Treatment

Symptoms, Risks and Diagnosis

Most uterine cancers start in the inner lining of the uterus (the endometrium). Uterine sarcoma is an uncommon form of uterine cancer that forms in the muscle and tissue that support the uterus.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of uterine cancer

Because the cancer starts inside the uterus, there may be no symptoms initially. When symptoms do arise, they may be indicative of uterine cancer or other conditions, such as endometriosis. Check with your doctor if you have any of the following:

  • Vaginal bleeding or discharge not related to periods or after menopause.
  • Difficult or painful urination.
  • Pain during sexual intercourse.
  • Pain in the pelvic area.

Risk factors for uterine cancer

Previous radiation therapy to the pelvis can increase the risk of uterine sarcoma. Taking tamoxifen for breast cancer can increase the risk of both endometrial cancer and uterine sarcoma.

Additional risk factors for endometrial cancer include:
  • Obesity
  • High blood pressure
  • Diabetes mellitus.
Making a diagnosis of uterine cancer may involve different approaches. The following tests and procedures may be used:
  1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities
  2. Pelvic Exam: A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. Because this cancer begins inside the uterus, it may not show up on a Pap test. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
  3. Transvaginal ultrasound exam: this procedure examines the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  4. Dilatation and curettage: Also called a D & C, this procedure removes samples of tissue from the inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped instrument) or a thin, flexible tube is inserted into the uterus to remove tissue. The tissue samples are checked under a microscope for signs of disease. Tissue for biopsy can also be obtained in a simple office procedure called an endometrial biopsy.
Additional tests might be used to determine extent (stage) of a cancer diagnosed by the tests above:
  • CA 125 assay: This blood test measures the level of CA 125 in the blood, a substance released by cells into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other condition.
  • CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection or oral intake of a dye to help the organs or tissues show up more clearly.
  • PET scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.

Diagnosis and staging of uterine cancer

Surgical removal of the uterus is used to diagnose, stage and treat all uterine cancers, and may include:

Genetic testing: All patients are tested for genetic disease. (Link to genetic page)

Laparoscopic (minimally invasive, small incision)/robotic (Da Vinci) surgery: This is the most common procedure usedto diagnose, stage and treat these cancers.

Laparotomy, or an incisional procedure, is used less commonly when minimally invasive approaches aren’t appropriate (uterus too large or cancer is suspected to have spread). An incision in the wall of the abdomen is made to check the inside of the abdomen for signs of disease, to remove tissue samples, lymph nodes and/or the uterus.

Abdominal and pelvic washings: A saline solution is placed into the abdominal and pelvic body cavities through an incision. The fluid is then removed and checked under a microscope for cancer cells.

The Washington University Genomics and Pathology Service (GPS) offers genomic testing and next generation sequencing of cancer cells to identify optimal patient treatment strategies for your specific cancer type and subtype, and refine prognosis.

Stages of uterine cancer

Stage I: Cancer is found in the uterus only.

Stage II: Cancer has spread into the connective tissue of the cervix but beyond the uterus.

Stage III: Cancer has spread beyond the uterus but is confined to the pelvis.

Stage IV: Cancer has spread beyond the pelvis

Recurrent Cancer: This cancer has come back in the pelvis or some other part of the body after treatment.

Staging is very useful in determining the correct treatment.

Prognosis

The prognosis (chance of recovery) depends on the following:
  • The stage of the cancer (size of the tumor and whether it affects only the uterus or has spread to the lymph nodes or other places in the body).
  • The type of uterine cancer.
  • The patient’s age and general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Uterine cancer is best controlled before it has spread and can be removed by surgery. Clinical trials are a good option for getting the latest treatment.