What You

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Cancerof the

Uterus

NATIONAL INSTITUTES OF HEALTHNational Cancer Institute

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This booklet is about cancer of theuterus. The Cancer Information Servicecan help you learn more about thisdisease. The staff can talk with you inEnglish or Spanish.

The number is 1–800–4–CANCER(1–800–422–6237). The number fordeaf and hard of hearing callers withTTY equipment is 1–800–332–8615.The call is free.

Este folleto es acerca del cáncer delútero. Llame al Servicio de Informaciónsobre el Cáncer para saber más sobreesta enfermedad. Este servicio tienepersonal que habla español.

El número a llamar es el 1–800–4–CANCER(1–800–422–6237).Personas con dificultades de audición yque quentan con equipo TTY puedenllamar al 1–800–332–8615. La llamadaes gratis.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health ServiceNational Institutes of Health

Contents

The Uterus 2

Understanding Cancer 3

Uterine Cancer: Who’s at Risk? 6

Symptoms 8

Diagnosis 8

Staging 11

Treatment 12

Side Effects of Cancer Treatment 19

Nutrition 22

Followup Care 23

Support for Women with Uterine Cancer 23

The Promise of Cancer Research 24

Dictionary 26

National Cancer Institute Information Resources 35

National Cancer Institute Booklets 37

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What You Need To Know About™Cancer of the Uterus

his National Cancer Institute (NCI) booklet hasimportant information about cancer* of the

uterus. In the United States, cancer of the uterus is themost common cancer of the female reproductivesystem. It accounts for six percent of all cancers inwomen in this country.

This booklet has information about the possiblecauses, symptoms, diagnosis, and treatment of cancerof the uterus. It will help patients and their families andfriends better understand and cope with this disease.

Research is increasing what we know about cancerof the uterus. Scientists are learning more about itscauses. They are exploring new ways to prevent, detect,diagnose, and treat this disease. Research has helped toimprove patients’ quality of life and lower the chanceof dying from this disease.

Information specialists at the Cancer InformationService can answer callers’ questions about cancer andcan send other National Cancer Institute publications.The number to call is 1–800–4–CANCER. Also,anyone may view or order NCI publications on theInternet at http://cancer.gov/publications.

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*Words that may be new to readers are printed in italics. The“Dictionary” section gives definitions of these terms. Some words inthe “Dictionary” have a “sounds-like” spelling to show how topronounce them.

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The Uterus

he uterus is part of a woman’s reproductivesystem. It is the hollow, pear-shaped organ where

a baby grows. The uterus is in the pelvis between thebladder and the rectum.

The narrow, lower portion of the uterus is the cervix.The broad, middle part of the uterus is the body orcorpus. The dome-shaped top of the uterus is thefundus. The fallopian tubes extend from either side ofthe top of the uterus to the ovaries.

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The wall of the uterus has two layers of tissue. Theinner layer or lining is the endometrium. The outerlayer of muscle tissue is the myometrium.

In women of childbearing age, the lining of theuterus grows and thickens each month to prepare forpregnancy. If a woman does not become pregnant, thethick, bloody lining flows out of the body through thevagina. This flow is called menstruation.

This picture shows the ovaries, fallopian tubes, and uterus(cervix, corpus, fundus, endometrium, and myometrium).

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Understanding Cancer

ancer is a group of many related diseases. Allcancers begin in cells, the body’s basic unit of

life. Cells make up tissues, and tissues make up theorgans of the body.

Normally, cells grow and divide to form new cells asthe body needs them. When cells grow old and die,new cells take their place.

Sometimes this orderly process goes wrong. Newcells form when the body does not need them, and oldcells do not die when they should. These extra cells canform a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

• Benign tumors are not cancer. Usually, doctors canremove them. Cells from benign tumors do notspread to other parts of the body. In most cases,benign tumors do not come back after they areremoved. Most important, benign tumors are rarely athreat to life.

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Benign Conditions of the Uterus

• Fibroids are common benign tumors that growin the muscle of the uterus. They occur mainlyin women in their 40s. Women may have manyfibroids at the same time. Fibroids do notdevelop into cancer. As a woman reachesmenopause, fibroids are likely to becomesmaller, and sometimes they disappear.

Usually, fibroids cause no symptoms and needno treatment. But depending on their size andlocation, fibroids can cause bleeding, vaginaldischarge, and frequent urination. Women with

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• Malignant tumors are cancer. They are generallymore serious and may be life threatening. Cancercells can invade and damage nearby tissues andorgans. Also, cancer cells can break away from amalignant tumor and enter the bloodstream orlymphatic system. That is how cancer cells spread

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these symptoms should see a doctor. If fibroidscause heavy bleeding, or if they press againstnearby organs and cause pain, the doctor maysuggest surgery or other treatment.

• Endometriosis is another benign condition thataffects the uterus. It is most common inwomen in their thirties and forties, especiallyin women who have never been pregnant. Itoccurs when endometrial tissue begins to growon the outside of the uterus and on nearbyorgans. This condition may cause painfulmenstrual periods, abnormal vaginal bleeding,and sometimes loss of fertility (ability to getpregnant), but it does not cause cancer. Womenwith endometriosis may be treated withhormones or surgery.

• Endometrial hyperplasia is an increase in thenumber of cells in the lining of the uterus. It isnot cancer. Sometimes it develops into cancer.Heavy menstrual periods, bleeding betweenperiods, and bleeding after menopause arecommon symptoms of hyperplasia. It is mostcommon after age 40.

To prevent endometrial hyperplasia fromdeveloping into cancer, the doctor mayrecommend surgery to remove the uterus(hysterectomy) or treatment with hormones(progesterone) and regular followup exams.

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from the original (primary) tumor to form newtumors in other organs. The spread of cancer iscalled metastasis.

When uterine cancer spreads (metastasizes) outsidethe uterus, cancer cells are often found in nearby lymphnodes, nerves, or blood vessels. If the cancer hasreached the lymph nodes, cancer cells may have spreadto other lymph nodes and other organs, such as thelungs, liver, and bones.

When cancer spreads from its original place toanother part of the body, the new tumor has the samekind of abnormal cells and the same name as theprimary tumor. For example, if cancer of the uterusspreads to the lungs, the cancer cells in the lungs areactually uterine cancer cells. The disease is metastaticuterine cancer, not lung cancer. It is treated as uterinecancer, not lung cancer. Doctors sometimes call thenew tumor “distant” disease.

The most common type of cancer of the uterusbegins in the lining (endometrium). It is calledendometrial cancer, uterine cancer, or cancer of theuterus. In this booklet, we will use the terms uterinecancer or cancer of the uterus to refer to cancer thatbegins in the endometrium.

A different type of cancer, uterine sarcoma, developsin the outer layer of muscle (myometrium). Cancer thatbegins in the cervix is also a different type of cancer.This booklet does not deal with uterine sarcoma or withcancer of the cervix. The Cancer Information Service(1–800–4–CANCER) can provide information aboutthese types of cancer. Also, National Cancer Institutepublications may be viewed or ordered on the Internetat http://cancer.gov.publications.

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Uterine Cancer: Who’s at Risk?

o one knows the exact causes of uterine cancer.However, it is clear that this disease is not

contagious. No one can “catch” cancer from anotherperson.

Women who get this disease are more likely thanother women to have certain risk factors. A risk factoris something that increases a person’s chance ofdeveloping the disease.

Most women who have known risk factors do notget uterine cancer. On the other hand, many who do getthis disease have none of these factors. Doctors canseldom explain why one woman gets uterine cancer andanother does not.

Studies have found the following risk factors:

• Age. Cancer of the uterus occurs mostly in womenover age 50.

• Endometrial hyperplasia. The risk of uterinecancer is higher if a woman has endometrialhyperplasia. This condition and its treatment aredescribed on page 4.

• Hormone replacement therapy (HRT). HRT is usedto control the symptoms of menopause, to preventosteoporosis (thinning of the bones), and to reducethe risk of heart disease or stroke. Women who useestrogen without progesterone have an increased riskof uterine cancer. Long-term use and large doses ofestrogen seem to increase this risk.

Women who use a combination of estrogen andprogesterone have a lower risk of uterine cancer thanwomen who use estrogen alone. The progesteroneprotects the uterus.

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Women should discuss the benefits and risks of HRTwith their doctor. Also, having regular checkupswhile taking HRT may improve the chance that thedoctor will find uterine cancer at an early stage, if itdoes develop.

• Obesity and related conditions. The body makessome of its estrogen in fatty tissue. That’s why obesewomen are more likely than thin women to havehigher levels of estrogen in their bodies. High levelsof estrogen may be the reason that obese womenhave an increased risk of developing uterine cancer.The risk of this disease is also higher in women withdiabetes or high blood pressure (conditions thatoccur in many obese women).

• Tamoxifen. Women taking the drug tamoxifen toprevent or treat breast cancer have an increased riskof uterine cancer. This risk appears to be related tothe estrogen-like effect of this drug on the uterus.Doctors monitor women taking tamoxifen forpossible signs or symptoms of uterine cancer.

The benefits of tamoxifen to treat breast canceroutweigh the risk of developing other cancers. Still,each woman is different. Any woman consideringtaking tamoxifen should discuss with the doctor herpersonal and family medical history and herconcerns.

• Race. White women are more likely than African-American women to get uterine cancer.

• Colorectal cancer. Women who have had aninherited form of colorectal cancer have a higher riskof developing uterine cancer than other women.

Other risk factors are related to how long a woman’sbody is exposed to estrogen. Women who have nochildren, begin menstruation at a very young age, orenter menopause late in life are exposed to estrogenlonger and have a higher risk.

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Women with known risk factors and those who areconcerned about uterine cancer should ask their doctorabout the symptoms to watch for and how often to havecheckups. The doctor’s advice will be based on thewoman’s age, medical history, and other factors.

Symptoms

terine cancer usually occurs after menopause. Butit may also occur around the time that menopause

begins. Abnormal vaginal bleeding is the most commonsymptom of uterine cancer. Bleeding may start as awatery, blood-streaked flow that gradually containsmore blood. Women should not assume that abnormalvaginal bleeding is part of menopause.

A woman should see her doctor if she has any of thefollowing 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 otherless serious conditions. Most often they are not cancer,but only a doctor can tell for sure.

Diagnosis

f a woman has symptoms that suggest uterinecancer, her doctor may check general signs of

health and may order blood and urine tests. The doctoralso may perform one or more of the exams describedon the next pages.

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• Pelvic exam–A woman has a pelvic exam to checkthe vagina, uterus, bladder, and rectum. The doctorfeels these organs for any lumps or changes in theirshape or size. To see the upper part of the vagina andthe cervix, the doctor inserts an instrument called aspeculum into the vagina.

• Pap test–The doctor collects cells from the cervixand upper vagina. A medical laboratory checks forabnormal cells. Although the Pap test can detectcancer of the cervix, cells from inside the uterususually do not show up on a Pap test. This is whythe doctor collects samples of cells from inside theuterus in a procedure called a biopsy.

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• Transvaginal ultrasound–The doctor inserts aninstrument into the vagina. The instrument aimshigh-frequency sound waves at the uterus. Thepattern of the echoes they produce creates a picture.If the endometrium looks too thick, the doctor cando a biopsy.

• Biopsy–The doctor removes a sample of tissue fromthe uterine lining. This usually can be done in thedoctor’s office. In some cases, however, a womanmay need to have a dilation and curettage (D&C). AD&C is usually done as same-day surgery withanesthesia in a hospital. A pathologist examines thetissue to check for cancer cells, hyperplasia, andother conditions. For a short time after the biopsy,some women have cramps and vaginal bleeding.

A woman who needs a biopsy may want to askthe doctor the following questions:

• What type of biopsy will I have? Why?

• How long will it take? Will I be awake? Will ithurt?

• How soon will I know the results?

• Are there any risks? What is the chance ofinfection or bleeding afterward?

• If I do have cancer, who will talk with meabout treatment? When?

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Staging

f uterine cancer is diagnosed, the doctor needs toknow the stage, or extent, of the disease to plan

the best treatment. Staging is a careful attempt to findout whether the cancer has spread, and if so, to whatparts of the body.

The doctor may order blood and urine tests and chestx-rays. The woman also may have other x-rays, CTscans, an ultrasound test, magnetic resonance imaging(MRI), sigmoidoscopy, or colonoscopy.

In most cases, the most reliable way to stage thisdisease is to remove the uterus (hysterectomy). (Thedescription of surgery in the “Methods of Treatment”section has more information.) After the uterus hasbeen removed, the surgeon can look for obvious signsthat the cancer has invaded the muscle of the uterus.The surgeon also can check the lymph nodes and otherorgans in the pelvic area for signs of cancer. Apathologist uses a microscope to examine the uterusand other tissues removed by the surgeon.

These are the main features of each stage of thedisease:

• Stage I–The cancer is only in the body of the uterus.It is not in the cervix.

• Stage II–The cancer has spread from the body of theuterus to the cervix.

• Stage III–The cancer has spread outside the uterus,but not outside the pelvis (and not to the bladder orrectum). Lymph nodes in the pelvis may containcancer cells.

• Stage IV–The cancer has spread into the bladder orrectum. Or it has spread beyond the pelvis to otherbody parts.

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Treatment

any women want to take an active part in makingdecisions about their medical care. They want to

learn all they can about their disease and their treatmentchoices. However, the shock and stress that people mayfeel after a diagnosis of cancer can make it hard forthem to think of everything they want to ask the doctor.It often helps to make a list of questions before anappointment. To help remember what the doctor says,patients may take notes or ask whether they may use atape recorder. Some women also want to have a familymember or friend with them when they talk to thedoctor–to take part in the discussion, to take notes, orjust to listen.

The patient’s doctor may refer her to doctors whospecialize in treating cancer, or she may ask for areferral. Treatment generally begins within a few weeksafter the diagnosis. There will be time for the woman totalk with the doctor about her treatment choices, get asecond opinion, and learn more about uterine cancer.

Getting a Second OpinionBefore starting treatment, a woman might want a

second opinion about the diagnosis, the stage of cancer,and the treatment plan. Some insurance companiesrequire a second opinion; others may cover a secondopinion if the woman requests it. Gathering medicalrecords and arranging to see another doctor may take alittle time. In most cases, a brief delay does not maketreatment less effective.

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There are a number of ways to find a doctor for asecond opinion:

• The patient’s doctor may refer her to one or morespecialists. Specialists who treat women with uterinecancer include surgeons, gynecologic oncologists,medical oncologists, and radiation oncologists. Atcancer centers, these doctors often work together asa team.

• The Cancer Information Service, at1–800–4–CANCER, can tell callers about treatmentfacilities, including cancer centers and otherprograms supported by the National Cancer Institute.

• People can get the names of specialists from theirlocal medical society, a nearby hospital, or a medicalschool.

• The Official ABMS Directory of Board CertifiedMedical Specialists lists doctors’ names along withtheir speciality and their educational background.This resource is available in most public libraries.The American Board of Medical Specialties(ABMS) also has telephone and Internet services.People may use these services to check whether adoctor is board certified. The telephone number is1–866–ASK–ABMS (1–866–275–2267). The Internet address ishttp://www.abms.org/newsearch.asp.

Preparing for TreatmentThe choice of treatment depends on the size of the

tumor, the stage of the disease, whether femalehormones affect tumor growth, and the tumor grade.(The grade tells how closely the cancer cells resemblenormal cells and suggests how fast the cancer is likelyto grow. Low-grade cancers are likely to grow andspread more slowly than high-grade cancers.) Thedoctor also considers other factors, including thewoman’s age and general health.

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Women do not need to ask all their questions orunderstand all the answers at once. They will haveother chances to ask the doctor to explain things thatare not clear and to ask for more information.

Methods of TreatmentWomen with uterine cancer have many treatment

options. Most women with uterine cancer are treatedwith surgery. Some have radiation therapy. A smaller

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These are some questions a woman may wantto ask the doctor:

• What kind of uterine cancer do I have?

• Has the cancer spread? What is the stage of thedisease?

• Do I need any more tests to check for spread ofthe disease?

• What is the grade of the tumor?

• What are my treatment choices? Which do yourecommend for me? Why?

• What are the expected benefits of each kind oftreatment?

• What are the risks and possible side effects ofeach treatment?

• What is the treatment likely to cost?

• How will treatment affect my normalactivities?

• How often should I have checkups?

• Would a clinical trial (research study) beappropriate for me?

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number of women may be treated with hormonaltherapy. Some patients receive a combination oftherapies.

The doctor is the best person to describe thetreatment choices and discuss the expected results oftreatment.

A woman may want to talk with her doctor abouttaking part in a clinical trial, a research study of newtreatment methods. Clinical trials are an importantoption for women with all stages of uterine cancer. Thesection on “The Promise of Cancer Research” hasmore information about clinical trials.

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Most women with uterine cancer have surgery toremove the uterus (hysterectomy) through an incisionin the abdomen. During a hysterectomy, the doctor alsoremoves both fallopian tubes and both ovaries. (Thisoperation is called a bilateral salpingo-oophorectomy.)

The doctor may also remove the lymph nodes nearthe tumor to see if they contain cancer. If cancer cellshave reached the lymph nodes, it may mean that thedisease has spread to other parts of the body. If cancercells have not spread beyond the endometrium, thewoman may not need to have any other treatment. Thelength of the hospital stay may vary from several daysto a week.

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These are some questions a woman may want toask the doctor about surgery:

• What kind of operation will it be?

• How will I feel after the operation?

• What help will I get if I have pain?

• How long will I have to stay in the hospital?

• Will I have any long-term effects because ofthis operation?

• When will I be able to resume my normalactivities?

• Will the surgery affect my sex life?

• Will followup visits be necessary?

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In radiation therapy, high-energy rays are used tokill cancer cells. Like surgery, radiation therapy is alocal therapy. It affects cancer cells only in the treatedarea.

Some women with Stage I, II, or III uterine cancerneed both radiation therapy and surgery. They mayhave radiation before surgery to shrink the tumor orafter surgery to destroy any cancer cells that remain inthe area. Also, the doctor may suggest radiationtreatments for the small number of women who cannothave surgery.

Doctors use two types of radiation therapy to treatuterine cancer:

• External radiation: In external radiation therapy, alarge machine outside the body is used to aimradiation at the tumor area. The woman is usually anoutpatient in a hospital or clinic and receivesexternal radiation 5 days a week for several weeks.This schedule helps protect healthy cells and tissueby spreading out the total dose of radiation. Noradioactive materials are put into the body forexternal radiation therapy.

• Internal radiation: In internal radiation therapy, tinytubes containing a radioactive substance are insertedthrough the vagina and left in place for a few days.The woman stays in the hospital during thistreatment. To protect others from radiation exposure,the patient may not be able to have visitors or mayhave visitors only for a short period of time whilethe implant is in place. Once the implant is removed,the woman has no radioactivity in her body.

Some patients need both external and internalradiation therapies.

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Hormonal therapy involves substances that preventcancer cells from getting or using the hormones theymay need to grow. Hormones can attach to hormonereceptors, causing changes in uterine tissue. Beforetherapy begins, the doctor may request a hormonereceptor test. This special lab test of uterine tissuehelps the doctor learn if estrogen and progesteronereceptors are present. If the tissue has receptors, thewoman is more likely to respond to hormonal therapy.

Hormonal therapy is called a systemic therapybecause it can affect cancer cells throughout the body.Usually, hormonal therapy is a type of progesteronetaken as a pill.

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These are some questions a woman may want toask the doctor about radiation therapy:

• What is the goal of this treatment?

• How will the radiation be given?

• Will I need to stay in the hospital? For howlong?

• When will the treatments begin? When willthey end?

• How will I feel during therapy? Are there sideeffects?

• What can I do to take care of myself during therapy?

• How will we know if the radiation therapy isworking?

• Will I be able to continue my normal activities during treatment?

• How will radiation therapy affect my sex life?

• Will followup visits be necessary?

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The doctor may use hormonal therapy for womenwith uterine cancer who are unable to have surgery orradiation therapy. Also, the doctor may give hormonaltherapy to women with uterine cancer that has spread tothe lungs or other distant sites. It is also given towomen with uterine cancer that has come back.

These are some questions a woman may want toask the doctor about hormonal therapy:

• Why do I need this treatment?

• What were the results of the hormone receptortest?

• What hormones will I be taking? What willthey do?

• Will I have side effects? What can I do aboutthem?

• How long will I be on this treatment?

Side Effects of Cancer Treatment

ecause cancer treatment may damage healthy cellsand tissues, unwanted side effects sometimes

occur. These side effects depend on many factors,including the type and extent of the treatment. Sideeffects may not be the same for each person, and theymay even change from one treatment session to thenext. Before treatment starts, doctors and nurses willexplain the possible side effects and how they will helpyou manage them.

The NCI provides helpful booklets about cancertreatments and coping with side effects, such asRadiation Therapy and You and Eating Hints forCancer Patients. See the sections “National Cancer

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Institute Information Resources” and “National CancerInstitute Booklets” for other sources of informationabout side effects.

SurgeryAfter a hysterectomy, women usually have some

pain and feel extremely tired. Most women return totheir normal activities within 4 to 8 weeks after surgery.Some may need more time than that.

Some women may have problems with nausea andvomiting after surgery, and some may have bladder andbowel problems. The doctor may restrict the woman’sdiet to liquids at first, with a gradual return to solidfood.

Women who have had a hysterectomy no longerhave menstrual periods and can no longer get pregnant.When the ovaries are removed, menopause occurs atonce. Hot flashes and other symptoms of menopausecaused by surgery may be more severe than thosecaused by natural menopause. Hormone replacementtherapy (HRT) is often given to women who have nothad uterine cancer to relieve these problems. However,doctors usually do not give the hormone estrogen towomen who have had uterine cancer. Because estrogenis a risk factor for this disease (see “Uterine Cancer:Who’s at Risk?”), many doctors are concerned thatestrogen may cause uterine cancer to return. Otherdoctors point out that there is no scientific evidence thatestrogen increases the risk that cancer will come back.NCI is sponsoring a large research study to learnwhether women who have had early stage uterinecancer can take estrogen safely.

For some women, a hysterectomy can affect sexualintimacy. A woman may have feelings of loss that may

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make intimacy difficult. Sharing these feelings with herpartner may be helpful.

Radiation TherapyThe side effects of radiation therapy depend mainly

on the treatment dose and the part of the body that istreated. Common side effects of radiation include dry,reddened skin and hair loss in the treated area, loss ofappetite, and extreme tiredness. Some women mayhave dryness, itching, tightening, and burning in thevagina. Radiation also may cause diarrhea or frequentand uncomfortable urination. It may reduce the numberof white blood cells, which help protect the bodyagainst infection.

Doctors may advise their patients not to haveintercourse during radiation therapy. However, mostcan resume sexual activity within a few weeks aftertreatment ends. The doctor or nurse may suggest waysto relieve any vaginal discomfort related to treatment.

Hormonal TherapyHormonal therapy can cause a number of side

effects. Women taking progesterone may retain fluid,have an increased appetite, and gain weight. Womenwho are still menstruating may have changes in theirperiods.

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Nutrition

eople need to eat well during cancer therapy.They need enough calories and protein to

promote healing, maintain strength, and keep a healthyweight. Eating well often helps people with cancer feelbetter and have more energy.

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Patients may not feel like eating if they areuncomfortable or tired. Also, the side effects oftreatment such as poor appetite, nausea, or vomitingcan make eating difficult. Foods may taste different.

The doctor, dietitian, or other health care providercan advise patients about ways to maintain a healthydiet. Patients and their families may want to read theNational Cancer Institute booklet Eating Hints forCancer Patients, which contains many usefulsuggestions and recipes. The section “National CancerInstitute Booklets” tells how to get this publication.

Followup Care

ollowup care after treatment for uterine cancer isimportant. Women should not hesitate to discuss

followup with their doctor. Regular checkups ensurethat any changes in health are noticed. Any problemthat develops can be found and treated as soon aspossible. Checkups may include a physical exam, apelvic exam, x-rays, and laboratory tests.

Support for Women with Uterine Cancer

iving with a serious disease such as cancer is noteasy. Some people find they need help coping

with the emotional and practical aspects of theirdisease. Support groups can help. In these groups,patients or their family members get together to sharewhat they have learned about coping with the diseaseand the effects of treatment. Patients may want to talkwith a member of their health care team about finding asupport group.

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It is natural for a woman to be worried about theeffects of uterine cancer and its treatment on hersexuality. She may want to talk with the doctor aboutpossible side effects and whether these effects arelikely to be temporary or permanent. Whatever theoutlook, it may be helpful for women and their partnersto talk about their feelings and help one another findways to share intimacy during and after treatment.

People living with cancer may worry about caringfor their families, holding on to their jobs, or keepingup with daily activities. Concerns about treatments andmanaging side effects, hospital stays, and medical billsare also common. Doctors, nurses, and other membersof the health care team will answer questions abouttreatment, working, or other activities. Meeting with asocial worker, counselor, or member of the clergy canbe helpful to those who want to talk about theirfeelings or discuss their concerns. Often, a socialworker can suggest resources for financial aid,transportation, home care, or emotional support.

Printed materials are available from the CancerInformation Service and through other sources listed inthe “National Cancer Institute Information Resources”section. The Cancer Information Service can alsoprovide information to help patients and their familieslocate programs, services, and publications.

The Promise of Cancer Research

octors all over the country are conducting manytypes of clinical trials, research studies in which

people take part voluntarily. Many treatment studies forwomen with uterine cancer are under way. Researchhas already led to advances, and researchers continueto search for more effective approaches.

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Patients who take part in clinical trials have the firstchance to benefit from treatments that have shownpromise in earlier research. They also make animportant contribution to medical science by helpingdoctors learn more about the disease. Although clinicaltrials may pose some risks, researchers take many verycareful steps to protect people who take part.

In a large trial with hundreds of women, doctors arestudying a less extensive method of surgery to removethe uterus. Normally, the doctor makes an incision inthe abdomen to remove the uterus. In this study, doctorsuse a laparoscope (a lighted tube) to help remove theuterus through the vagina. Also, the doctor can use thelaparoscope to help remove the ovaries and lymphnodes and to look into the abdomen for signs of cancer.

Other researchers are looking at the effectiveness ofradiation therapy after surgery, as well as at thecombination of surgery, radiation, and chemotherapy.Other trials are studying new drugs, new drugcombinations, and biological therapies. Some of thesestudies are designed to find ways to reduce the sideeffects of treatment and to improve the quality ofwomen’s lives.

A woman who is interested in being part of a clinicaltrial should talk with her doctor. She may want to readTaking Part in Clinical Trials: What Cancer PatientsNeed To Know. This NCI booklet describes howresearch studies are carried out and explains theirpossible benefits and risks. NCI’s cancerTrials™ Website at http://cancertrials.nci.nih.gov provides generalinformation about clinical trials. It also offers detailedinformation about specific ongoing studies of uterinecancer by linking to PDQ®, a cancer informationdatabase developed by the NCI. The CancerInformation Service at 1–800–4–CANCER can answerquestions about cancer and provide information fromthe PDQ database.

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Dictionary

Abdomen (AB-do-men): The part of the body that con-tains the pancreas, stomach, intestines, liver, gallblad-der, reproductive organs, and other organs.

Anesthesia (an-es-THEE-zha): Loss of feeling orawareness. Local anesthetics cause loss of feeling in apart of the body. General anesthetics put the person tosleep.

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

Biological therapy (by-o-LAHJ-i-kul): Treatment tostimulate or restore the ability of the immune system tofight infection and disease. Also used to lessen sideeffects of some cancer treatments. Also known asimmunotherapy, biotherapy, or biological responsemodifier (BRM) therapy.

Biopsy (BY-ahp-see): The removal of cells or tissuesfor examination under a microscope. When only asample of tissue is removed, the procedure is called anincisional biopsy or core biopsy. When an entire tumoror lesion is removed, the procedure is called an exci-sional biopsy. When a sample of tissue or fluid isremoved with a needle, the procedure is called a needlebiopsy or fine-needle aspiration.

Bladder: The organ that stores urine.

Cancer: A term for diseases in which abnormal cellsdivide without control. Cancer cells can invade nearbytissues and can spread through the bloodstream andlymphatic system to other parts of the body.

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

Chemotherapy (kee-mo-THER-a-pee): Treatment withanticancer drugs.

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Clinical trial: A research study that tests how well newmedical treatments or other interventions work in peo-ple. Each study is designed to test new methods ofscreening, prevention, diagnosis, or treatment of adisease.

Colonoscopy (ko-lun-AHS-ko-pee): An examination ofthe inside of the colon using a thin, lighted tube (calleda colonoscope) inserted into the rectum. If abnormalareas are seen, tissue can be removed and examinedunder a microscope to determine whether disease ispresent.

Colorectal (ko-lo-REK-tul): Having to do with thecolon or the rectum.

Corpus: The body of the uterus.

CT scan: Computed tomography scan. A series ofdetailed pictures of areas inside the body taken fromdifferent angles; the pictures are created by a computerlinked to an x-ray machine. Also called computerizedtomography and computerized axial tomography (CAT)scan.

Dilation and curettage (dye-LAY-shun and kyoo-reh-TAHZH): D&C. A procedure that expands the cervix sothat the cervical canal and uterine lining can be scrapedwith a spoon-shaped instrument called a curette.

Endometriosis (en-do-mee-tree-O-sis): A benign condi-tion in which tissue that looks like endometrial tissuegrows in abnormal places in the abdomen.

Endometrium (en-do-MEE-tree-um): The layer of tis-sue that lines the uterus.

Estrogens (ES-tro-jins): A family of hormones that pro-mote the development and maintenance of female sexcharacteristics.

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External radiation (ray-dee-AY-shun): Radiation thera-py that uses a machine to aim high-energy rays at thecancer. Also called external-beam radiation.

Fallopian tubes (fa-LO-pee-in): Part of the femalereproductive tract. The long slender tubes throughwhich eggs pass from the ovaries to the uterus.

Fertility (fer-TIL-i-tee): The ability to produce children.

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

Fundus: In a hollow organ (such as the bladder, gall-bladder, stomach, uterus, eye, or cavity of the middleear), the larger part that is farthest away from theorgan’s opening.

Grade: The grade of a tumor depends on how abnormalthe cancer cells look under a microscope and howquickly the tumor is likely to grow and spread. Gradingsystems 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 ofthe female reproductive organs.

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

Hormone receptors: Certain proteins found in the tis-sue of the breast, uterus, and other organs. Hormonescan attach to these proteins, causing changes in thetissue.

Hormone receptor test: A test to measure the amountof certain proteins, called hormone receptors, in cancertissue. Hormones can attach to these proteins. A highlevel of hormone receptors may mean that hormoneshelp the cancer grow.

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Hormone replacement therapy: HRT. Hormones(estrogen, progesterone, or both) given to post-menopausal women or women who have had theirovaries surgically removed to replace the estrogen nolonger produced by the ovaries.

Hormones: Chemicals produced by glands in the bodyand circulated in the bloodstream. Hormones controlthe actions of certain cells or organs.

Hyperplasia (hye-per-PLAY-zha): An abnormalincrease in the number of cells in an organ or tissue.

Hysterectomy (hiss-ter-EK-toe-mee): An operation inwhich the uterus is removed.

Internal radiation (ray-dee-AY-shun): A procedure inwhich radioactive material sealed in needles, seeds,wires, or catheters is placed directly into or near thetumor. Also called brachytherapy, implant radiation, orinterstitial radiation therapy.

Laparoscope (LAP-a-rah-scope): A thin, lighted tubethat is inserted through the abdominal wall to inspectthe inside of the abdomen and remove tissue samples.

Laparotomy (lap-a-RAH-toe-mee): A surgical incisionmade in the wall of the abdomen.

Local therapy: Treatment that affects cells in the tumorand the area close to it.

Lymph node: A rounded mass of lymphatic tissue thatis surrounded by a capsule of connective tissue. Alsoknown as a lymph gland. Lymph nodes are spread outalong lymphatic vessels and contain many lympho-cytes, which filter the lymphatic fluid (lymph).

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Lymphatic system (lim-FAT-ik): The tissues and organsthat produce, store, and carry white blood cells, whichfight infection and other diseases. This system includesthe bone marrow, spleen, thymus, and lymph nodes anda network of thin tubes that carry lymph and whiteblood cells. These tubes branch, like blood vessels, intoall the tissues of the body.

Magnetic resonance imaging (mag-NET-ik REZ-o-nans IM-a-jing): MRI. A procedure in which a magnetlinked to a computer is used to create detailed picturesof areas inside the body.

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

Medical oncologist (on-KOL-o-jist): A doctor whospecializes in diagnosing and treating cancer usingchemotherapy, hormonal therapy, and biological thera-py. A medical oncologist often serves as the main care-taker of someone who has cancer and coordinatestreatment provided by other specialists.

Menopause (MEN-o-pawz): The time of life when awoman’s menstrual periods stop permanently. Alsocalled “change of life.”

Menstruation: Periodic discharge of blood and tissuefrom the uterus. Until menopause, menstruation occursapproximately every 28 days when a woman is notpregnant.

Metastasis (meh-TAS-ta-sis): The spread of cancerfrom one part of the body to another. Tumors formedfrom cells that have spread are called “secondarytumors” and contain cells that are like those in the orig-inal (primary) tumor. The plural is metastases.

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Metastasize (meh-TAS-ta-size): To spread from onepart of the body to another. When cancer cells metasta-size and form secondary tumors, the cells in themetastatic tumor are like those in the original (primary)tumor.

MRI: Magnetic resonance imaging (mag-NET-ik REZ-o-nans IM-a-jing). A procedure in which a magnetlinked to a computer is used to create detailed picturesof areas inside the body.

Myometrium (mye-oh-MEE-tree-um): The muscularouter layer of the uterus.

Osteoporosis (OSS-tee-oh-pa-ROW-sis): A conditionthat is characterized by a decrease in bone mass anddensity, causing bones to become fragile.

Ovaries (O-va-reez): The pair of female reproductiveglands in which the ova, or eggs, are formed. Theovaries are located in the pelvis, one on each side of theuterus.

Pap test: The collection of cells from the cervix forexamination under a microscope. It is used to detectchanges that may be cancer or may lead to cancer, andcan show noncancerous conditions, such as infection orinflammation. Also called a Pap smear.

Pathologist (pa-THOL-o-jist): A doctor who identifiesdiseases by studying cells and tissues under a micro-scope.

Pelvic: Of or relating to the pelvis, the lower part of theabdomen. The pelvic area is located between the hipbones.

Pelvis: The lower part of the abdomen, located betweenthe hip bones.

Primary tumor: The original tumor.

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

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

Radiation therapy (ray-dee-AY-shun): The use of high-energy radiation from x-rays, gamma 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 it may come fromradioactive material that is placed in the body in thearea near cancer cells (internal radiation therapy,implant radiation, or brachytherapy). Systemic radiationtherapy uses a radioactive substance, such as a radio-labeled monoclonal antibody, that circulates throughoutthe body. Also called radiotherapy.

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

Reproductive system: In women, this system includesthe ovaries, the fallopian tubes, the uterus (womb), thecervix, and the vagina (birth canal). The reproductivesystem in men includes the prostate, the testes, and thepenis.

Risk factor: A habit, trait, condition, or genetic alter-ation that increases a person’s chance of developing adisease.

Salpingo-oophorectomy (sal-PIN-go o-o-for-EK-toe-me): Surgical removal of the fallopian tubes andovaries.

Side effects: Problems that occur when treatmentaffects healthy cells. Common side effects of cancertreatment are fatigue, nausea, vomiting, decreasedblood cell counts, hair loss, and mouth sores.

Sigmoidoscopy (sig-moid-OSS-ko-pee): Inspection ofthe lower colon using a thin, lighted tube called asigmoidoscope. Samples of tissue or cells may becollected for examination under a microscope tolearn whether disease is present. Also calledproctosigmoidoscopy.

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Speculum (SPEK-yoo-lum): An instrument used towiden an opening of the body to make it easier to lookinside.

Stage: The extent of a cancer, especially whether thedisease has spread from the original site to other partsof the body.

Staging: Performing exams and tests to learn the extentof the cancer within the body, especially whether thedisease has spread from the original site to other partsof the body.

Surgery: A procedure to remove or repair a part of thebody or to find out whether disease is present.

Symptom: A sign that a person has a condition or dis-ease. Some examples of symptoms are headache, fever,fatigue, nausea, vomiting, and pain.

Systemic therapy (sis-TEM-ik): Treatment that usessubstances that travel through the bloodstream, reach-ing and affecting cells all over the body.

Tamoxifen: An anticancer drug that belongs to the fam-ily of drugs called antiestrogens. Tamoxifen blocks theeffects of the hormone estrogen in the body. It is usedto prevent or delay the return of breast cancer or to con-trol its spread. It is also used to prevent breast cancer inwomen at increased risk for this disease.

Tissue (TISH-oo): A group or layer of cells that arealike in type and work together to perform a specificfunction.

Transvaginal ultrasound: A procedure used to examinethe vagina, uterus, fallopian tubes, and bladder. Aninstrument is inserted into the vagina, and sound wavesbounce off organs inside the pelvic area. These soundwaves create echoes, which a computer uses to create apicture called a sonogram. Also called TVS.

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Tumor (TOO-mer): An abnormal mass of tissue thatresults from excessive cell division. Tumors perform nouseful body function. They may be benign (not cancer-ous) or malignant (cancerous).

Ultrasonography (UL-tra-son-OG-ra-fee): A procedurein which sound waves (called ultrasound) are bouncedoff tissues and the echoes produce a picture(sonogram).

Ultrasound test: A test that bounces sound waves offtissues and internal organs and changes the echoes intopictures (sonograms).

Uterus (YOO-ter-us): The small, hollow, pear-shapedorgan in a woman’s pelvis. This is the organ in which afetus develops. Also called the womb.

Vagina (vah-JYE-na): The muscular canal extendingfrom the uterus to the exterior of the body. Also calledthe birth canal.

X-ray: High-energy radiation used in low doses to diag-nose diseases and in high doses to treat cancer.

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National Cancer Institute InformationResources

ou may want more information for yourself, yourfamily, and your doctor. The following National

Cancer Institute (NCI) services are available to helpyou.

TelephoneCancer Information Service (CIS)

Provides accurate, up-to-date information on cancerto patients and their families, health professionals, andthe general public. Information specialists translate thelatest scientific information into understandablelanguage and respond in English, Spanish, or on TTYequipment.

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

TTY: 1–800–332–8615

InternetThese Web sites may be useful:

http://cancer.gov

NCI’s primary Web site; contains information aboutthe Institute and its programs.

http://cancertrials.nci.nih.gov

cancerTrials™; NCI’s comprehensive clinical trialsinformation center for patients, health professionals,and the public. Includes information on understandingtrials, deciding whether to participate in a trial, findingspecific trials, plus research news and other resources.

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http://cancernet.nci.nih.gov

CancerNet™; contains material for healthprofessionals, patients, and the public, includinginformation from PDQ® about cancer treatment,screening, prevention, supportive care, and clinicaltrials; and CANCERLIT®, a bibliographic database;and a dictionary of medical terms related to cancer andits treatment.

E-mailCancerMail

Includes NCI information about cancer treatment,screening, prevention, and supportive care. To obtain a contents list, send an e-mail tocancermail@cips.nci.nih.gov with the word “help” inthe body of the message.

FaxCancerFax®

Includes NCI information about cancer treatment,screening, prevention, and supportive care. To obtain acontents list, dial 1–800–624–2511 or 301– 402–5874from your touch-tone phone or fax machine handsetand follow the recorded instructions.

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National Cancer Institute Booklets

hese National Cancer Institute (NCI) booklets areavailable from the Cancer Information Service by

calling 1–800–4–CANCER. They are also available onthe NCI Web site, which is located athttp://cancer.gov/publications on the Internet.

Booklets About Cancer Treatment• Chemotherapy and You: A Guide to Self-Help

During Treatment

• Help Yourself During Chemotherapy: 4 Steps forPatients

• Radiation Therapy and You: A Guide to Self-HelpDuring Treatment

• Get Relief From Cancer Pain

• Understanding Cancer Pain

• Pain Control: A Guide for People with Cancer andTheir Families

• Eating Hints for Cancer Patients

• Taking Part in Clinical Trials: What CancerPatients Need To Know

• Datos sobre el tratamiento de quimioterapia contrael cáncer (Facts About Chemotherapy)

• El dolor relacionado con el cáncer (UnderstandingCancer Pain)

• El tratamiento de radioterapia: Guía para elpaciente durante el tratamiento (Radiation Therapyand You: A Guide to Self-Help During Treatment)

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• ¿En qué consisten los estudios clínicos? Un folletopara los pacientes de cáncer (What Are ClinicalTrials All About? A Guide for Cancer Patients)

Booklets About Living with Cancer• Advanced Cancer: Living Each Day

• Facing Forward: A Guide for Cancer Survivors

• Taking Time: Support for People With Cancer andthe People Who Care About Them

• When Cancer Recurs: Meeting the Challenge

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This booklet was written and published by the NationalCancer Institute (NCI), 31 Center Drive, MSC 2580,Bethesda, MD 20892–2580. The NCI, the largestcomponent of the National Institutes of Health,coordinates a national research program on cancercauses and prevention, detection and diagnosis, andtreatment. In addition, NCI's mission includesdissemination of information about cancer to patients,the public, and health professionals.

The National Cancer Act, passed by Congress in 1971,made research a National priority. Since that time, theNCI, the lead Federal agency for cancer research, hascollaborated with top researchers and facilities acrossthe country to conduct innovative research leading toprogress in cancer prevention, detection, diagnosis, andtreatment. These efforts have resulted in a decrease inthe overall cancer death rate, and have helped improveand extend the lives of millions of Americans.

The written text of NCI material is in the publicdomain and is not subject to copyright restrictions.Special permission to reproduce or translate NCIwritten text is not necessary. However, we wouldappreciate a credit line and a copy of any translatedmaterial.

The copyright for artwork developed for NCI byprivate sector designers, photographers, and illustratorsunder contract to the Government remains in the handsof the originators. Permission to use or reproduce thesematerials is needed. In many cases, permission will begranted, but a credit line and/or fees for usage may berequired. To learn if permission is required, or toobtain permission to reproduce NCI artwork, write to:Communication Services Branch, Office ofCommunications, National Cancer Institute, Room10A28, 31 Center Drive, MSC 2580, Bethesda, MD20892–2580.

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NIH Publication No. 01–1562Revised April 2001Printed July 2001

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