Uterine Cancer

What Is Uterine Cancer?

Uterine cancer begins in the uterus, the hollow organ in a woman’s pelvis where a baby grows during pregnancy. Most uterine cancers start in the lining of the uterus, called the endometrium, which is why this condition is often referred to as endometrial cancer.

In some cases, cancer may start in the muscle wall of the uterus. These are called uterine sarcomas. They are less common than endometrial cancers but are often more aggressive and require specialised treatment. This is one of the more frequently diagnosed cancers of the female reproductive system, and it often shows up with early warning signs, especially abnormal bleeding.

The most important warning sign of uterine cancer is postmenopausal bleeding. Because symptoms often appear early, uterine cancer is frequently detected in earlier stages, which improves treatment outcomes significantly.

Uterine cancer tends to affect postmenopausal women more often, but it can also occur in younger women, particularly when certain risk factors are present. The good news is that when it is found early, treatment is often highly effective.

Types of Uterine Cancer

Uterine cancer is not a single disease. The two major types include:

• Endometrial carcinoma: The most common type, which begins in the uterine lining. 

• Uterine sarcoma: A rarer and more aggressive cancer that starts in the muscle or supporting tissues of the uterus.

Signs and Symptoms of Uterine Cancer

One of the most important things to remember is that uterine cancer often announces itself through bleeding changes. Postmenopausal bleeding is the most important warning sign of uterine cancer.

This makes it more likely to be detected early than many other cancers.

Common signs include:

• Vaginal bleeding after menopause 

• Bleeding between periods 

• Heavier than usual periods 

• Longer than usual menstrual bleeding 

• Bleeding after intercourse (post-coital bleeding) 

• Pelvic pain or pressure 

• Pain during intercourse 

• Unusual vaginal discharge, sometimes watery or blood-tinged 

• Unexplained weight loss 

• Fatigue or weakness

Symptoms of Advanced Disease

In more advanced stages, symptoms may also include:

• Bowel-related symptoms 

• Bladder-related symptoms 

• Persistent pelvic pain 

• Low limb edema (leg swelling) 

• Severe weakness 

• Significant unexplained weight loss 

Any abnormal bleeding, especially after menopause, should be taken seriously and checked by a doctor.

Why Does Uterine Cancer Happen?

There is no single cause, but uterine cancer develops when cells in the uterus begin to grow abnormally and lose control over their normal growth pattern. Hormonal imbalance, especially prolonged exposure to estrogen without enough progesterone, can increase the risk.

Risk factors may include:

• Obesity

• Older age

• Diabetes

• High blood pressure

• Early menstruation or late menopause

• Never having been pregnant

• Polycystic ovary syndrome

• Use of estrogen-only hormone therapy

• Family history of uterine, colon, or ovarian cancer

• Inherited conditions such as Lynch syndrome

Having a risk factor does not mean a person will develop cancer. It simply means the chances may be higher.

Diagnosis of Uterine Cancer

Diagnosis usually begins when a woman reports abnormal bleeding or pelvic symptoms. A doctor may recommend several tests to understand what is happening.

• Pelvic examination: Helps the doctor check for enlargement, tenderness, or other unusual findings.

• Transvaginal ultrasound: Uses sound waves to look at the uterus and measure the thickness of the lining.

• Endometrial biopsy: A small tissue sample is taken from the uterine lining and examined under a microscope. This is one of the most important tests.

• Dilation and curettage (D&C): May be done if more tissue is needed for diagnosis.

• Hysteroscopy: A thin camera is used to look directly inside the uterus.

• Imaging tests: CT scan, MRI, or sometimes a PET scan may be used to check whether the cancer has spread.

Imaging tests such as MRI, CT scan, and in advanced stages, PET CT scan, are mainly used to understand the stage of cancer and whether it has spread beyond the uterus. Getting the diagnosis right is essential because treatment depends heavily on the exact type and stage of the disease.

Treatment Options for Uterine Cancer

Treatment is chosen based on the type of cancer, the stage, and the person’s overall health.

• Surgery: Often the main treatment and may include removal of the uterus, ovaries, and fallopian tubes.

Surgery usually includes the removal of:

• Uterus 

• Ovaries 

• Fallopian tubes

Complete Surgical Staging

Surgical treatment also includes complete staging, which may involve:

• Pelvic lymph nodes 

• In selected cases, para-aortic lymph nodes 

In advanced disease, surgery may become more extensive if cancer has spread to nearby abdominal organs.

Radiation Therapy

The need for radiation therapy is decided based on the post-surgical staging.

Radiation may include:

• Brachytherapy (internal radiation) 

• External Beam Radiation Therapy (EBRT)

The choice depends on the final pathology report and disease stage after surgery.

Chemotherapy

Chemotherapy may be recommended in:

• More advanced cancers 

• Aggressive uterine cancers 

• High-risk disease after surgery

Further treatment decisions, such as chemotherapy or radiation, are usually based on surgical staging and imaging findings, rather than replacing surgery as the first line of treatment.

Hormone Therapy, Targeted Therapy & Immunotherapy

Hormone therapy may help in hormone-sensitive cancers. Targeted therapy and immunotherapy may be used in selected advanced cancers depending on tumour biology and molecular testing.

Minimally Invasive Surgery

At specialised centres, uterine cancer surgery may be performed using:

• Laparoscopic surgery 

• Robotic surgery 

• These minimal access techniques offer:

• Smaller incisions 

• Less blood loss 

• Faster recovery 

• Better surgical precision 

• Shorter hospital stay

This improves overall patient recovery significantly. For many people, surgery is the first step. In others, treatment may begin with radiation or chemotherapy if the cancer has spread further.

Recovery and Follow-Up

Recovery depends on the type of treatment received. After surgery, there may be pain, tiredness, and a temporary limit on physical activity. Radiation or chemotherapy can also cause fatigue, nausea, bowel changes, or lowered immunity.

Follow-up care often includes:

• Regular pelvic examinations

• Imaging tests when needed

• Watching for signs of recurrence

• Managing menopause symptoms if the ovaries were removed

• Emotional support and counselling

• Lifestyle guidance for long-term health