Uterine cancer is a malignant condition affecting the uterus. Almost 90% of uterine cancers are endometrial. The most common type is endometrioid adenocarcinoma, accounting for more than 75% of cases. The other prevalent types are clear cell carcinoma and papillary serous adenocarcinoma, which carry a worse prognosis and high risk of invasive or metastatic disease. Uterine sarcomas are rare mesenchymal tumors accounting for less than 10% of all uterine cancers.

Uterine cancer is the most common gynecologic cancer in the United States. Lifetime risk is 1 in 40. It was the fourth most common cancer diagnosis in 2018 according to the US Centers for Disease Control and Prevention (CDC), with approximately 63 000 new cases. Worldwide, it was the sixth most common cancer. Average age at diagnosis is 60 years.

Risk factors include exogenous estrogen exposure (ie, unopposed estrogen from hormone replacement therapy, obesity), nulliparity, tamoxifen use, family history of uterine cancer, history of polycystic ovary syndrome (PCOS), history of diabetes, European decent, infertility, early menarche, late menopause, and history of Lynch syndrome. Long-term use of chemical hair relaxers / straighteners has been associated with a significantly increased risk of uterine cancer in postmenopausal Black women.

It is thought that varying degrees of protection are afforded from a history of breastfeeding, menopausal hormone use (estrogen plus progesterone), progesterone intrauterine device (IUD) use, parity, tobacco use, and moderate activity levels.

Patients will usually present with abnormal uterine bleeding, most commonly postmenopausal bleeding. Although the bleeding can be associated with pain / cramping, usually it is painless, and postmenopausal bleeding can be as light as spotting with wiping after voiding. Patients may also have bloating, fatigue, early satiety, pelvic pain, and/or bowel changes if the disease has progressed to an advanced stage.

Related topic: endometrial carcinoma