Uterine cancer is the most common cancer that affects the female reproductive system. Uterine cancer is a general term that defines cancer in the uterus, comprising two types of cancer: endometrial cancer (more prevalent) and uterine sarcoma (rare). Endometrial cancer, often known as uterine cancer, is a type of cancer that grows in the layer of cells that line the uterus (the endometrium). Uterine sarcoma occurs in the myometrium, the muscle wall of the uterus.

Uterine cancer is the most common cancer that affects the female reproductive system. It begins in the uterus.

Symptoms

Patients with endometrial cancer and uterine sarcoma often experience similar symptoms, which include:

• The most prevalent symptom is unusual vaginal bleeding which can include bleeding during or between periods, bleeding during sexual activity, heavy bleeding, irregular or heavy bleeding during menopause, or any bleeding beyond menopause.

• Unusual vaginal discharge

• Difficult or painful urination

• Pain in the lower abdomen or pelvic area

• Unintentional weight loss

• Back pain.

Diagnosis

The choice of a diagnostic test for uterine cancer depends on the type of cancer suspected, the patient's symptoms, the patient's age, and general health, as well as the findings of earlier medical tests. The following tests and techniques are used to identify uterine cancer:

• Pelvic examination: After a general physical examination, the physician will perform a pelvic examination. During a pelvic examination, the physician carefully inspects the uterus, vagina, ovaries, and rectum for any unusual findings. 

• Endometrial biopsy: A biopsy is the removal of a tiny sample of endometrial tissue for microscopic examination. Other tests can suggest the presence of cancer, but only a biopsy can give a definite diagnosis. 

• Dilation and curettage (D&C): This technique is used to remove tissue samples from the uterus. Under anesthetic conditions, the cervix is widened (dilated), and a specialized device is used to remove tissue samples from the endometrium. If the endometrial biopsy sample was too tiny or the results were not clear, this could be done. 

• Hysteroscopy: A long, thin tube called a hysteroscope is inserted during a hysteroscopy to reach the uterus and it provides detailed images of the uterus. 

• Imaging: To determine the size of the tumor and to determine whether it has spread to other tissues, imaging techniques such as X-rays, transvaginal ultrasonography, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI) may be employed. 

• Blood tests: These are used to determine whether cancer metastases to the liver or kidneys. One such test is the CA-125 assay, which quantifies the CA-125 protein.

Management

Treatment for uterine cancer may be different for each patient and it depends on the type and stage of cancer. The frequently used treatment strategies for uterine cancer include:

• Surgery:

  
  

  • Total abdominal hysterectomy: Surgeons remove the uterus and cervix in a hysterectomy which is used to cure stage 1 cancers.

  • Bilateral salpingo-oophorectomy (BSO): Surgeons remove the uterus, cervix, ovaries, and fallopian tubes.

     

• Radiation therapy: High-energy X-rays are used in radiation therapy to destroy or shrink tumor cells. Before surgery, radiation therapy can be used to reduce tumor size, and it can also be administered following surgery to reduce the risk of recurrence. Radiation for uterine tumors may be administered via external radiation (from a machine outside the body) or brachytherapy (internal radiation, which includes temporarily implanting radioactive seeds inside the vagina).

• Chemotherapy: Chemotherapeutic drugs can be administered intravenously or orally. The patient could be prescribed a single drug at a time or a combination of two or more drugs. Following surgery, chemotherapy may occasionally be advised to lower the chance of recurrence. Additionally, chemotherapy may be advised for the treatment of endometrial cancer that has progressed outside the uterus or is recurring or advanced.

• Hormone therapy: Certain uterine cancer cell types that express hormone receptors can be treated with hormone therapy to halt their proliferation. A high dose of the sex hormone progesterone is frequently used in hormone therapy for uterine cancer. Other hormone therapies include aromatase inhibitors (anastrozole, letrozole, and exemestane) and hormone-expressing intrauterine devices.

• Targeted therapy: Targeted therapy is a treatment that specifically targets the genes, proteins, or tissue environment that the cancer uses to grow and survive. This therapy limits damage to healthy cells. Targeted therapy for uterine cancer includes anti-angiogenesis therapy (Bevacizumab), mammalian target of rapamycin (mTOR) inhibitors (everolimus), and HER2 targeted therapy (trastuzumab). For the treatment of advanced endometrial cancer, chemotherapy is frequently coupled with targeted therapy.

• Immunotherapy: Immunotherapy helps the immune system to fight cancer. Immunotherapy is more effective against uterine tumors that have mismatch repair defects. Pembrolizumab (Keytruda), an immunotherapy drug, is approved to treat tumors with either high microsatellite instability or mismatch repair defects. Advanced endometrial cancer may be treated with a combination of pembrolizumab and lenvatinib (targeted therapy). Dostarlimab (Jemperli), an immunotherapy drug, received FDA approval in April 2021 to treat recurred or advanced endometrial cancer. Patients who have not responded to systemic therapy, and are not candidates for surgery or radiation therapy may benefit from immunotherapy.

  
  

Future research will examine the effectiveness of various treatment modalities to increase survival in uterine cancer patients as well as uncover new biomarkers and immune therapies that may have a major and long-lasting clinical impact on this patient population.