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Overview

What is Cancer?

Cells in the body normally reproduce themselves in an orderly manner. Cancer cells start dividing uncontrollably, and do not die the way normal cells do. As the cells produce more cells, a mass or tumor may appear. The tumor can invade surrounding tissue and keep the healthy tissue from doing its normal job.

There are two kinds of tumors:

Benign tumors are not life threatening. They do not invade other tissues and when they are removed they very seldom return.
Malignant tumors are cancerous. These tumors contain cells that divide and grow without order. The cells will invade and take over nearby tissues and can spread (metastasize) to other organs by traveling through the body's bloodstream and lymphatic system.

The uterus, or womb, is the muscular organ in a woman's pelvis where fertilized eggs grow into babies. If a fertilized egg does not implant in the uterus then the lining of the uterus is shed every month. This is called menstruation. The cervix is the part of the uterus that connects to the vagina. The endometrium is the lining of the inner surface of the uterus. This lining is a glandular epithelium, which is sensitive to hormonal stimulation and changes throughout the menstrual cycle and during pregnancy. It is supported by the structural or connective tissues called the endometrial stroma, together these are referred to as the endometrium. This is where most uterine or endometrial cancers occur. The myometrium is the muscle wall of the uterus.

Survival

The American Cancer Society estimates that 42,160 new cases of cancer of the uterine corpus (body of the uterus) will be diagnosed in the US during 2009, but more than 95% of these will be endometrial cancers. An estimated 7,780 women in the US will die from cancer of the uterine corpus during 2009 (ACS Cancer Facts & Figures, 2009).

According to estimates from various studies, uterine sarcomas (including carcinosarcomas, leiomyosarcomas, and endometrial stromal sarcomas) account for between 2% and 4% of cancers of the uterus. The majority of these women are diagnosed between 50-59 years of age and are postmenopausal. As long as the cancer has not spread beyond the uterus, the likelihood of a cure is excellent. According to the ACS, 95 percent of women treated at this early stage of the disease can expect to live for a minimum of five years, and the majority of cases are discovered at this early, curable stage. As is the case with most cancers, the key to cure is early detection. If you have any abnormal vaginal bleeding, the most common sign of uterine cancer, you should contact your doctor.

Recurrence

Although the risk of cancer returning is low in early stage endometrial cancer, women who have had this cancer are advised to continue regular follow-up care to monitor any signs of recurrent cancer and to manage any treatment side effects.

What is Uterine Cancer?

Benign Tumors

Distinct from endometrial cancer are the benign tumors known as fibroids. These abnormal growths seldom cause pain, but can become large enough to be uncomfortable as they press on organs around the uterus and eventually produce bleeding. They rarely invade nearby tissues or organs and can be removed surgically. Endometrial hyperplasia -- an abnormal increase in the cells of the endometrium -- is common among women who are nearing menopause and who seldom ovulate. It also can be caused by over stimulation of the uterus by estrogen replacement therapy. It is not in itself cancerous, but can change progressively to become malignant.

Since endometrial hyperplasia can be a forerunner of endometrial cancer, your doctor will investigate it carefully. The type of treatment will depend on which of the three classes of hyperplasia is identified:

Cystic hyperplasia is generally considered unlikely to become malignant, and will be monitored regularly.
Adenomatous hyperplasia is more likely to progress to cancer in 25 percent of women who develop it, and generally requires some type of treatment.
Atypical hyperplasia is considered a precancerous condition, and may be treated by surgical removal of the uterus.

Malignant Tumors

In uterine cancer the tissue most commonly involved is the inner lining of the uterus, or endometrium. When cancer cells arise among the cells of this lining, new cells develop faster than existing ones die. The excess cells continue trying to create tissue and perform their normal tasks, but have neither the room nor the ability to do it properly.

With the loss of orderly growth, they multiply, and eventually form extra tissue that has no function. As the tissue grows, it forms masses or tumors. Cancerous tumors can destroy normal uterine tissue and break away to spread or metastasize to other parts of the body.

Endometrial cancer is one of two major cancers that occur in the uterus. In most cases, it first develops in the glandular cells of the lining. Later, it may affect the supporting structure known as the stroma. It can spread by invading the muscle tissue or myometrium. It can also spread into the cervix at the mouth of the uterus, and into the bladder, bowel, and lower abdominal cavity. The lymph and blood systems may also allow it to spread to more distant areas of the body, such as the lung or the liver.

The second form of uterine cancer, called sarcoma, begins in the myometrium. It grows rapidly and may eventually reach the endometrium to also involve the surface cells of the uterine lining. While sarcoma currently accounts for only about five percent of uterine cancer, it is becoming more frequent.

In nearly three-quarters of all cases, uterine cancer establishes its initial foothold in the glandular cells that line the surface of the endometrium. Uncontrolled multiplication of these cells leads first to hyperplasia -- an excessive number of cells -- then to tumors formed by a large mass of abnormal cells. If an Endometrial tumor is cancerous, it will penetrate deep into the uterine wall, destroying normal tissue as it goes and eventually spreading to nearby organs.

Other Cancers of the Uterus

The vast majority (95 percent) of cancers of the uterus are endometrial cancers, 75 percent of which are identified by the pathologist as adenocarcinomas, cancer of epithelium or cells lining the uterine wall. The remaining 25 percent include:18 percent adenosquamous (scale-like cells), 6 percent papillary serous (ridge-like cells) and 1 percent clear cell carcinomas. These three grow more rapidly and are more aggressive than adenocarcinoma.
Uterine sarcoma begins in the smooth muscle of the uterine wall or the connective tissue called the stroma, which supports the endometrium. The various types of uterine sarcomas include leiomyosarcoma, endometrial stromal sarcoma, and mixed M�llerian sarcoma. These are more serious and grow faster than adenocarcinoma.
Endometrial stromal sarcoma can be further subdivided into low-grade (slow growing) and high-grade (faster growing) types. Low-grade stromal sarcoma enlarges the uterus uniformly, while the high-grade stromal sarcoma protrudes into the endometrial cavity, invading the lymphatic channels and blood vessels of the myometrium and the muscular wall of the uterus. Both types can spread. The low-grade type can recur as long as 20 years after removal of the primary tumor.
Mixed M�llerian sarcoma grows rapidly and often spreads to other parts of the body. It usually occurs in women age 70 or older. Pelvic pain and vaginal discharge often accompany bleeding. The tumor contains both stroma and epithelial cells, either of which may be benign or malignant. If the sarcoma has no stroma cells, it is called carcinosarcoma. Once it has spread outside the uterus or penetrated half the depth of the myometrium, it is difficult to cure.
M�llerian adenosarcoma is, on the other hand, a less malignant cancer that develops both in older and younger women.
Leiomyosarcoma represents only one percent of malignant uterine tumors. It begins in the wall of the uterus, causing pain and bleeding. The uterus becomes enlarged. It most often occurs in women in their 40s and 50s.
A few cancers found in the uterus are not really "uterine" at all. Because other organs -- bladder, rectum, colon, lymph nodes -- lie close to the uterus and some -- ovaries and fallopian tubes -- are actually connected to it, a cancer originating in any of these organs can spread to the uterus.

This content is reviewed regularly. Last Updated 6/17/2009

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