Womb (uterus) cancer

Definition
Womb cancer, medically known as uterine cancer, most often refers to endometrial cancer, which develops in the lining of the uterus (endometrium). Less commonly, it can refer to uterine sarcomas, which arise from the muscle layer or connective tissue of the uterus.

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Types

1. Endometrial carcinoma – the most common type (≈ 90% of uterine cancers)

   • Endometrioid adenocarcinoma (most common subtype)

   • Serous carcinoma

   • Clear cell carcinoma

2. Uterine sarcomas – rarer, more aggressive

   • Leiomyosarcoma

   • Endometrial stromal sarcoma

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Risk Factors

• Hormonal: Prolonged unopposed estrogen exposure (without progesterone)

• Reproductive history: Never having been pregnant, late menopause, early menarche

• Medical conditions: Obesity, polycystic ovary syndrome (PCOS), type 2 diabetes, hypertension

• Hormone therapy: Use of estrogen-only hormone replacement therapy (HRT)

• Medications: Tamoxifen (used in breast cancer treatment)

• Genetic: Lynch syndrome (hereditary nonpolyposis colorectal cancer)

• Age: Most common in women over 50 years

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Signs and Symptoms

• Abnormal vaginal bleeding (most common)

  • Postmenopausal bleeding

  • Intermenstrual bleeding

  • Heavy or prolonged periods

• Pelvic pain or pressure

• Pain during intercourse

• Unexplained weight loss (in advanced disease)

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Diagnosis

• Pelvic examination

• Transvaginal ultrasound (TVUS) – assesses endometrial thickness

• Endometrial biopsy – definitive diagnosis

• Hysteroscopy with curettage – direct visualization and sampling

• Imaging for staging: MRI or CT scan for extent of spread

• Pathology: Determines histologic type, grade, and stage

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Staging (FIGO System)

• Stage I: Confined to uterus

• Stage II: Involves uterus and cervix

• Stage III: Spread to pelvic tissues or lymph nodes

• Stage IV: Spread beyond pelvis (bladder, rectum, distant organs)

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Treatment
Treatment depends on stage, type, grade, and patient health status.

1. Surgery (Primary treatment for most cases)

   • Total hysterectomy (removal of uterus and cervix)

   • Bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries)

   • Pelvic and para-aortic lymph node assessment

2. Radiotherapy

   • External beam radiation therapy (EBRT)

   • Vaginal brachytherapy (internal radiation)

   • Used as adjuvant therapy in intermediate/high-risk disease or for palliation

3. Chemotherapy

   • Common agents: Carboplatin + paclitaxel

   • Used in advanced or recurrent disease, or high-grade tumors

4. Hormonal therapy

   • For hormone receptor-positive tumors, especially in advanced or recurrent disease

   • Progestins (megestrol acetate, medroxyprogesterone acetate)

   • Tamoxifen (in select cases)

   • Aromatase inhibitors (letrozole, anastrozole) in postmenopausal women

5. Targeted and Immunotherapy (for advanced/refractory cases)

   • Pembrolizumab (anti–PD-1) ± lenvatinib (for certain advanced cases)

   • Trastuzumab for HER2-positive serous carcinoma

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Prognosis

• Early-stage endometrioid adenocarcinoma: Excellent prognosis (5-year survival >90% for stage I)

• High-grade tumors and uterine sarcomas: Lower survival rates due to aggressive nature

• Prognosis depends on stage, grade, histologic subtype, and lymphovascular invasion

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Prevention and Risk Reduction

• Maintain a healthy weight and active lifestyle

• Use of combined oral contraceptives (protective effect)

• Manage chronic conditions (e.g., diabetes, hypertension)

• Monitor women with Lynch syndrome and consider prophylactic surgery after childbearing