From Encyclopedia of Sex and Sexuality
Cancer of the uterus is a disease of advancing age. Most cases occur in women over the age of fifty. It is estimated that 3 percent of women develop carcinoma of the uterine mucosa (endometrium) by age seventy-five. The increasing rate of endometrial cancer during the last decade is partly due to an increasing proportion of older women in the general population. Environmental factors may also play a part in the development of endometrial cancer. In the West there was a rise in the incidence of the disease in the early 1970s and there are substantially lower rates in Asia and South America.
 Risk Factors
The incidence of uterine cancer is highest among women who have no children—with impaired fertility due to lack of ovulation; with few or no pregnancies; with impaired menstrual patterns, especially with long intervals between periods; obese women who suffer from diabetes mellitus or hypertension; women with a family history of malignancy; and women of higher socioeconomic groups. Continuous estrogen stimulation with hormonal imbalance is associated with the development of endometrial cancer. On the other hand, women taking oral contraceptives for more than one year are at lower risk of developing endometrial cancer than other women.
The most common first sign of uterine cancer is abnormal vaginal bleeding: vaginal bleeding in postmenopausal women is abnormal and should be immediately investigated. In premenstrual women symptoms such as spotting, heavy prolonged vaginal bleeding, and intermenstrual bleeding should be investigated. These symptoms usually appear early in the course of the disease. If diagnosis is established then and treatment undertaken immediately, survival rates are above 95 percent. On the other hand, the cure rate for advanced cases is negligible. Other symptoms such as pressure and distension of the pelvis and bladder irritation occur as the disease progresses.
 Screening and Early Diagnosis
Any woman who experiences abnormal bleeding should be investigated by a physician and an endometrial sampling should be taken. Other procedures for screening high risk populations include: a pap test; ultrasonography, endometrial samplings, and hysteroscopy.
Fortunately, symptoms usually occur at an early stage, before the disease has spread beyond the uterus. With early diagnosis, there is a high cure rate. Both surgery and irradiation have been effectively used to treat carcinoma of the endometrium. For patients in good physical condition, surgery is the main treatment. During surgery the extent of the cancer’s spread is evaluated and the uterus and both ovaries are removed. For early stages of uterine carcinoma, this treatment alone provides a five-year survival rate of more than 85 percent. For patients who cannot medically tolerate an operation or for women with cancer that has spread beyond the uterus, irradiation, either locally (vaginal or intrauterine irradiation) or externally is the treatment of choice. There are several combinations of different treatment modalities and any woman with endometrial cancer should be treated at an experienced oncological center where the best treatment routine will be chosen. Treatment should be discussed with the patient, taking into consideration the advantages and disadvantages of each modality.