Uterine Cancer: Young Women Are Not Immune

Cancer of the uterus has a much better five-year survival rate than ovarian cancer (83 percent compared with 46), but it, too, lacks a good screening test. And it's much more common.
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Some 40,000 women were diagnosed with uterine cancer last year, almost all of it cancer of the endometrium, the lining of the uterus. "Traditionally, we think of uterine cancer as a disease of postmenopausal women," says Memorial Sloan-Kettering's Dr. Carol Brown, also chair of SGO's government relations committee. Indeed, actress Fran Drescher's first doctor told her she was perimenopausal and prescribed progesterone pills without doing tests to determine why the then-40-year-old actress had been spotting and bleeding heavily for months.

But in fact up to 15 percent of women with uterine cancer are under 40, says a 2007 study in Obstetrics & Gynecology. And Dr. Brown is seeing more younger women with this disease, possibly because of rising rates of obesity.

Diagnosis is usually made with a uterine biopsy or a D&C (dilation and curettage). Both remove uterine cells for testing; the D&C removes additional excess tissue that can cause spotting or heavy bleeding. (If it isn't caused by cancer, the bleeding may turn out to be from a usually benign condition called endometrial hyperplasia, in which too much tissue grows on the lining of the uterus.)

If cancer is found the usual treatment is hysterectomy. If the tumor is small and hasn't spread the surgeon may remove only the uterus, allowing the patient to keep her ovaries and fallopian tubes. Some women with early-stage uterine cancer may be able to avoid a hysterectomy -- for a time or permanently -- by taking progestin. This may slow tumor growth in cancers sensitive to estrogen or progesterone, studies suggest, but the cancer is likely to recur.

Whether a woman needs radiation and/or chemo depends on how advanced her cancer is. Identifying its stage requires carefully removing specific lymph nodes along with the cancer. But according to the Mayo Clinic, doctors may miss or diagnose the wrong stage of cancer in up to 46 percent of patients because they don't remove and test enough nodes. If all the nodes are clear, a woman can be spared follow-up radiation of the area, which can have serious complications in some cases, including damage to the bladder and bowel.


Originally published in Ladies' Home Journal, September 2008.


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