Uterine cancer refers to all malignancies arising from the body of the uterus. The large majority (around 90%) are endometrial carcinomas — cancers of the inner lining of the uterus. The remaining 10% are uterine sarcomas, which arise from the muscle or connective tissue of the uterine wall and are distinctly different in behaviour and treatment. Uterine cancer is now the most common gynaecological cancer in urban India and is increasing in incidence, driven by rising rates of obesity and metabolic syndrome.
The good news: most uterine cancers are diagnosed at an early stage because they cause postmenopausal bleeding — a symptom that prompts rapid medical attention. Early-stage uterine cancer is highly curable with surgery alone, with five-year survival rates exceeding 95% for Stage I disease.
Dr. Nishtha Tripathi Patel performs total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymph node staging for uterine cancer, including sentinel lymph node mapping, at Sterling Hospitals and KD Hospital, Ahmedabad.
Trust Signals
- Specialty: Gynecologic Oncology
Types of Uterine Cancer
Endometrial carcinomas (90%):
- Endometrioid adenocarcinoma (Type I) — the most common subtype (~80% of endometrial carcinomas). Strongly linked to oestrogen excess (obesity, unopposed HRT, PCOS). Usually low-grade at diagnosis and carries an excellent prognosis.
- Serous carcinoma (Type II) — aggressive, high-grade tumour unrelated to oestrogen. Often presents at an advanced stage. Associated with TP53 mutations. Behaves similarly to high-grade ovarian cancer.
- Clear cell carcinoma (Type II) — rare, high-grade, and carries a worse prognosis than endometrioid. Often diagnosed at Stage I but with a higher risk of relapse.
- Carcinosarcoma (MMMT) — contains both carcinoma and sarcoma elements. Highly aggressive; classified as a high-grade carcinoma. Requires aggressive surgical and chemotherapy treatment.
Uterine sarcomas (10%):
- Leiomyosarcoma (LMS) — arises from uterine smooth muscle. Often misdiagnosed preoperatively as a benign fibroid. Carries a poor prognosis at advanced stages.
- Endometrial stromal sarcoma (ESS) — low-grade (LGESS) or high-grade (HGESS). LGESS is hormone-sensitive and has a relatively indolent course; HGESS is aggressive.
- Undifferentiated uterine sarcoma (UUS) — rare, highly aggressive, no specific differentiation.
Risk Factors
Most risk factors for endometrial cancer relate to excess or prolonged oestrogen exposure:
- Obesity — the most significant modifiable risk factor. Adipose tissue converts androgens to oestrogen, leading to unopposed oestrogen stimulation of the endometrium. Obese women have a 2–4 times higher risk than women of normal weight.
- Oestrogen-only HRT — postmenopausal women taking oestrogen without progesterone have a significantly increased risk. Combined oestrogen-progesterone HRT does not carry this risk.
- Tamoxifen use — used to treat breast cancer, tamoxifen acts as an oestrogen agonist in the endometrium and increases endometrial cancer risk with long-term use (>5 years).
- PCOS (polycystic ovary syndrome) — causes chronic anovulation with unopposed oestrogen, increasing endometrial cancer risk in younger women.
- Nulliparity and infertility — women who have never been pregnant have a higher risk.
- Lynch syndrome (HNPCC) — women with Lynch syndrome have a 40–60% lifetime risk of endometrial cancer; this is often their first cancer and typically occurs before age 50.
- Diabetes mellitus and hypertension — both are independently associated with increased risk, partly through insulin resistance and its effect on oestrogen metabolism.
- Late menopause (after age 55) — prolonged oestrogen exposure through extended reproductive years.
Protective factors include pregnancy, breastfeeding, combined oral contraceptive use, and physical activity.
Symptoms and Diagnosis
Key symptom: Postmenopausal bleeding (PMB) — any vaginal bleeding occurring 12 or more months after the last menstrual period — is an endometrial cancer until proven otherwise. Approximately 10% of women with PMB have endometrial cancer. Do not wait for bleeding to resolve or assume it is normal.
In premenopausal women: abnormal uterine bleeding, heavy or prolonged periods, or intermenstrual bleeding, particularly after age 40 or with risk factors.
Diagnostic pathway:
- Transvaginal ultrasound (TVS) — measures endometrial thickness. In postmenopausal women not on HRT, an endometrial thickness ≤4 mm has a very low likelihood of endometrial cancer (negative predictive value >99%); thickness >4 mm requires further investigation.
- Endometrial biopsy (Pipelle) — an outpatient procedure in which a thin suction device samples endometrial tissue through the cervix. Sensitivity ~80–90% for endometrial carcinoma.
- Hysteroscopy + directed biopsy (D&C) — direct visualisation of the uterine cavity with targeted biopsy. The gold standard when Pipelle is inconclusive or when a focal lesion is suspected.
- MRI pelvis — assesses depth of myometrial invasion (critical for staging), cervical involvement, and lymph node status. Determines surgical planning and informs the need for lymphadenectomy.
- CT chest/abdomen/pelvis — for high-grade or advanced tumours to assess for extra-uterine spread.
Staging (FIGO 2023)
Uterine cancer is staged surgically. The updated FIGO 2023 system incorporates molecular classification:
- Stage I — Confined to the uterus
- IA: ≤50% myometrial invasion (with or without LVSI)
- IB: >50% myometrial invasion
- IC: Serous, clear cell, carcinosarcoma, or undifferentiated histology confined to endometrium or inner half of myometrium (regardless of size)
- Stage II — Cervical stromal invasion or LVSI-substantial
- IIA: Cervical stromal invasion
- IIB: Substantial LVSI in any grade 3 or aggressive histology
- Stage III — Spread beyond the uterus within the pelvis
- IIIA: Ovaries, tubes, or uterine serosa
- IIIB: Vaginal or parametrial involvement
- IIIC1: Pelvic lymph node metastasis
- IIIC2: Para-aortic lymph node metastasis
- Stage IV — Bladder, bowel mucosa, or distant spread
- IVA: Bladder or bowel mucosal involvement
- IVB: Distant metastasis (lung, liver, bone, brain, inguinal lymph nodes)
Treatment
Surgery — the mainstay of treatment:
- Total laparoscopic hysterectomy (TLH) + bilateral salpingo-oophorectomy (BSO) — the standard operation for all stages of uterine cancer. Removal of the uterus, cervix, fallopian tubes, and ovaries. Dr. Nishtha performs this minimally invasively, with benefits including shorter hospital stay, less pain, and faster recovery compared to open surgery.
- Lymph node staging — pelvic (and para-aortic when indicated) lymphadenectomy or sentinel lymph node mapping using fluorescent dye (ICG) is performed to determine lymph node involvement and guide adjuvant therapy decisions.
- Peritoneal biopsies and omentectomy — for high-grade or aggressive histological subtypes (serous, clear cell, carcinosarcoma), comprehensive staging including peritoneal sampling is recommended.
Adjuvant treatment (after surgery):
- Vaginal brachytherapy (VBT) — for intermediate-risk Stage I disease. Local radiation to the vaginal cuff; reduces vaginal vault recurrence without systemic side effects.
- External beam radiotherapy (EBRT) — for high-risk Stage I and Stage II disease. Treats pelvic lymph node fields.
- Chemotherapy (carboplatin + paclitaxel) — for high-grade histologies (serous, clear cell, carcinosarcoma) and Stage III/IV disease. May be combined with radiotherapy as “sandwich” therapy.
- Lenvatinib + pembrolizumab — for mismatch repair proficient (pMMR) advanced or recurrent endometrial cancer; the KEYNOTE-775 trial demonstrated significant survival improvement and is now approved for second-line treatment.
- Dostarlimab or pembrolizumab — for MSI-high / dMMR endometrial cancer; demonstrated dramatic response rates in both first and subsequent lines.
Treatment planning is guided by Dr. Nishtha Tripathi Patel, Consultant Gynecological Oncosurgeon in Ahmedabad.
Consultation available in Ahmedabad, Surat, Vadodara, and Gandhinagar.
Frequently Asked Questions
- Is postmenopausal bleeding always a sign of uterine cancer?
No — postmenopausal bleeding has many causes, including vaginal atrophy (the most common cause), endometrial polyps, submucosal fibroids, endometrial hyperplasia, and cervical lesions. However, approximately 10% of cases are caused by endometrial cancer. Because the consequences of missing a cancer diagnosis are severe, all postmenopausal bleeding should be evaluated without delay. A transvaginal ultrasound measuring endometrial thickness, followed by endometrial biopsy if the lining is thickened, is the standard first-line investigation.
- Can uterine cancer be treated without a hysterectomy?
For most women with endometrial cancer, hysterectomy is the standard treatment. However, for highly selected younger women with early-stage, low-grade endometrial cancer (Stage IA Grade 1 endometrioid) who have not yet completed their family, fertility-sparing management using high-dose progestin therapy (medroxyprogesterone acetate or levonorgestrel IUD) can be considered as a temporary measure. This approach requires very careful patient selection, close monitoring with serial biopsies every 3–6 months, and commitment to definitive hysterectomy once childbearing is complete. It is not appropriate for high-grade, deep invasion, or sarcoma subtypes. Dr. Nishtha can discuss whether this approach is suitable for your situation.
- What is Lynch syndrome and should I be tested?
Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC) is an inherited condition caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2). It significantly increases the lifetime risk of endometrial cancer (40–60%), colorectal cancer (50–80%), ovarian cancer, and several other cancers. Lynch syndrome testing is recommended if you have endometrial cancer diagnosed before age 50, a personal or family history of Lynch-associated cancers, or abnormal mismatch repair protein expression on tumour immunohistochemistry. Identifying Lynch syndrome has important implications for your own surveillance and for testing your family members.
- What is the recovery like after laparoscopic hysterectomy for uterine cancer?
Most women who undergo total laparoscopic hysterectomy for early-stage uterine cancer are discharged from hospital within 1–2 days. Pain is typically manageable with oral analgesics. Most patients return to light activity within 2 weeks and resume normal activities within 4–6 weeks. The minimally invasive approach significantly reduces the risk of wound complications and hernia compared to open surgery. Driving can typically resume 2–3 weeks after surgery once you can perform an emergency stop comfortably. Sexual intercourse is usually safe after 6–8 weeks once the vaginal vault has healed.
- Does uterine cancer affect my hormones or cause early menopause?
Yes. Bilateral salpingo-oophorectomy (removal of both ovaries) — which is performed as part of staging for uterine cancer — causes immediate surgical menopause in premenopausal women. This can result in hot flushes, night sweats, sleep disturbance, mood changes, vaginal dryness, and (over time) bone density loss. For low-risk endometrioid cancer, hormone replacement therapy (HRT) is generally considered safe after surgery and can significantly improve quality of life. However, for hormone-sensitive subtypes (serous, clear cell) or in women with other contraindications, non-hormonal management strategies are used. Dr. Nishtha will discuss menopausal symptom management at your post-operative consultation.
- What is the difference between uterine cancer and endometrial cancer?
Endometrial cancer is the most common type of uterine cancer — it arises from the inner lining (endometrium) of the uterus and accounts for approximately 90% of uterine cancers. Uterine cancer is the broader term that also includes uterine sarcomas (arising from the muscle or connective tissue of the uterine wall). The distinction matters clinically because sarcomas and endometrial carcinomas have different staging systems, treatment approaches, and prognoses. When most people refer to “uterine cancer,” they typically mean endometrial carcinoma.