Uterine Cancer Symptoms, Diagnosis & Treatment

Uterine cancer is the most common type of cancer in the female reproductive system and is the fourth most commonly diagnosed cancer among women in the U.S. The risk increases with age and is most common in postmenopausal women, but it can develop in adults at any age.

Uterine cancer develops in the tissues of the uterus, the pear-shaped organ in the pelvis where fetal development occurs during pregnancy. Uterine cancer begins when cells in the uterus grow out of control, forming a tumor that may invade nearby tissues and, in some cases, spread to other parts of the body.

Types of Uterine Cancer

There are two main types of uterine cancer.

Endometrial Cancer

Endometrial cancer is the most common type. It starts in the lining of the uterus, the endometrium. There are many different types of endometrial cancer and the first symptom is usually abnormal vaginal bleeding or postmenopausal bleeding (even spotting!).

Uterine Sarcoma

Uterine sarcoma is a rare type of uterine cancer that begins in the uterine muscle (myometrium) and other supporting tissues. Uterine cancer and endometrial cancer are not the same thing. While all endometrial cancers are uterine cancers, not all uterine cancers are endometrial. As noted above, uterine sarcoma starts in different tissues within the uterus. Recognizing this distinction is important for guiding treatment and management.

Uterine Cancer Symptoms

Uterine cancer often causes symptoms in its early stages, which can lead to earlier diagnosis and better treatment outcomes.

Common Symptoms

• Abnormal vaginal bleeding, especially after menopause (affects approximately 90% of women with endometrial cancer)
• Bleeding between periods or unusually heavy periods
• Pelvic pain or pressure
• Pain during intercourse
• Pain when urinating or having a bowel movement
• Unexplained weight loss

If you experience abnormal vaginal bleeding, including ANY vaginal bleeding (even just a little bit) after menopause, contact your doctor immediately.

Causes of Uterine Cancer

Although the exact cause of uterine cancer is not always clear, several factors can contribute. Genetic mutations in uterine cells can lead to uncontrolled growth, leading to tumor formation. Additional risk factors include:

• Increasing age
• Obesity
• A history of endometrial hyperplasia
• Hormone imbalances (particularly elevated levels of estrogen) or polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS)
• Certain inherited conditions, like Lynch syndrome

Understanding these contributing factors is important, as it can help patients and their health care teams recognize risks and take steps toward early detection and prevention.

Uterine Cancer Risk Factors

Factors that can increase the risk of uterine cancer include:

• Age, most cases occur in women over 50
• Early onset of menstruation or late menopause
• Never having been pregnant
• Obesity, which raises estrogen levels
• Hormone therapy using estrogen without progesterone
• Family history of uterine or colorectal cancer
• Certain inherited conditions, such as Lynch syndrome
• Diabetes
• High blood pressure
• PMOS (formerly PCOS)

Reduce Your Risk of Uterine Cancer

While some risk factors cannot be changed, you can take steps to help lower your uterine cancer risk.

• Maintain a healthy weight: Achieving and maintaining a weight appropriate for your body can help regulate hormone levels, particularly estrogen.
• Stay physically active: Regular exercise supports healthy weight management and hormonal balance, lowering cancer risk.
• Manage chronic conditions: Controlling diabetes and high blood pressure can reduce overall health risks, including cancer.
• Know your family history: If you have a family history of uterine or colorectal cancer or inherited conditions like Lynch syndrome, discuss genetic counseling and increased monitoring with your doctor.
• Balance hormone therapy: If you use hormone therapy for menopause symptoms, talk with your health care team about the risks of unopposed estrogen (without progesterone) and possible alternatives.
• Seek evaluation for abnormal bleeding: Prompt assessment of unusual or postmenopausal vaginal bleeding can lead to early detection.
• Avoid tobacco use: Quitting smoking improves well-being and may help reduce your risk of cancer.

Adopting healthy habits and remaining attentive to changes in your body can reduce your risk. Regular checkups with your health care team help ensure any concerns are addressed early.

Diagnosis and Tests

To diagnose uterine cancer, your health care team may recommend the following tests.

• Pelvic exam: An assessment for abnormalities in the uterus and surrounding structures
• Transvaginal ultrasound: Imaging to measure the thickness of the endometrial lining
• Endometrial biopsy: Removal of a tissue sample from the uterine lining for laboratory analysis
• Hysteroscopy, dilation and curettage: Inserting a thin camera into the uterus to look for abnormalities and then scraping the lining of the uterus for diagnosis
• Imaging tests: CT, MRI or PET scans to determine if cancer has spread

Uterine Cancer and Endometrial Cancer Treatment Options

Uterine cancer treatment is personalized based on the type and stage of cancer, as well as overall health and preferences. Each treatment option may play a role at different points of care.

Surgery

Surgery is often the first and most common treatment for uterine cancer. For most people with early-stage disease, the primary surgical treatment is a hysterectomy to remove the uterus. This may include removal of the cervix (total hysterectomy) and fallopian tubes, and frequently also the ovaries. We also perform biopsies or remove the lymph nodes in the pelvis depending on the clinical situation.

Some patients may qualify for minimally invasive approaches, including laparoscopic or robotic-assisted surgery, which can result in shorter recovery and less discomfort.

The objective of surgery is not only to remove cancer but also to determine if it has spread. Information from surgery guides any additional treatment recommendations. Throughout the process, supportive care is available to help prepare for surgery and recovery.

Radiation Therapy

Radiation therapy uses high-energy rays to destroy uterine cancer cells. We can give it after surgery to reduce the risk of recurrence, especially if certain microscopic/molecular features suggest an increased risk. Radiation is also used as a primary treatment when surgery is not possible or to treat certain types of recurrence.

Vaginal Brachytherapy (Internal Radiation Therapy)

During vaginal brachytherapy, small radioactive implants are placed in the vagina to prevent cancer recurrence. Because brachytherapy can be targeted to a very specific region, the healthy tissues of the bladder and rectum receive very little radiation. And because the radiation is concentrated, treatment only takes a few visits. Froedtert & MCW specialists were the first in the region to use high-dose rate brachytherapy to treat gynecologic cancers.

External Radiation Therapy

If the cancer has spread beyond the uterus, external beam radiation may be required. Our gynecologic cancer patients receive radiation therapy guided by imaging scans to design the radiation fields. This allows the radiation oncologist to specifically target radiation to the desired area. Our patients can also receive intensity modulated radiation therapy (IMRT) which helps spare normal tissues and preferentially treats the tumor tissues.

Hormone Therapy

Hormone-based treatments can be effective for certain uterine cancers, such as those that are hormone receptor-positive (most often endometrioid-type). Hormone therapy may be used if surgery is not possible, for advanced disease or to preserve fertility. We may also use hormone therapy to treat cancer that has returned or spread.

Chemotherapy

Chemotherapy uses medication to destroy cancer cells and is usually recommended for advanced, high-grade or recurrent uterine cancers. It may be used after surgery to lower the risk of recurrence (adjuvant therapy), as a primary treatment if surgery is not an option or to treat cancer that has spread.

Targeted Therapy and Immunotherapy

Targeted therapies are medications designed to attack specific genetic changes or pathways in cancer cells.

Immunotherapy harnesses the immune system to attack cancer cells and may be an option for some advanced or recurrent cases, particularly when molecular testing suggests potential benefit.

Treatment decisions are made collaboratively, considering cancer type, stage, personal goals and recommendations from a specialized care team. Many patients with advanced endometrial cancer qualify for targeted or immunotherapy.

Clinical trials

Many patients may qualify for clinical trials available through the Froedtert & MCW Cancer Network. Please call 414-805-0505 to book a consultation (virtual visits are available).

Is Uterine Cancer Curable?

Many cases of uterine cancer — especially those diagnosed early — are highly treatable and frequently curable. Most endometrial cancers are detected before they spread beyond the uterus, allowing effective treatment. Outcomes depend on cancer type, stage at diagnosis and overall health.

While more aggressive or advanced cancers such as uterine sarcoma may be harder to treat, therapies are available. Early detection and prompt care are critical for the best possible outcome.

Disease Management and Prognosis

After diagnosis, disease management typically includes regular follow-up appointments, monitoring and healthy lifestyle adjustments. Many individuals will have periodic imaging or lab tests to help detect recurrence.

Prognosis varies based on the type of uterine cancer, stage at diagnosis and individual health factors. In general, early-stage endometrial cancer is associated with excellent survival rates, while advanced or more aggressive cancers, such as uterine sarcoma, may be more difficult to treat. Early detection and comprehensive care are essential to optimizing outcomes and quality of life.

If you notice symptoms or have concerns about uterine cancer, reach out to your doctor for evaluation, guidance and support.