| Uterine cancer occurs when cancerous cells develop in the uterus. When the cancer arises from the lining of the uterus (endometrium), it is referred to as endometrial carcinoma. When the cancer arises in the muscle or other supporting tissues of the uterus, it is referred to as uterine sarcoma. Endometrial cancer accounts for 95% of cancers of the uterus ("Overview").
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.
In the US, endometrial cancer is the most common cancer of the female reproductive organs, accounting for 13% of all cancers in women. Overall, it is the fourth most common cancer in women after breast, lung, and colorectal cancer (Winter). Many endometrial cancers develop slowly over many years.
A summary of the stages of endometrial cancer is as follows: stage I, cancer is confined to the body of the uterus; 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 the lymph nodes but remains in the pelvic area and has not spread to distant sites; and stage IV, cancer has spread to other parts of the body, including regional lymph nodes.Risk: Conditions that increase the risk of developing uterine cancer include those associated with increased estrogen exposure including early menarche, late menopause, infertility, obesity, 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 exposure, polycystic ovaries, 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 ("Overview").
Factors associated with a lower risk of uterine cancer include having multiple children (multiparity) ("Multiparity Associated”), the use of oral contraceptives with combined estrogen and progestin, and taking ERT combined with progesterone during menopause. Incidence and Prevalence: Uterine cancer is the most common cancer of the female reproductive system. In the US, the American Cancer Society estimates that about 40,100 women will be diagnosed with uterine cancer in 2008, and about 7,470 women will die from the disease ("Overview"). |
Source: Medical Disability Advisor
| History: Early symptoms of uterine cancer include post menopausal bleeding, spotting or discharge. Pelvic pain, a pelvic mass or weight loss occur at later stages. 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. The Pap test, in which a sampling of cells is collected from the cervix and upper vagina and sent to a medical laboratory to be evaluated for cancer cells, abnormal cells (hyperplasia), or other abnormalities screens for cancer of the cervix (the lower part of the uterus). Tests: At this time, there are no standard tests to screen for early-stage uterine cancer.
If uterine cancer is suspected by history and exam, a tissue sample is obtained by biopsy (endometrial biopsy) and examined under the microscope. A grade of 1 to 3 is assigned. 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 confirm the diagnosis.
Additional tests may be performed to determine if the cancer has spread to other organs including transvaginal ultrasound, CT and MRI scans of the pelvis and abdomen, intravenous pyelogram (IVP), chest and skeletal x-rays, barium enema, cystoscopy, proctoscopy, sigmoidoscopy, and lymphangiography.
Blood tests of liver and kidney function, and to measure CA 125, a substance released into the bloodstream by many endometrial cancers, may be performed. |
Source: Medical Disability Advisor
| 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 child bearing 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, it if has, to determine what other parts of the body are affected. If pathology tests show the cancer has not spread (metastasis) 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 in the affected area. In some cases, radiation is used before surgery to shrink the tumor. For a small number of women who cannot have surgery, radiation therapy is the mainstay of the treatment process.
Some women 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, given orally, prevents cancer cells from obtaining the hormones they need to grow. It is prepared from natural or synthetic progesterone, a hormone that is produced by the corpus luteum of the ovary and by the placenta. Both chemotherapy and hormone therapy are referred to as systemic treatments because the therapy agent travels through the body via the bloodstream.
Psychiatric or psychological counseling or intervention may be required because of the severity and life-threatening nature of this disease. |
Source: Medical Disability Advisor
| The most significant predictor of outcome is the stage of the cancer at the time of diagnosis. Uterine cancers are staged (stages 0 to IV) according to whether they are still localized (remaining in the uterus) or have spread beyond the uterus. 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, 90% to 95%; stage II, 75%; stage III, 60%; and stage IV, 15% to 26% ("Detailed Guide: Endometrial Cancer").
The predicted outcome in stages 0 and I, when the cancer confined to the uterus and the uterus has been surgically removed (hysterectomy), is good and full recovery is anticipated. If recurrence in another location in the body occurs, it usually happens within 3 years.
The prognosis for uterine sarcoma depends on the type of sarcoma, its stage, and grade. Five-year survival rates are as follows: stage I, 50%; stage II, 20%; stages III and IV, 10% ("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
| 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 each 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 therapy, 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. This 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 of uterine cancer result from the spread of the cancer to other organs and progressive functional loss of the affected organs. Some complications include bowel obstruction, urinary obstruction, and fluid collection in the abdominal area (ascites). Bowel and urinary obstructions could result in the surgical removal of the bowel and urinary tract. The symptoms of ascites depend on the amount of fluid in the abdominal cavity; the symptoms will increase as more fluid accumulates. Among the most common manifestations of uterine cancer are abdominal enlargement (distention), loss of appetite, shortness of breath, abdominal pain, low blood pressure, weakness, and fatigue.
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 minimizes 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
| 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
| 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, other cancers, or no menstruation for extended periods?
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Does individual have few or no children?
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Has individual taken estrogen replacement therapy (ERT) without supplemental progestin?
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Does individual report abnormal (i.e., postmenopausal) uterine bleeding, ranging from minor, watery, blood-tinged discharge or spotting to heavy hemorrhage?
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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?
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Was a transvaginal ultrasound done? Were blood tests for liver and kidney function taken? 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 an endometrial biopsy obtained, or did individual have a dilation and curettage (D&C)?
Regarding treatment:
- What type of surgery did individual undergo? Complete or radical hysterectomy?
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Has the cancer spread (metastasized)? If so, how extensive are the metastases?
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Does individual require radiation therapy?
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Does individual require chemotherapy or hormone therapy, such as progesterone-based therapy?
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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)?
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Have complications occurred as a result of surgery, chemotherapy, or radiation therapy? As a result of the cancer metastasizing? Are there any psychological complications?
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What is the treatment plan for complications? How will complications affect individual's activities of daily living?
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Source: Medical Disability Advisor
| "Detailed Guide: Endometrial Cancer." American Cancer Society. 1 Feb. 2005 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_endometrial_cancer_staged.asp?sitearea=>. "Detailed Guide: Uterine Sarcoma." American Cancer Society. 1 Feb. 2005 <http://www.cancer.org>. "Multiparity Associated With Lower Endometrial Cancer Risk." OncoLink. 2 May. 2002. Trustees of the University of Pennsylvania. 26 Sep. 2006 <http://www.oncolink.com/resources/article.cfm?c=3&s=8&ss=23&id=8358&month=05&year=2002>. "Overview: Endometrial Cancer ." American Cancer Society. 18 Aug. 2008. 20 Mar. 2009 <http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=11>. Winter, William E., and Jim A. Gosewehr. "Uterine Cancer." eMedicine. Eds. John J. Kavanagh, et al. 19 May. 2006. Medscape. 2 Sep. 2004 <http://emedicine.medscape.com/article/258148-overview>. |
Source: Medical Disability Advisor
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