Cancer of the Uterus
NIH Publication No. 98-1562 Originally Posted: 9/28/1998 Last Modified: 12/12/2000

Introduction

Cancer of the uterus is the most common cancer of the female reproductive tract. The National Cancer Institute (NCI) has written this booklet to help women with cancer of the uterus and their families and friends better understand this disease. We hope others will read it as well to learn more about cancer of the uterus.

Words that may be new to readers appear in italics. Definitions of these and other terms related to uterine cancer can be found in the Dictionary. For some words, a "sounds-like" spelling is also given.

This booklet discusses symptoms, diagnosis, and treatment. It also has information about resources and sources of support to help women cope with cancer of the uterus.

Our knowledge of cancer of the uterus keeps increasing. For up-to-date information or to order this publication, call the National Cancer Institute's Cancer Information Service (CIS). The toll-free number is 1-800-4-CANCER (1-800-422-6237). The number for callers with TTY equipment is 1-800-332-8615.

The CIS staff uses a National Cancer Institute cancer information database called PDQ and other NCI resources to answer callers' questions. Cancer Information Specialists can send callers information from PDQ and other NCI materials about cancer, its treatment, and living with the disease. The CIS and other sources of information from NCI can be found in the Resources section.

The Uterus

The uterus is a hollow, pear-shaped organ. It is located in a woman's lower abdomen between the bladder and the rectum. Attached to either side of the top of the uterus are the fallopian tubes, which extend from the uterus to the ovaries.

The narrow, lower portion of the uterus is the cervix; the broad, middle part is the corpus; and the dome-shaped upper portion is the fundus. The walls of the uterus are made of two layers of tissue: the inner layer or lining (endometrium) and the outer layer or muscle (myometrium).

In women of childbearing age, the lining of the uterus grows and thickens each month so that it will be ready if pregnancy occurs. If a woman does not become pregnant, the thickened tissue and blood flow out of the body through the vagina; this flow is called menstruation.

What Is Cancer?

Cancer is a group of many different diseases that have some important things in common. They all affect cells, the body's basic unit of life. To understand cancer, it is helpful to know about normal cells and about what happens when cells become cancerous.

The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. A mass of extra tissue forms, and this mass is called a growth or tumor. Tumors can be benign or malignant.

• Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.

  Fibroids are common benign tumors of the uterine muscle. These tumors do not develop into cancer. Fibroids are found mainly in women in their forties. Women may have many fibroid tumors at the same time. In most cases, fibroids cause no symptoms and require no treatment, although they should be checked by a doctor. Depending on the size and location of the tumors, however, symptoms sometimes occur. These symptoms may include irregular bleeding, vaginal discharge, and frequent urination. When fibroids cause heavy bleeding or press against nearby organs and cause pain, surgery or other treatment may be recommended. When a woman reaches menopause, fibroids are likely to become smaller, and sometimes disappear.

  Endometriosis is another benign condition that affects the uterus. It does not develop into cancer. Endometriosis is seen mostly in women in their thirties and forties, particularly in women who have never been pregnant. It occurs when endometrial tissue begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility (ability to produce children). Treatment options generally include hormone therapy and surgery.

  Endometrial hyperplasia, also a benign condition, is an increase in the number of cells lining the uterus. Although it is not cancer, endometrial hyperplasia is considered a precancerous condition; in some cases, it may develop into cancer. Heavy menstrual periods, bleeding between periods, and bleeding after menopause are common symptoms of hyperplasia. The treatment is usually hysterectomy or hormone therapy with progesterone, depending on the extent of the condition and whether a woman wants to have children.

• Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

Most cancers are named for the part of the body in which they begin. The most common type of cancer of the uterus begins in the endometrium. This type of cancer is called endometrial or uterine cancer. In this booklet, we will use the term uterine cancer to refer to cancer that begins in the endometrium. A different type of cancer, uterine sarcoma, develops in the uterine muscle. Cancer that begins in the cervix is also a different type of cancer. This booklet does not deal with uterine sarcoma or cancer of the cervix. The Cancer Information Service can provide information about uterine sarcoma and cancer of the cervix.

As uterine cancer grows, it may invade nearby organs. Uterine cancer cells also may break away from the tumor and spread to other parts of the body, such as the lungs, liver, and bones. When cancer spreads to another part of the body, the new cancer has the same kind of abnormal cells and the same name as the original (primary) cancer. For example, if uterine cancer spreads to the lungs, the cancer cells in the new tumor are uterine cancer cells. Cancer that has spread from the uterus to other parts of the body is called metastatic uterine cancer; it is not lung cancer.

Symptoms

Abnormal vaginal bleeding, especially after menopause, is the most common symptom of uterine cancer. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. Although uterine cancer usually occurs after menopause, it sometimes occurs around the time that menopause begins. Abnormal bleeding should not be considered simply part of menopause; it should always be checked by a doctor.

A woman should see a doctor if she has any of the following symptoms:

• Unusual vaginal bleeding or discharge
• Difficult or painful urination
• Pain during intercourse
• Pain in the pelvic area

These symptoms can be caused by cancer or other less serious conditions. Most often, they are not cancer, but only a doctor can tell for sure.

Diagnosis

If a woman has symptoms, her doctor asks about her medical history and conducts a physical exam. In addition to checking general signs of health, the doctor usually performs blood and urine tests and one or more of the following procedures:

• The doctor performs a pelvic exam, checking the vagina, uterus, ovaries, bladder, and rectum. The doctor feels these organs for any lumps or changes in their shape or size. An instrument called a speculum is used to widen the vagina so the doctor can see the upper portion of the vagina and the cervix.

• The Pap test is often performed during a pelvic exam. The doctor uses a wooden scraper (spatula) or small brush to collect a sample of cells from the cervix and upper vagina. The cells are then sent to a medical laboratory to be checked for abnormal changes. Because uterine cancer begins inside the uterus, it may not show up on a Pap test, which examines cells from the cervix.

• A biopsy is necessary to help the doctor make a diagnosis. A biopsy can usually be done in the doctor's office. In a biopsy, the doctor removes a sample of tissue from the uterine lining. In some cases, a woman may require a dilation and curettage (D&C), which is usually same-day surgery done in a hospital with anesthesia. During a D&C, the opening of the cervix is widened and the doctor scrapes tissue from the lining of the uterus. A pathologist examines the tissue to check for cancer cells, hyperplasia, or other conditions. After a D&C, women may have cramps and vaginal bleeding during healing.

A woman who needs a biopsy may want to ask the doctor some of the following questions:

• What type of biopsy will I have? Why?
• How long will it take? Will I be awake? Will it hurt?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

Staging

Once uterine cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease in order to plan the best treatment. Staging procedures help the doctor find out whether the cancer has spread and, if so, what parts of the body are affected. For most women, staging procedures include blood and urine tests and chest x-rays. Doctors may also order a CT scan, MRI, sigmoidoscopy, colonoscopy, ultrasonography, or other x-rays.

Treatment

After diagnosis and initial evaluation, the doctor considers treatment options that fit each woman's needs and discusses these options with her. The choice of treatment depends on the size of the tumor, the stage of the disease, whether female hormones affect tumor growth, and tumor grade. (The tumor grade tells how closely the cancer resembles normal cells and suggests how fast the cancer is likely to grow. Low-grade cancers are likely to grow and spread more slowly than high-grade cancers.) Other factors, including the woman's age and general health, are also considered when planning treatment. Women with uterine cancer may be treated by a team of specialists that may include a gynecologist, gynecologic oncologist (a doctor who specializes in treating cancer of the female reproductive tract), and a radiation oncologist.

Getting a Second Opinion

Before starting treatment, a woman may want a second specialist to confirm the diagnosis and review her treatment options. It may take a week or two to arrange for another opinion, but a short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; many others cover a second opinion if the patient requests it. There are a number of ways to find a doctor who can give a second opinion:

• The woman's doctor may be able to suggest specialists to consult.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.

• A woman can get the names of doctors from her local medical society, a nearby hospital, or a medical school.

• The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their background. This resource is in most public libraries.

Preparing for Treatment

Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a woman learns she has uterine cancer, shock and stress are natural reactions. These feelings may make it difficult for her to think of everything she may want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, a woman may take notes or ask whether she may use a tape recorder. Some patients find it helpful to have a family member or friend with them when talking to the doctor to participate in the discussion, take notes, or just listen.

These are some questions a woman may want to ask the doctor:

• What kind of uterine cancer do I have?
• Is there any evidence the cancer has spread? What is the stage of the disease?
• What is the tumor grade?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• What is the treatment likely to cost?
• How will treatment affect my normal activities?
• How often should I have a checkup?
• Would a treatment study be appropriate for me?

Women do not need to ask all their questions or understand all the answers at once. They will have many chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Treatment

Most women with uterine cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormone therapy or chemotherapy. Another treatment option for women with uterine cancer is to take part in treatment studies (clinical trials). Such studies are designed to improve cancer treatment. (See Treatment Studies for more information.) The following sections describe types of uterine cancer treatment.

Surgery to remove the uterus (hysterectomy) and the fallopian tubes and ovaries (bilateral salpingo-oophorectomy) is the treatment recommended for most women with uterine cancer. Lymph nodes near the tumor may also be removed during surgery to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean that the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the disease can usually be cured with surgery alone.

These are some questions a woman may want to ask the doctor before having surgery:

• What kind of operation will it be?
• How will I feel after the operation?
• If I have pain, how will you help?
• How long will I have to stay in the hospital?
• Will I have any long-term effects because of this operation?
• When will I be able to resume my normal activities?
• Will follow-up visits be necessary?

In radiation therapy (also called radiotherapy), high-energy rays are used to kill cancer cells. The rays may come from a small container of radioactive material, called an implant, which is placed directly into or near the tumor site (internal radiation). It may also come from a large machine outside the body (external radiation). Some patients with uterine cancer need both internal and external radiation therapy. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area. Radiation therapy may be used in addition to surgery to treat women with certain stages of uterine cancer. Radiation may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, for a small number of women who cannot have surgery, radiation treatment is sometimes used instead.

In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The patient is hospitalized during this treatment. Patients may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, there is no radioactivity in the body. External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation.

These are some questions a woman may want to ask the doctor before having radiation therapy:

• What is the goal of treatment?
• How will the radiation be given?
• When will the treatments begin? When will they end?
• How will I feel during therapy? Are there side effects?
• What can I do to take care of myself during therapy?
• How will we know if the radiation therapy is working?
• Will I be able to continue my normal activities during treatment?

Hormone therapy is the use of drugs, such as progesterone, that prevent cancer cells from getting or using the hormones they may need to grow. Hormone treatment is a systemic therapy. The drugs, which are usually taken by mouth, enter the bloodstream, travel through the body, and control cancer cells outside the uterus. Women who are unable to have surgery are sometimes treated with hormone therapy. Also, this form of treatment is often recommended for women who have metastatic or recurrent endometrial cancer.

These are some questions a woman may want to ask the doctor before having hormone therapy:

• Why do I need this treatment?
• What hormones will I be taking? What will they do?
• Will I have side effects? What can I do about them?
• How long will I be on this treatment?

Chemotherapy is the use of drugs to kill cancer cells. Anticancer drugs may be taken by mouth or given by injection into a blood vessel or a muscle. Like hormone therapy, chemotherapy is a systemic therapy; it can kill cancer cells throughout the body. Chemotherapy is being evaluated in treatment studies for patients with uterine cancer that has spread.

These are some questions a woman may want to ask the doctor before starting chemotherapy:

• What is the goal of this treatment?
• What drugs will I be taking?
• Will the drugs cause side effects? What can I do about them?
• How long will I need to take this treatment?
• How will we know if the drugs are working?

Treatment Studies

Doctors conduct treatment studies to learn about the effectiveness and side effects of new treatments. In some studies, all patients receive the new treatment. In other studies, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group. Treatment studies are also designed to compare one standard treatment with another.

Women who take part in these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science.

Doctors are studying new ways of giving radiation therapy and chemotherapy, new drugs and drug combinations, biological therapies, and new ways of combining various types of treatment. Some studies are designed to find ways to reduce the side effects of treatment and to improve the quality of women's lives.

Women who are interested in taking part in a study should talk with their doctor. They may want to read the National Cancer Institute booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know, which explains the possible benefits and risks of treatment studies.

Another way to learn about treatment studies is through PDQ, a cancer information database developed by the National Cancer Institute. PDQ contains information about cancer treatment and about treatment studies in progress throughout the country. The Cancer Information Service can provide PDQ information to patients and the public.

Side Effects of Cancer Treatment

In treating cancer, it is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes side effects.

The side effects of cancer treatment depend on a variety of factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment to the next. Doctors and nurses can explain possible side effects, and they can help relieve symptoms that may occur during and after treatment.

Surgery

After a hysterectomy, women usually have some pain and general fatigue. In some cases, patients may have nausea and vomiting following surgery, and some women may have problems returning to normal bladder and bowel function. The effects of anesthesia and discomfort may also temporarily limit physical activity. Diet is usually restricted to liquids at first and gradually increases to regular meals. The length of the hospital stay may vary from several days to a week.

Women who have had a hysterectomy no longer have menstrual periods. When the ovaries are removed, menopause occurs immediately. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. In the general population, estrogen replacement therapy (ERT) is often prescribed to relieve these problems. However, ERT is not commonly used for women who have had endometrial cancer. Because estrogen has been linked to the development of uterine cancer (see Possible Causes and Prevention), many doctors are concerned that ERT may cause uterine cancer to recur. Other doctors point out that there is no scientific evidence that ERT increases the risk of recurrence. A large research study is being conducted to determine whether women who have had early stage endometrial cancer can safely take estrogen.

After surgery, normal activities usually can be resumed in 4 to 8 weeks. Sexual desire and sexual intercourse are not usually affected by hysterectomy. However, some women may experience feelings of loss that may make intimacy difficult. Counseling or support for both the patient and her partner may be helpful.

Radiation Therapy

Radiation therapy destroys the ability of cells to grow and divide. Both normal and diseased cells are affected, but most normal cells are able to recover. With radiation therapy, the side effects depend largely on the treatment dose and the part of the body that is treated. During radiation therapy, people are likely to become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Patients receiving radiation for uterine cancer commonly have side effects that include dry, reddened skin and hair loss in the treated area, loss of appetite, and fatigue. Radiation therapy also may cause a decrease in the number of white blood cells that help protect the body against infection. Treatment may also cause diarrhea or frequent and uncomfortable urination. Some women have dryness, itching, tightening, and burning in the vagina. Women may be advised not to have intercourse during treatment; however, most can resume sexual activity within a few weeks after treatment ends. Women may be taught how to use a dilator, as well as a water-soluble lubricant to help minimize these problems.

The National Cancer Institute booklet Radiation Therapy and You has helpful information about radiation therapy and managing its side effects.

Hormone Therapy

Hormone therapy can cause a number of side effects. Women taking progesterone may experience fatigue and changes in appetite and weight, and they may retain fluid. Premenopausal women may have changes in their menstrual periods. Women may wish to discuss the side effects of hormone therapy with their doctor.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs and the doses received. In addition, as with other types of treatment, side effects vary for each individual. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects, such as poor appetite, nausea and vomiting, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over.

The National Cancer Institute booklet Chemotherapy and You has helpful information about chemotherapy and coping with its side effects.

Nutrition for Cancer Patients

Good nutrition is important. Patients who eat well often feel better and have more energy. Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss, regain strength, and rebuild normal tissues.

Some women find it hard to eat well during treatment. They may lose their appetite. In addition to loss of appetite, common side effects of treatment, such as nausea and vomiting, can make eating difficult. Also, women may not feel like eating when they are uncomfortable or tired.

Doctors, nurses, and dietitians can offer advice for healthy eating during cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful suggestions.

Follow-up Care

It is important for women who have had uterine cancer to have regular follow-up examinations after their treatment is over, in case the cancer comes back. Follow-up care is a part of the overall treatment plan, and women with cancer should not hesitate to discuss it with the doctor. Regular follow-up care ensures that any changes in health are discussed, and any recurrent cancer can be treated as soon as possible. Between follow-up appointments, women who have had uterine cancer should report any health problems as soon as they appear.

Checkups may include a physical exam, a pelvic exam, a chest x-ray, and laboratory tests.

Recovery and Outlook

People with cancer and their families are naturally concerned about their recovery from cancer. Sometimes people use statistics to try to figure out their chances of being cured. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike; treatments and responses vary greatly. The patient's doctor is in the best position to discuss the issue of prognosis, or the probable outcome or course of the disease.

When doctors discuss a patient's prognosis, they may talk about surviving cancer rather than a cure. Although many patients with uterine cancer are actually cured, the disease can return. It is important to discuss the possibility of recurrence with the doctor.

Support for Cancer Patients

Living with a serious disease is not easy. People with cancer and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services. Several useful National Cancer Institute booklets, including Taking Time, are available from the Cancer Information Service.

Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learned about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another--even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.

Cancer patients may worry about holding their jobs, caring for their families, keeping up with daily activities, or starting new relationships. Concerns about tests, treatments, hospital stays, and medical bills are common. Doctors, nurses, social workers, and other members of the health care team can answer questions about treatment, working, or other activities. They can also discuss outlook (prognosis) and the activity level people may be able to manage. Meeting with a social worker, counselor, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns.

It is natural for a woman to be worried about the effects of uterine cancer and its treatment on her sexuality. She may want to talk with the doctor about possible side effects and whether these side effects are likely to be temporary or permanent. Whatever the outlook, it may be helpful for women and their partners to talk about their feelings and help one another find ways to share intimacy during and after treatment.

Information about programs and local resources for women with uterine cancer and their families is available through the Cancer Information Service.

The Promise of Cancer Research

Over the last several decades, researchers have been unraveling the mysteries of cancer. As they learn more and more about cancer, they have begun to use this new knowledge to find better ways of preventing, detecting, and treating this disease. Opportunities exist as never before to build on this foundation and achieve new successes against cancer. Although there is much work to be done, there are many reasons to be optimistic about the future. Each achievement in laboratories and clinics brings researchers closer to the eventual control of cancer.

Possible Causes and Prevention

Scientists at hospitals and medical centers all across the country are studying uterine cancer. They are trying to learn more about what causes the disease and how to prevent it.

At this time, we do not know exactly what causes uterine cancer, and doctors can seldom explain why one woman gets this disease and another does not. It is clear, however, that uterine cancer is not caused by an injury, and is not contagious; no one can "catch" uterine cancer from another person.

By studying patterns of cancer in the population, researchers have found certain factors that are more common in women who get uterine cancer than in those who don't get this disease. It is important to know that most women with these risk factors do not get cancer, and many who do get uterine cancer have none of these factors.

The following are some of the known risk factors for this disease:

• Age. Cancer of the uterus is most common in women over age 50.

• Endometrial hyperplasia. Women who have endometrial hyperplasia have a higher risk of developing uterine cancer. This condition and its treatment are described in the What Is Cancer? section.

• Estrogen replacement therapy. Women who use estrogen replacement therapy to control symptoms associated with menopause, to prevent osteoporosis (thinning of the bones), or to reduce the risk of heart disease or stroke may have an increased risk of uterine cancer. Long-term treatment and large doses seem to increase this risk. Using a combination of estrogen and progesterone decreases the risk linked to the use of estrogen alone. The progesterone protects the endometrium from the cancer-causing effect of estrogen. A woman considering hormone replacement therapy should discuss the benefits and risks with her doctor. Regular follow-up visits with a health professional while taking estrogen replacement therapy may improve the chances of detecting and treating uterine cancer in the early stages should it develop.

• Overweight. Scientists believe that too much estrogen may be the reason why overweight women are more than twice as likely to develop uterine cancer as women of normal weight. Because fat converts certain hormones into a form of estrogen, women with excess fat produce higher levels of estrogen.

• Diabetes and high blood pressure. Some studies suggest that diabetes and high blood pressure increase the risk of uterine cancer. Because these conditions often occur in overweight people, researchers cannot be certain whether the conditions themselves or the relationship between body fat and estrogen levels increases uterine cancer risk.

• Other cancers. Women with a history of colon cancer, rectal cancer, or breast cancer have a slightly higher risk of developing uterine cancer than do most other women. Women who have had uterine cancer also have an increased risk of developing certain other cancers.

• Tamoxifen. An increased risk of developing uterine cancer has been found in women taking the drug tamoxifen for the treatment of breast cancer. This risk may be related to the estrogen-like effect of this drug on the uterus. Women taking tamoxifen should be closely monitored by the doctor for possible signs or symptoms of uterine cancer. Doctors emphasize that the benefits of tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risk of other cancers.

• Race. White women have a greater chance of developing uterine cancer than black women.

Other risk factors for uterine cancer are also related to estrogen, including having few or no children or entering menopause late in life. Some studies of women who have used oral contraceptives that combine estrogen and progesterone show that these women have a lower than average risk of uterine cancer.

Women with known risk factors and those who are concerned about uterine cancer should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the woman's age, medical history, and other factors.

Other Booklets

The National Cancer Institute booklets listed below and others are available from the Cancer Information Service by calling 1-800-4-CANCER.

Booklets About Cancer Treatment

• Helping Yourself During Chemotherapy: 4 Steps for Patients
• Chemotherapy and You: A Guide to Self-Help During Treatment
• Radiation Therapy and You: A Guide to Self-Help During Treatment
• Eating Hints for Cancer Patients
• Get Relief from Cancer Pain
• Pain Control: A Guide for People with Cancer and Their Families
• Taking Part in Clinical Trials: What Cancer Patients Need To Know

Booklets About Living With Cancer

• Taking Time: Support for People With Cancer and the People Who Care About Them
• Facing Forward: A Guide for Cancer Survivors
• When Someone in Your Family Has Cancer
• When Cancer Recurs: Meeting the Challenge Again
• Advanced Cancer: Living Each Day

National Cancer Institute Information Resources

You may want more information for yourself, your family, and your health care provider. The following National Cancer Institute (NCI) services are available to help you.

Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)

TTY (for deaf and hard of hearing callers): 1-800-332-8615

Internet

These Web sites may be useful:

http://cancer.gov		NCI's primary Web site; contains information about the Institute and its programs.
http://cancertrials.nci.nih.gov		cancerTrials™; NCI's comprehensive clinical trials information center for patients, health professionals, and the public. Includes information on understanding trials, deciding whether to participate in trials, finding specific trials, plus research news and other resources.
http://cancernet.nci.nih.gov		CancerNet™; contains material for health professionals, patients, and the public, including information from PDQ® about cancer treatment, screening, prevention, supportive care, genetics, and clinical trials; CANCERLIT®, a bibliographic database; and a dictionary with medical terms related to cancer.

E-mail
CancerMail
Includes NCI information about cancer treatment, screening, prevention, and supportive care. To obtain a contents list, send e-mail to cancermail@icicc.nci.nih.gov with the word "help" in the body of the message.

Fax
CancerFax^®
Includes NCI information about cancer treatment, screening, prevention, and supportive care. To obtain a contents list, dial 1-800-624-2511 or 301-402-5874 from your touch tone phone or fax machine hand set and follow the recorded instructions.

Dictionary

abdomen (AB-do-men): The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

benign (beh-NINE): Not cancerous; does not invade nearby tissue or spread to other parts of the body.

biological therapy (by-o-LAHJ-i-kul): Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy.

biopsy (BY-ahp-see): The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

bladder: The organ that stores urine.

cancer: A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.

cervix (SER-viks): The lower, narrow end of the uterus that forms a canal between the uterus and vagina.

chemotherapy (kee-mo-THER-a-pee): Treatment with anticancer drugs.

clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease.

colonoscopy (ko-lun-AHS-ko-pee): An examination of the inside of the colon using a thin, lighted tube (called a colonoscope) inserted into the rectum. If abnormal areas are seen, tissue can be removed and examined under a microscope to determine whether disease is present.

corpus: The body of the uterus.

CT scan: Computed tomography scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan.

dilation and curettage (dye-LAY-shun and kyoo-reh-TAHZH): D&C. A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage).

endometriosis (en-do-mee-tree-O-sis): A benign condition in which tissue that looks like endometrial tissue grows in abnormal places in the abdomen.

endometrium (en-do-MEE-tree-um): The layer of tissue that lines the uterus.

estrogen replacement therapy: ERT. Hormones (estrogen, progesterone, or both) given to postmenopausal women or to women who have had their ovaries surgically removed. Hormones are given to replace the estrogen no longer produced by the ovaries.

estrogens (ES-tro-jins): A family of hormones that promote the development and maintenance of female sex characteristics.

fallopian tubes (fa-LO-pee-in): Part of the female reproductive tract. The long slender tubes through which eggs pass from the ovaries to the uterus.

fibroid (FYE-broyd): A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma.

fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus.

grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

gynecologic oncologist (guy-neh-ko-LAH-jik on-KOL-o-jist): A doctor who specializes in treating cancers of the female reproductive organs.

gynecologist (guy-neh-KAH-lo-jist): A doctor who specializes in treating diseases of the female reproductive organs.

hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy.

hormones: Chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the actions of certain cells or organs.

hyperplasia (hye-per-PLAY-zha): An abnormal increase in the number of cells in an organ or tissue.

hysterectomy (hiss-ter-EK-toe-mee): An operation in which the uterus is removed.

local therapy: Treatment that affects cells in the tumor and the area close to it.

lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph).

lymphatic system (lim-FAT-ik): The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, and lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body.

malignant (ma-LIG-nant): Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body.

menopause (MEN-o-pawz): The time of life when a woman's menstrual periods stop permanently. Also called "change of life."

menstruation: Periodic discharge of blood and tissue from the uterus. Until menopause, menstruation occurs approximately every 28 days when a woman is not pregnant.

metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases.

MRI: Magnetic resonance imaging (mag-NET-ik REZ-o- nans IM-a-jing). A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. Also called nuclear magnetic resonance imaging (NMRI).

myometrium (mye-o-MEE-tree-um): The muscular outer layer of the uterus.

osteoporosis (OSS-tee-oh-pa-ROW-sis): A condition that is characterized by a decrease in bone mass and density, causing bones to become fragile.

ovaries (O-va-reez): The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

Pap test: The collection of cells from the cervix for examination under a microscope. It is used to detect changes that may be cancer or may lead to cancer, and can show noncancerous conditions, such as infection or inflammation. Also called a Pap smear.

pathologist (pa-THOL-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.

pelvis: The lower part of the abdomen, located between the hip bones.

precancerous (pre-KAN-ser-us): A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant.

progesterone (pro-JES-ter-own): A female hormone.

prognosis (prog-NO-sis): The likely outcome or course of a disease; the chance of recovery or recurrence.

radiation oncologist (ray-dee-AY-shun on-KOL-o-jist): A doctor who specializes in using radiation to treat cancer.

radiation therapy (ray-dee-AY-shun): The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy.

rectum: The last 8 to 10 inches of the large intestine.

risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease.

salpingo-oophorectomy (sal-PIN-go o-o-for-EK-toe-mee): Surgical removal of the fallopian tubes and ovaries.

sarcoma: A cancer of the bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue.

side effects: Problems that occur when treatment affects healthy cells. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

sigmoidoscopy (sig-moid-OSS-ko-pee): Inspection of the lower colon using a thin, lighted tube called a sigmoidoscope. Samples of tissue or cells may be collected for examination under a microscope. Also called proctosigmoidoscopy.

speculum (SPEK-yoo-lum): An instrument used to widen an opening of the body to make it easier to look inside.

stage: The extent of a cancer, especially whether the disease has spread from the original site to other parts of the body.

staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body.

surgery: A procedure to remove or repair a part of the body or to find out whether disease is present.

systemic therapy (sis-TEM-ik): Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body.

tissue (TISH-oo): A group or layer of cells that are alike in type and work together to perform a specific function.

tumor (TOO-mer): An abnormal mass of tissue that results from excessive cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).

ultrasonography (UL-tra-son-OG-ra-fee): A procedure in which sound waves (called ultrasound) are bounced off

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