How Does the Uterus Work?

The uterus is the sac in a woman's pelvis which allows the baby to develop from a fertilized egg and houses it until birth. In a woman of child-bearing age, the uterus undergoes substantial changes during every monthly cycle. The inner lining of the uterus, called the "endometrium," becomes thicker as the ovary is preparing to release an egg. This thickening is in preparation for receiving the egg and allowing a surface for the egg to couple with a man's sperm. If this fertilization takes place, the uterus' inner lining continues to become thicker to house the new embryo, and eventually to form a "placenta" (organ to transfer nourishment from the mother) for the developing fetus. When the baby is fully developed, the muscle layers of the uterus, called the "myometrium," help propel it out through the birth canal. The uterus is partially surrounded by a thin membrane, the "serosa," which completes the third "layer" after the endometrium and myometrium. The lowest portion of the uterus is called the "cervix" which connects to the vaginal opening.

Although the cervix is technically part of the uterus, cancers arising there, and in the vagina, are different and so are considered separate topics. The uterus has a rich blood supply from vessels which connect to ones in the ovaries, cervix and vagina. This makes a possible route of spread for infections or cancer to other pelvic organs. The uterus also has a rich network of "lymph glands," bean-sized filters which purify the blood and help destroy germs. The "lymph channels" which connect these glands provide another way that infections or cancer can spread within the pelvis, or even to distant areas of the body. The uterus' inner lining is built up by a "proliferation" (division and growth) of the endometrial cells which form it. The cells naturally form into gland-like patterns, making a rich spongy surface, full of blood vessels, for a fetus to grow in. If the egg is not fertilized, then the uterus' inner lining has been built up in vain. A change in hormone levels signals the uterus' lining to slough off, disposing the egg and lining through the vagina. This is called a woman's monthly period. Once last month's lining has been ejected, the hormones again change to repeat the buildup process and await the next possible fertilization. In most woman, this cycle continues from the age of the first period (menarche) to the last period (menopause) over about 4 decades. Most women have no trouble with the uterus, but some develop an abundance of scar-like tissue which can spread locally and cause pain, called "endometriosis." Ultimately, the uterus should shrink up after menopause, and bleeding from it should totally cease.

What is Uterus Cancer?

As you can see from the way the uterus' inner lining cycles between thickening and getting sloughed off, there are new cells forming in the uterus followed by cell death. It is a very dynamic system. Normally, the formation of new cells, from the division of previous ones, is a very tightly controlled process. In the fertile woman, this control is by the female hormones estrogen and progesterone. The cell surfaces have "receptors" that allow them to identify the hormones present, and respond accordingly. Uterine cancer starts in just one cell. A change occurs in this cell which causes it to lose control of it's division, and so it starts dividing in an uncontrolled manner. Eventually it will form a clump of abnormal cells, called a "tumor," which simply means a swelling. "Benign" tumors stay in their local area of origin, they are not cancer. A uterine "fibroid" is an example of a benign tumor, and endometriosis may be thought of as many benign tumors. In contrast, "malignant" tumors have the capacity to spread throughout the body, they are cancer. Most swellings in the uterus aren't malignant, but when they are, they will spread if untreated and eventually kill the patient.

How Common is Uterine Cancer?

Uterine cancer is the most common gynecological cancer in American women, with 35,000 new cases each year. It causes 3000 deaths each year. You can see that less than one woman in ten dies of their disease. This is because most cases of uterine cancer are caught early, when it is more curable. Women in other countries do less well than American women, since their disease is usually more advanced when diagnosed. In general, the death rate from uterus cancer in American women has been decreasing over the past 5 decades.

What Causes or Increases the Risk for Uterine Cancer?

As with any cancer, the exact reason why one woman gets uterine and another does not is unknown . However, there are well-recognized risk factors which increase a woman's chance of developing it. These have much in common with breast cancer risks, since both cells in the uterus and breast respond to hormone stimulation:

Obesity is linked to a 10 times greater risk of getting uterine cancer. Thus, other conditions associated with being too fat, such as diabetes and high-blood pressure are also linked to uterine cancer. The reason why obese woman get more uterine cancer is thought due to hormone changes caused by fat cells. Specifically, fat cells cause more estrogen to be produced, which builds up the uterine lining more than normal. The more this lining is built up, the more chance that one of the lining cells will become cancerous. In fact, anything that increases the amount of a woman's estrogen over time increases her risk for both breast and uterine cancer.

Older Age (after menopause) is a factor for developing uterine cancer. The average age of a uterus cancer patient is 60 years old. Only about 10% of patients are less than 40 years old.

Childless women are more likely to get uterine (and breast) cancer, since they have more "unopposed estrogen stimulation of the uterus." This means that a woman's uterine lining has a period of "rest" during pregnancy, estrogen levels are low and progesterone levels are high. Anything that stops the estrogen level from being high, even for a while, lowers the risk of uterine cancer.

Birth Control Pills containing only estrogen stimulate the uterine lining and thus increase the risk of cancer. That is why modern birth control pills are not pure estrogen (as they once were) but contain progesterone which allows the uterine lining a monthly "rest." Giving supplemental estrogen after menopause helps keep proper bone density and heart disease risk low, but slightly increases the risks to develop uterine and breast cancer.

Heredity, women whos mothers or maternal aunts have uterine or breast cancer, are at increased risk. There are certain "family cancer syndromes" that raise the risk of uterine, breast, ovarian and colon cancer. Also, certain rare genetic diseases like "Stein-Leventhal" syndrome (cystic disease of the ovary) increase estrogen and thus the risk of uterine cancer.

Hyperplasia (thickening) of the uterine lining, especially when the cells look abnormal, can raise the chance of getting uterine cancer to 20%.

Radiation Exposure is a rare, but possible cause of uterine cancers, especially those arising from the muscular wall of the uterus ("sarcomas").

Alcohol and Tobacco use do not increase the risk of uterine cancer.

What are the Symptoms of Uterine Cancer?

Bleeding out the vagina is the most common symptom of uterine cancer, and is very suspicious for cancer in a woman after her menopause. Uterine bleeding is seen in over 90% of patients and is why the disease is usually caught early.Of woman with new onset vaginal bleeding after menopause, 30% will have cancer, with the chance of it being uterine or cervical about equal. In women still having periods, abnormal spotting or changes in the cycle are seen. These abnormalities may be increased bleeding ("menorrhagia"), or at the wrong time ("metrorrhagia"). The bleeding may both be increased and at the wrong times ("menometrorrhagia"). There may also be a foul discharge suggestive of infection, or sloughed-off tumor. Infection may be the first indication of a cancer problem.

Abnormal Pap Smear may be seen in uterine cancer, and this usually suggests a more advanced uterine cancer. It is uncommon in the absence of bleeding. The Pap smear is about 80% accurate for detecting cervical cancer, but only about 40% accurate for picking up uterine cancer.

Advanced Disease Symptoms from a large tumor include pelvic pain, and change in bowel and bladder habits (since the uterus is sandwitched between the rectum and bladder in the female pelvis). Also seen are increasing abdominal girth, and swelling in the groin from spread to lymph glands, and signs of distant spread to bone, lung, liver and brain. This distant spread is rare unless the cancer is large.

How Does Uterine Cancer Spread?

The vast majority of uterine cancers start on the inner lining ("endometrium"). In fact, the disease is also called endometrial cancer. As the cancer grows, it penetrates into the muscular wall of the uterus. When it penetrates deeply, the cancer is said to show "deep myometrial invasion." At this point it becomes more likely to spread to the local lymph glands in the pelvis and groin. When these lymph glands are invaded by cancer, they enlarge. The cancer can further grow into the fallopian tubes, cervix and vagina, or into the bladder or rectum. Sometimes, it can escape through the outer lining ("serosa" ) of the uterus or out the fallopian tubes to "seed" into the abdomen, and grow multiple tumors upon it's inner membrane lining, called the "peritoneum." The larger the cancer is, the more chance it has to migrate locally and shed cells distantly, spreading to the pelvic organs, lymph glands, abdomen, bone, lung, liver and brain.

How is Uterine Cancer Detected and Evaluated?

The only way to make an absolute diagnosis of cancer is to get a piece of it and have it examined by a pathologist, a physician who specializes in diagnosing disease from tissue samples. The better the sample of the tumor from the uterus, the more accurate will be the diagnosis. If only a vaginal smear of fluid is examined, the accuracy is just 40%, while if an actual piece of the tumor is sampled ("biopsy"), the accuracy increases to over 90%. Evaluation of the patient with suspected uterine cancer includes:

Fractional Dilation and Curettage (D&C) Which is the same procedure done for an incomplete miscarriage. Under general anesthesia, the cervix is progressively dilated with a series of enlarging probes, and the inner lining of the uterus is scraped off. The scrapings from each part of the uterus are kept separate, and submitted for analysis, so that the location of the tumor can be identified (that's what makes it "fractional"). Just brushing the endometrium or washing it out to look for cancer cells is much less accurate; actual tissue must be obtained. However, "suction curettage" done on an outpatient basis is also over 90% and preferred by some gynecologists.

Endometrial Biopsy directed at the tumor is appropriate if an actual mass is seen and increases diagnostic accuracy. It is sometimes hard to distinguish between tumor starting in the uterus and extending down to the cervix, versus cervical tumor extending up into the uterus. Ways to help tell include the location of the larger portion of tumor, and special stains of the tumor ("mucicarmine") which is more likely absent with uterine than cervical cancer.

Routine Blood Tests include Complete Blood Count (CBC) to check for anemia and infection. Chemistry Panel (SMA) tells about liver and kidney function, and key blood components (i.e. sodium, potassium, calcium) along with cholesterol. It can also suggest (via the "alkaline phosphatase" test) whether the cancer invades into bone. If surgery is contemplated, it is routine to get blood clotting ability tests (PT and PTT). Unfortunately, there is not yet a specific blood test for uterine cancer.

Radiology Tests to image the tumor and surrounding tissues. The most basic tests are Chest X-ray to look for spread to the lungs and CT Scan of the pelvis to see how deeply the tumor penetrates into the uterine wall. Other tests for spread, such as barium enema (rectal), urethrogram (urinary tract) and bone scans are only useful if specific symptoms suggest spread to these areas, if not they are not appropriate to order, being uncomfortable and expensive. The MRI (magnetic resonance imaging) scan is increasingly used to examine the soft tissues in the pelvis and look for lymph node involvement, but is still considered investigational. It uses magnetism instead of radiation, and isn't uncomfortable, except if the patient has a fear of confined spaced (claustrophobia). It costs about three times as much as a CT scan (~$1000). Bone and brain scans are only ordered if there are signs or symptoms suggesting spread to these areas. It makes no sense to do a radical local surgery if the cancer has already spread distantly.

What are the Types of Uterine Cancer?

Adenocarcinoma is the most common type of uterine cancer, it arises from the glands of the endometrium. About 80% of uterine cancers are adenocarcinomas, and they have varying aggressiveness. The pathologist assigns a "grade" to this cancer, which basically says how cancerous it looks under the microscope. While "Grade I" looks a lot like normal uterine tissue and can be very indolent, "Grade III" looks very cancerous and will probably be aggressive. "Grade II" is intermediate in looks and behavior. About 40% of adenocarcinomas are "Grade I," 20% are "Grade II," and 40% are "Grade III." There may be a mixture of grades or even cancer types in the tumor.

Adenosquamous Carcinoma is about 10% and are a combination of 2 types of malignant cells, both the glandular ("adeno") and the cervical ("squamous") type. They need not involve the cervix, but tend to be more advanced at presentation and were once though less curable, but this is now disputed.

Papillary Serous Carcinoma is the worst type since it is very aggressive and tends to come back even when caught early. It represents 5% of uterine cancers.

Clear Cell Carcinoma is an aggressive cancer accounting for about 2% of uterine cancers. It is associated with a woman's mother having used a hormone called DES while pregnant, and is getting less common with DES no longer used.

Sarcomas of the uterus arise from its muscle wall.There are many subtypes and they tend to spread through the bloodstream to the lungs. They can contain muscle, cartilage and bone, and their treatment is different from the above types.

How is the Extent of Uterine Cancer Gauged?

Like all cancers, the extent of uterine cancer is given by the "Stage." The system used most commonly is called the"FIGO" staging, it goes like this:

"Stage I" means the cancer is limited to the uterus proper.
"IA" means just the inner lining (endometrium) is involved.
"IB" means less than 1/2 of the muscular wall is invaded
"IC" means more than 1/2 the muscular wall is invaded.

"Stage II" means there is extension to the cervix.
"IIA" means just the cervix's glands are involved
"IIB" means the cervix's muscle is involved.

"Stage III" means the disease is more advanced but still in the pelvis.
"IIIA" means the cancer has spread toward the ovaries or cancer
cells (microscopic) have escaped into the abdomen.
"IIIB" means the cancer has spread down into the vagina
"IIIC" means the lymph glands are involved.

"Stage IV" means extension to the bowel or bladder, or distant spread.
"IVA" means bowel or bladder invasion by the cancer
"IVB" means the cancer has spread to distant sites in the body (i.e. lung, liver, bone or brain).
(Note: This staging is based upon the results seen at surgery by the pathologist).

What is the Survival from Uterine Cancer?

This depends upon the type of cancer, it's stage, and the treatment selected. In general, survival is given by stage:

Important factors predicting better survival in uterine cancer include low grade, low stage, no deep penetration in the muscular wall of the uterus and proper treatment. It is crucial to note that the above figures are only textbook average. No one can say how long any individual patient will live, or whether the cancer will be cured or not. Intangible factors, such as the person's attitude, will to live, and family help are all part of the picture. Numerous people live many years of high quality life with "incurable" cancer!

What is the Best Treatment of Uterus Cancer?

Surgery is the conventional, and current, first treatment for most patients. Surgery both helps make the diagnosis and define the stage of disease, and also helps treat it. There are several possible surgeries which can be done, of varying extensiveness. The most common operation is removal of the uterus, fallopian tubes and ovaries. This is called a "Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy" or "TAH-BSO" for short. At the time of surgery, the lymph glands in the area are sampled, and "washings" are taken of the pelvis and abdomen to look for escaped cancer cells. The omentum is a fatty apron of tissue that overlies the bowel, biopsy samples may be taken of it as well as any other suspicious areas. The tissues samples are sent to a pathologist for evaluation. The results of the pathologist's evaluation will determine whether the surgery was curative and no further therapy is needed, or whether additional treatment (called "adjuvant" therapy) with radiation or chemotherapy or hormones is appropriate. Side-effects of TAH-BSO include an operative death rate of 2%, an infection risk of 10%, urinary tract problems (such as dribbling) of 5% and late problems of bowel obstruction in 5% (higher if patients get adjuvant radiation). The recovery period from the surgery is typically one month, provided that complications such as infection don't set in. For early cancers, the uterus may be removed through the vagina, eliminating the need to cut into the abdomen. While this "vaginal surgery" is quite safe and easier to recover from, it is not as thorough a cancer operation as "abdominal hystectectomy." For advanced cancers, some patients can be cured by a drastic operation called "pelvic exenteration." Exenteration removes the uterus, tubes, ovaries, bladder and rectum, basically everything in the pelvis. It can cure about 20% of patients with locally advanced uterine cancer. As will be seen, radi cal radiation therapy achieve can achieve the same results, often with less complications ("morbidity"). While surgery alone can cure many early cancers, some early cancers may recur after surgery, especially in the vaginal area. Therefore, adjuvant therapy with radiation is recommended for any cancer with high grade or muscle wall penetration. Exenteration may be used for initial treatment of large cancers, or for cancers that recur in the pelvis. Surgical techniques continue to improve and the surgery is best performed by a certified "gynecologic oncologist," a specialist in woman's cancers. Even if the surgery is not curative, it can give useful palliation by stopping bleeding and pain and so improve the patient's quality of life.

Radiation Therapy has been used since the turn of the century for treating uterine cancer. It may be given as adjuvant therapy to help prevent recurrence after surgery, as palliative treatment for patients with advanced or recurrent disease, or even as potentially curative treatment alone for those unable to tolerate surgery. Treatment is prescribed by a "radiation oncologist" (cancer doctor specializing in using radiation).Over the past three decades, tremendous advancements have been made in radiation therapy, and it is now safe and effective treatment. Two general methods of therapy are recognized, and both may be used on the same patient. The first is conventional "external beam" therapy, where the patient lies on a treatment machine and gets treated daily with a beam of photons. The second is "intracavity" or "brachytherapy," where seeds of radioactive material are temporarily "implanted" in in the uterus and vagina during a hospitilization. While external beam treatment covers a broad area to which the cancer may have spread, brachytherapy targets radiation to the local tumor area. To cure a cancer with radiation alone, doctors use both methods together for optimal treatment. External Beam treatment starts with a "simulation" during which the patient is positioned on a mock machine and the area to be treated is marked out. Often a marker is placed in the vagina, and some barium contrast in the rectum, to visualize those areas on X-Ray. The whole procedure takes less than 1 hour, and the patient then gets a CT scan or goes home. Information from the simulation and CT scans is fed into a "Treatment Planning Computer," and a "plan" is generated, and custom shielding blocks are cut. The patient returns to the department to start treatment, which takes only a few minutes each day, Monday through Friday, for 5 - 7 weeks. The total dose given by external beam is usually about 50 Gray (units of radiation). The treatment is painless, patients do not get sick, radioactive, or lose their scalp. Side effects of radiation are divided into "acute" and "late" reactions. Acute reactions occur during the course of treatment, while late reactions may occur months to years later. Expected "acute" reactions include treatment area skin redness, irritation, urinary frequency, and diarrhea. These resolve after treatment. "Late" reactions may include vaginal dryness, bowel obstruction (5%) urinary stricture (3%) and development of a second cancer from radiation (1%). In general, external beam radiation is well tolerated and effective.

Intracavitary Radiation ("Brachytherapy") means seeds of radioactive material (usually cesium-137) are placed in a special applicator which is inserted up into the vagina, cervix, and uterus. Different applicators are used for different treatments. The simplest just treats the vaginal area, this is called "vaginal cuff" or "vaginal mold" treatment. Vaginal radiation only is given with a radioactive "tampon" called a "Declos Applicator" which is easily inserted up into the vaginal cavity, no anesthesia is required. The patient rests in a hospital bed for 2 days or so while the treatment is given, and then the applicator is removed and the patient goes home. In contrast, to put radioactive sources into the cervix or uterus requires general anesthesia, with dilation of the cervix. Special X-ray films are taken to make sure the radioactive sources are in the right place, and to calculate the time they need to remain inserted to give the proper dose to the tumor. The patient lies in bed with the sources for several days, and is given antidiarrheal medicine. Again, the radiation sources are removed when the treatment is complete, this can often be done at the bedside so no further anesthesia is required. The side-effects of this kind of treatment are much like external beam, except the skin surface will not be reddened and the chance of infection is higher (5%). If an infection develops, the applicator must be removed right away. Sometimes several "applications" of brachytherapy are given, spaced every couple weeks, to allow the tumor time to shrink between treatments. The main advantage of brachytherapy is that the tumor and areas at highest risk get the most radiation, with normal tissues getting much less than with external beam treatment. Again, combining external beam and brachytherapy is often the optimal treatment. Radiation will be recommended if the tumor is of high grade, penetrates into the muscle of the uterus, or involves lymph glands. If all of the tumor was apparently removed at surgery, often only a "vaginal cuff" will be prescribed, since there is still about a 10% chance of recurrence in the vagina for even a stage I tumor that's of high grade. The vaginal cuff reduces this risk of recurrence to under 4%, and is a safe, effective therapy. Alternatively, the patient may just get external beam treatment to 50 Gray to the pelvis, which reduces recurrence risk everywhere in the pelvis. It is much, much easier to get treatment to prevent recurrence that to treat a cancer that has obviously recurred!

If the patient has a tumor which has spread beyond the uterus, they will get external beam treatment and possibly a "boost" with brachytherapy. If the uterus could not be removed, "radical radiation" is given to attempt a cure, this involves 5 - 7 weeks of external beam radiation followed by at least one brachytherapy application into the uterus, usually with cesium-137 loaded "Heyman-Simon" capsules for several days. The total dose to the tumor is around 90 Gray with this technique (combining the external beam dose and the brachytherapy dose). It would be impossible to give this kind of dose with external beam alone, as the side-effects would be too great-- but it can be done safely with combined therapy. Radical radiation cures about 50% of patients with stage II and 30% of patients with stage III disease. In combination with surgery, radiation raises the survival of stage II patients to over 70% and stage III patients to 40% at 5 years. Other types of radiation treatment include "extended field" therapy that treats the abdominal lymph nodes along the spine ("paraaortic nodes") or "whole abdominal radiation" for cancers which have seeded into the abdomen. If the paraaortic lymph nodes are the only site of disease outside the pelvis (stage IIIC) then nearly 50% of these patients can survive 5 years if "extended field" radiation is give. The value of whole abdominal radiation is less clear; usually 28 Gray are given to the whole abdomen which produces side effects of nausea, vomiting, and possible liver and kidney damage. Also, bowel perforation can occur in 5% of these patients. It is currently recommended for the "papillary serous carcinoma" which is very aggressive, even in stage I disease. The cancer cells in the abdomen can also be killed by instillation of "radioactive colloid" such as phosphorus-32. It is a liquid injected into the abdomen, it bathes the inner abdominal lining (the "peritoneum") and kills cancer cells on it's surface only. It does not work for solid tumors, since it's rays don't penetrate deeply into tissue. While it has provided some success in reducing recurrence when ovarian and uterine cancer spread to the abdomen, it has a nearly 30% rate of severe bowel complications when used in conjunction with external beam radiotherapy to the pelvis. Since most all of these patients will get pelvic radiation, phosphorus-32 is seldom used today. Radiation also provides excellent palliation (symptom relief) from patients with advanced cancer. Short course radiation, lasting 2 days to 2 weeks, can help stop pain and bleeding in over 80% of patients, and is safer than surgery. It can be given to the pelvis, or bone or brain if the cancer has spread to those areas.

Chemotherapy has not been widely used in uterine cancer. This is mostly because it has not been curative for advanced disease, and is unnecessary for early disease. It is currently mostly used for patients that have relapsed disease within previously irradiated areas; these areas can tolerate no further radiation. It would likewise make little sense to operate on these areas since the benefit of surgery at this point is small (except to relieve symptoms) so chemotherapy is about all that's left in the oncologist's arsenal. Also, it is used for patients with widespread, metastatic cancer (for lack of other effective therapy). The current most effective drugs are cisplatin (derived from platinum) and doxorubicin (a bright red liquid). Either cisplatin, doxorubicin, or even both together give a "response rate" of 40% - 60%, meaning the tumor shrinks. Only about 10% of patients get "complete response," meaning the tumor disappears altogether. Unfortunately, even a complete response does not signal cure. This is because cancers become strongly resistant to chemotherapy agents, much the same as bacteria become resistant to antibiotics. The average response lasts only about six months, then the disease progresses again. This helps explain why chemotherapy is used so little for uterine cancer. Also, it can be very toxic, causing nerve, lung, kidney, and heart damage as well as anemia and infection. It obviously must be very carefully monitored. Although many regimens of chemotherapy have been tried, the average duration of response has always been less than one year. Therefore, current chemotherapy has little usefulness in uterine cancer. Nonetheless, it is always possible for a more effective chemotherapy agent or regimen to be developed. This is done in "clinical trials" offered by University Hospitals for testing new therapy, and should be considered for the patient who wants aggressive therapy when other options run out. These trials often have "entrance criteria," meaning that the patient needs to be in modestly good health and hasn't had any other recent effective treatment, as that might confuse the conclusions of the trial. The gynecologic oncologist you are using should be familiar with current "open" clinical trials which may be appropriate for you.

Hormonal Therapy has become standard for any uterine cancer stage III or IV. The hormones most used are megesterol ("megace") or medroxyprogesterone ("provera"). Recall that the female hormone progesterone helps reverse the growth of the uterine lining that is stimulated by estrogen, and so is a component of modern birth-control pills. Both breast and uterine cancers may express "hormone-receptors" on their cell surface. The higher the number of these "hormone receptors" for a particular cancer, the more likely it will respond to hormonal therapy. The response rate to all progesterone-type drugs is as high as 40%. Even some patients with "negative" (very few) hormone receptors on their cancer cell surface may respond to hormone therapy, so it is worth a try. The duration of this response averages 30 months. Hormones like megace conveniently taken as a pill several times per day, they have possible side effects nausea, insomnia, hot flashes and increased risk of blood clots, but are usually well tolerated. If progesterone hormones fail, then the "anti-estrogen" pill tamoxifen may be tried; it gives about 20% response in previously treated patients. All of these drugs are more useful to help stop the disease from growing than actually shrink it. While they have not been found useful in early stage disease to prevent relapse, they have a long record of effectiveness in advanced uterine cancer.
For patients with advanced disease, proper pain and symptom relief are essential. Narcotic medications are effective for about 3/4 of patients with cancer pain, and should never be withheld for fear of causing addiction. Studies have shown that addiction only occurs when people self-administer pain medicine just to "feel good," not for relief of pain. Great strides have been made in pain relief with narcotic delivered by pump directly into the spinal canal ("epidural") or easy to wear fentanyl patches. In the other quarter of patients who don't respond well to drugs, neurosurgical operations to cut nerves or inject alcohol into nerve bundles can provide non-sedating relief. It is only when patients are pain-free that they can forget about their disease for a while and truly enjoy life. The future of treatment for uterine cancer is development of more effective chemotherapy; since there really has been no improvement in survival from this disease since 1965. Radiation and surgical techniques are very well developed-- but limited in their ability to cure advanced disease. Ultimately gene therapy, now only theoretical, may cure by cancer by turning off division signals cancer cells. The best approach today for curing this cancer is obviously early recognition and treatment, but for more advanced disease hope exists for those who use a competent gynecologist oncologist along with a program of nutrition, exercise, positive spiritual attitude, and possibly alternative therapies. All of us are born with a terminal disease called "earthly life," and the quality of the endurance is at least as important as the length of it. As Sir William Osler, the patriach of American medicine said, "cure rarely, palliate sometimes, comfort always" and this still holds true today.

Note: For information on open clinical trials for advanced disease, check the Internet site of the National Cancer Institute, they keep a current listing for each cancer.

If you're looking for cancer information, consult your physician. He or she can give you reliable medical advice on how to best treat your cancer. From women's cancers like uterine and breast cancer to cancers that affect all people, ask your doctor if you suspect you might be affected.

This is the full transcript, offered freely in the spirit of internet sharing, of CancerAnswers' report on Uterine Cancer. Much more, including latest additional treatments for Uterine Cancer can be found on our order page. Thank you for using CancerAnswers as your information resource.