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Cancer Of The Uterus

Alternate Names

  • uterine cancer
  • endometrial cancer
  • cancer of the endometrium

Definition

Cancer of the uterus occurs in the lining of the uterus, called the endometrium. Therefore, it is sometimes called endometrial cancer.

What is going on in the body?

The cells that line the uterus respond to signals sent by estrogen and progesterone, 2 hormones made in the ovaries. In the first 2 weeks of a woman's monthly cycle, estrogen makes these cells divide and grow as the uterus prepares for pregnancy. During the second 2 weeks, progesterone prepares the lining of the uterus for an embryo to implant.
If pregnancy does not occur, the levels of both hormones fall sharply. This causes the lining of the uterus to slough off, an event known as menstruation. The monthly menstrual cycle keeps the endometrium from growing too much. Some women's bodies do not make enough progesterone. Others make higher than normal levels of estrogen.
In either case, the cells lining the uterus grow continuously and are not sloughed off regularly. This makes it more likely that precancerous changes of the endometrium will occur. If a woman is not treated for this condition, cancer of the uterus may develop. Cancer of the uterus is most common in women between the ages of 50 to 65, but can also occur in younger women.

Risks

What are the causes and risks of the disease?

No one knows exactly what causes cancer of the uterus, but certain factors increase a woman's risk. For example, some women's bodies make high levels of estrogen that are not balanced by progesterone. This is called unopposed estrogen. Cancer of the uterus is also more likely in women who have the following conditions:
  • obesity, because fat cells can make extra estrogen
  • a history of infertility
  • late menopause, meaning after age 55
  • polycystic ovary syndrome, a condition in which fluid-filled sacs form on the ovaries
  • estrogen therapy for more than 1 year without taking progesterone as well
  • estrogen combined with less than 7 days of progesterone a month
A woman may also have a higher risk for this type of cancer if she has one of the following conditions:
  • high blood pressure
  • diabetes
  • cancer of the breast, ovaries, or colorectal cancer
  • few or no children. The more children a woman has delivered, the lower her risk for uterine cancer.
  • past use of tamoxifen, a medication used to prevent breast cancer from coming back
  • a family history of cancer of the uterus

Prevention

What can be done to prevent the disease?

Prevention is difficult because the cause of the cancer is unknown. However, a woman may be able to lessen her risk of getting it by taking the following steps:
  • eating a diet low in fat
  • maintaining a healthy weight
  • maintaining a normal blood pressure level
  • reporting any pattern of abnormal vaginal bleeding to the healthcare provider
  • having yearly pelvic exams and Pap smears
Also, a woman should talk with her healthcare professional about the risks of taking estrogen without progesterone after menopause if she has not had her uterus removed. The increased risk for cancer of the uterus may persist for as long as 10 years after adding progesterone or stopping estrogen therapy completely.

Diagnosed

How is the disease diagnosed?

A Pap smear is not intended to diagnose uterine cancer. This test is used to diagnose cancer of the cervix. However, Pap smears occasionally show changes in endometrial cells. More commonly, abnormal bleeding gives the healthcare professional reason to suspect uterine cancer.
In either case, an endometrial biopsy or a dilatation and curettage (D&C) will be done. This involves scraping the uterine wall to gather more cells from the lining of the uterus. If advanced cancer is suspected, other tests may be done, such as the following:
  • a complete blood count to rule out anemia, which is a low red blood cell count
  • a test to make sure that cancer has not spread to the kidneys
  • ultrasound of the vagina
  • a chest X-ray to make sure that the cancer has not spread to the lungs
  • liver function tests to make sure that the cancer has not spread to the liver
  • bone scan to be sure that the cancer has not spread to the bones

Long Term Effects

What are the long-term effects of the disease?

When cancer of the uterus is diagnosed early and treated, more than 80% of women will survive more than 5 years. Most are completely cured when the cancer is diagnosed and treated early.

Other Risks

What are the risks to others?

Uterine cancer is not contagious, so there are no risks to others.

Treatments

What are the treatments for the disease?

Cancer of the uterus is treated by removing the uterus in a procedure called an abdominal hysterectomy. Doing this surgery through the abdomen rather than the vagina is recommended because it allows the surgeon to see the entire pelvis and abdomen and to note any spread of the cancer. He or she can also take samples of cells from the abdominal cavity to check for any tiny floating cancer cells. The surgeon will also remove lymph nodes from the pelvic area to be sure that the cancer has not spread.
Sometimes a surgeon will remove the uterus through the vagina and then remove the lymph nodes through a small cut in the abdomen. This avoids leaving a large scar on the abdomen and shortens the hospital stay. Not all women are candidates for this procedure. Because tumor cells may have spread to the ovaries and fallopian tubes, these organs are usually removed also.
For women with advanced disease, the preferred treatment is surgery. If the surgeon finds that the cancer has not spread, there may be no further treatment. Women who are at a higher risk of the cancer coming back may have radiation treatments to the pelvis, or chemotherapy. Because this cancer comes from a tissue that is sensitive to hormones, treatment with hormones may also be effective.

Side Effects

What are the side effects of the treatments?

After having a hysterectomy, a woman may experience the following:
  • inability to control urine
  • sexual problems
  • stress
  • swelling in the legs
  • ascites, which is an accumulation of fluid in the abdomen
  • swelling in the veins of the lower legs that may lead to blood clots
  • surgical problems, such as a hole connecting the vagina and the rectum
  • bleeding that requires a blood transfusion
Radiation therapy will usually produce some hair loss. Chemotherapy is often associated with nausea, vomiting, and anemia, or a low red blood cell count.

After Treatment

What happens after treatment for the disease?

A woman who has been treated for cancer of the uterus should try to take these steps:
  • Eat a balanced diet following the food guide pyramid.
  • Get plenty of rest.
  • Drink plenty of fluids to avoid dehydration.
  • Decrease stress.
  • Rely on family members and friends for help with daily activities when feeling too tired to do them alone.
If a woman tries herbal remedies or alternative medicines for her symptoms, she should tell her healthcare professional. Sometimes toxic reactions can occur when certain therapies are combined.

Monitor

How is the disease monitored?

At least every 3 to 4 months after treatment, a woman should have a follow-up, including:
  • a pelvic exam
  • a physical exam
  • blood tests
Depending on the stage of the cancer, other tests made be used, such as the following:
  • pelvic ultrasound
  • CT scan
  • magnetic resonance imaging, or MRI
A woman should report any new or worsening symptoms, because they might suggest that the cancer is coming back. She can then be treated quickly, if necessary. Some of the signs of recurrent endometrial cancer include:
  • vaginal bleeding
  • abdominal bloating
  • changes in bowel or bladder habits
  • swelling of the lower legs
  • persistent cough
  • loss of appetite
  • weight loss
  • fatigue

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