>.

American Cancer Society. "Detailed Guide: Uterine Sarcoma." American Cancer Society. 7 Jan. 2010. 24 May 2011 <http://www.cancer.org/acs/groups/cid/documents/webcontent/003145-pdf.pdf>.

Chiang, Jing Wang. "Uterine Cancer." eMedicine. Eds. John J. Kavanagh, et al. 3 Sep. 2009. Medscape. 4 Jun. 2009 <http://emedicine.medscape.com/article/258148-overview>.

Creasman, William T. "Endometrial Carcinoma." eMedicine. Eds. John J. Kavanagh, et al. 3 Aug. 2009. Medscape. 3 Sep. 2009 <http://medscape.com/article/254083-overview>.

Source: Medical Disability Advisor






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