Cancer of the uterine body is the uncontrolled proliferation of cells within the uterus, the organ where the fetus develops. The disease can start in the inner lining, the muscles, or the supporting tissue of the uterus and occurs in any age group, but is more common in women who are already in menopause.
It is the sixth most common type of cancer among women in the world, with about 380,000 new cases per year.
In Brazil, cancer of the uterine body occupies the eighth position among the most incident malignant tumors in the female population (excluding non-melanoma skin cancer). For 2020, the Inca (National Cancer Institute) has estimated 6,540 new cases in the country.
Types of cancer of uterine body
There are two types of cancer of the uterine body: carcinoma and sarcoma.
More than 95% of malignant tumors of the uterus are carcinomas. They start in the endometrium – the inner lining of the uterus – and are called endometrial carcinomas.
The other cases are sarcomas, which originate in the muscle or uterine tissues and are classified according to the type of cell from which they develop. They are divided into:
- Uterine leiomyosarcomas – start in the myometrium (muscular wall of the uterus) and account for 2% of tumors;
- Stromal sarcomas of the endometrium – develop in the connective tissue that supports the endometrium (the stroma). They represent 1% of uterine cancers and offer the best prognosis for recovery among sarcomas of the uterus; and
- Undifferentiated sarcomas – although they are usually considered a subtype of stromal sarcoma of the endometrium, they are more aggressive and need different treatment. They also represent 1% of malignant uterine tumors.
Besides them, there is also the rare carcinosarcoma. The tumors originate in the endometrium and have characteristics of both carcinomas and sarcomas. They are known as mixed mesodermal tumors or malignant mixed mullerian tumors.
Symptoms of cancer of the uterine body
There is no screening test for endometrial cancer, so it is important to pay attention to the symptoms of this disease. Vaginal bleeding is the most common symptom of uterine body cancer. This includes:
- Vaginal bleeding between menstrual cycles or heavier than usual during the cycle. Remember that only about 20% of cases are diagnosed in women who are fertile and therefore have menstrual cycles; and
- Any vaginal bleeding in a woman who is already in menopause.
In addition to bleeding, symptoms are:
- Pelvic pain;
- Weight loss for no apparent reason.
Diagnosis of cancer of the uterine body
When the symptoms are present, the gynecologist starts to detect the cancer of the uterine body. To do so, the professional carries out exams and procedures that allow visualization of the uterus and its interior and aid in the diagnosis. They are
- Physical examination;
- Transvaginal ultrasonography;
- Hysteroscopy (visualization of the interior of the uterus through a camera introduced through the vagina); and
- Endometrial biopsy (removal of a small sample of the internal layer of the uterus for microscopic analysis).
Once the cancer of the uterine body is detected, its stage is checked – the stage in which it is and whether it is restricted to the original location or if there is dissemination to other organs. The following exams are then performed:
- Pelvic exam (with speculum and vaginal touch);
- Imaging exams (such as radiography, ultrasonography, tomography, nuclear magnetic resonance).
It is from there that the cancer treatment is defined.
The decision for the type of treatment for uterine body cancer will depend on factors such as the stage of the disease, the age and general health condition of the patient, the type of tumor, and the future intention of having children.
The following types of treatments are used, either alone or in combination, in the search for a cure for cancer of the uterine body:
- Surgery – removal of the cancer through surgical procedure. In most cases hysterectomy is used, which is surgery to remove the uterus, ovaries and fallopian tubes;
- Radiotherapy – complementary to surgery, it uses high-dose radiation to eliminate cancerous cells that may still be present. It can be external (applied outside the body) or internal (applied directly inside the vagina);
- Chemotherapy – the use of drugs to stop the growth and kill cancerous cells;
- Hormone therapy – the use of medication to inhibit the hormones activity that may cause the uterine body cancer tumor to grow.
The best prevention against cancer is to avoid factors or quickly treat/control diseases and health conditions that benefit its development.
The main factors to avoid in order to prevent cancer of the uterine body are:
- Excess body fat;
- Diets with high glycemic load (high amount of carbohydrates and/or food rich in processed and ultra-processed products);
- Use of estrogen for hormone replacement after menopause.
Diseases and health conditions to be treated or controlled quickly to prevent the development of cancer of the uterine body include:
- Genetic predisposition;
- Diabetes mellitus;
- Endometrial hyperplasia;
- Chronic lack of ovulation;
- Polycystic ovary syndrome;
- Lynch syndrome.