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Uterine Cancer Is on the Rise

Several reports have been published in the past few months saying that the rate of uterine cancer has risen significantly over the past decade in the US. More importantly, the death rate in women diagnosed with this cancer has also increased.

As reported in the New York Times in June 2022, the incidence has risen roughly two percent annually between 2010 and 2020. A recent study in the Journal of the American Medical Association (JAMA) Oncology publication also highlights the trend that the trend is even steeper in Black, Asian and Hispanic women.

There are a few main subtypes of uterine cancer – endometrial, endometrioid and non-endometrioid. Currently, about nine out of ten uterine cancers begin in the endometrium, the tissue that lines the uterus. 

Endometrial cancer deaths in the United States have remained steady, but the death rate from aggressive non-endometrioid tumors rose by 2.7% each year. Black women had worse outcomes for both subtypes than others.

What is Uterine Cancer?

Uterine cancer is the abnormal growth of cells in the uterus, a hollow, muscular organ in a woman’s pelvis that contains and nourishes the developing fetus (a baby). Uterine tumors are abnormal growths of cells within the uterus. These can be benign or malignant. Benign tumors are not cancerous and do not spread to other parts of the body. In contrast, malignant tumors can invade nearby tissues or spread to distant sites such as lymph nodes or other organs. Until now it was the fourth most common cancer among women. If the current trends of increase continue, it will probably overtake colorectal cancer as the third most common cancer among women by 2040.

The American Cancer Society estimates that uterine cancer will affect about one in thirty-two women during their lifetime.

What are the causes of uterine cancer?

Uterine cancers arise from cells which form in the tissue lining the uterus called the endometrium. It creates a thickened lining to provide nutrients to an embryo if pregnancy occurs. The endometrium also sheds each month as part of menstruation.

What are the Risk Factors for Developing Uterine Cancer?

Uterine cancer is a leading cause of death from gynecologic cancers. The risk factors for developing uterine cancer are age, race, ethnicity, family history, use of hormone replacement therapy and reproductive history. There are ways to prevent uterine cancer by avoiding known risk factors like smoking or using hormone replacement therapy. 

The symptoms of uterine cancer are:

  • Heavy or prolonged periods
  • Bleeding between periods
  • Painful urination
  • Painful sex
  • Lower back pain
  • Pelvic pain
  • Vaginal bleeding

Sometimes, it may be difficult to tell if you have uterine cancer. If you think you might have uterine cancer, your doctor will perform a pelvic exam to ensure they see no signs of cancer. If your doctor does see signs of uterine cancer, you may need a pelvic ultrasound, an MRI scan, or a biopsy. If cancer is detected, you may be referred for a laparoscopic hysteroscopy or alternately to undergo treatment by progesterone (see more here).

How Can I Reduce My Risk of Developing Uterine Cancer?

The risk of developing uterine cancer can be reduced by taking a few steps. These steps include avoiding high-risk pregnancies, getting regular pelvic exams, or by treatment with progesterone. Getting regular screenings and avoiding risky behaviors like smoking cigarettes or excessive use of alcohol or recreational drugs can also reduce the risk.

Risk Factors for Developing Uterine Cancer

The risk factors for uterine cancer are not entirely understood. Still, experts believe that genetics, hormone levels, and environmental exposures may all play a role. Research has shown that uterine neoplasms are more common among women with a family history of uterine cancer, ovarian cancer, or other gynecological cancers, were exposed to X-ray radiation from obstetric imaging studies, or have given birth to two or more children in close succession. The risk of developing uterine cancer increases with age for those who have not given birth.

Some of the main risk factors for uterine cancer include:

  • Age or onset of menopause (mid to late forties)
  • Cigarette smoking
  • Exposure to diethylstilbestrol in utero during pregnancy
  • Obesity (BMI greater than 30)

Several other risk factors may increase your chance of uterine cancer, including:

  • Ovarian cancer
  • Family history of uterine or ovarian cancer 
  • Personal history of breast cancer
  • Personal history of hormone therapy for cancer treatment 
  • Use of intrauterine device (IUD)

 

How to Prevent & Treat Uterine Cancer

Uterine cancer is one of the most common gynecological cancer in women. It develops from the lining of the uterus and is often diagnosed during a routine pelvic exam or screening.

Examination by your gynecologist of biopsied tissue will look for any abnormal growths that appear to be precancerous. For any such endometrial precancers, most doctors will recommend a hysterectomy, which completely removes the uterus and cervix. 

This may not be a viable option for anyone still wanting to have children, and obese women face higher risks for surgical complications.

There is another option, which is to treat women showing signs of endometrial precancer with progesterone. Progesterone works to balance the aggressive effects of estrogen during the menstrual cycle and plays a key role in the shedding of the endometrial lining. Treatment with oral drugs such as Prometrium, Provera, or injectable Depo-Provera supply a synthetic version of the hormone, which can shrink any abnormal growths in the endometrium. This is not a total cure, as only roughly two-thirds of women treated with progesterone had a full recovery from treatment during the study periods. Women with grade 1 endometrial cancer had only a 48% complete response. 

Treatment for uterine tumors depends on how far it has progressed but can include surgery to remove the tumor and chemotherapy or radiation therapy to kill any remaining cancer cells. 

There is not yet a cure for uterine tumors. Still, patients will respond better and survive longer if they receive treatment as soon as possible.

FAQ

What is the survival rate for uterine cancer?

When uterine cancer is first diagnosed, if it is still located only in the uterus, it is known as a local tumor, and the five-year survival rate is about 95%. If the cancer has already started to spread regionally, the five-year survival rate is around 69%.

What are the characteristics of ovarian cancer that differ from uterine cancer?

Ovarian cancer is a disease in which cells that line the surface of the ovary grow uncontrollably, increasing in number and spreading into surrounding tissues. If left untreated, ovarian cancer can spread to other parts of the body. There are many causes of ovarian cancer, including genetics, age and lifestyle factors such as diet and exercise. Early detection allows for effective treatment.

Ovarian cancer often has no warning signs in the early stages, but if detected early by surgery or CA-125 levels, it is more likely to survive. Despite the wide range of treatments available for ovarian cancer, the five-year survival rate is less than 30 percent. The most common symptoms are lower abdominal pain, back pain and vaginal bleeding that does not coincide with a period, or an urgent need to urinate.

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