Amanda Wilde (Host): Uterine cancer is the most common reproductive cancer. It has a super high cure rate, and yet, uterine cancer is increasing in the U.S. Gynecologic Oncologist Dr. Heather Williams from University of Arkansas for Medical Sciences is here to explain risk factors, what to look out for, and misconceptions about uterine cancer.

 This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Amanda Wilde. Dr. Williams, so glad to have you here.

Heather Williams, MD (Guest): I am so glad to be here. Thanks for inviting me, Amanda.

Host: Well, first, let's define our terms. What is uterine cancer?

Heather Williams, MD (Guest): Great question. Uterine cancer is a cancer that arises from the endometrial layer of the uterus, or commonly known as the womb, where women would carry a pregnancy.

Host: So are uterine cancer and endometrial cancer the same or different?

Heather Williams, MD (Guest): They are essentially the same. There are some other more rare types of cancer that arise from the muscle layer of the uterus. And so those would also fall under the umbrella of uterine cancer. But commonly, what we see most often are just cancers that arise from the endometrial layer, which is the inner layer, and where women have their menstrual cycle each month, that's the layer that kind of sheds, and that's the cancers that are most common. So it's easier to just kind of umbrella term it as uterine cancer.

Host: Mm hmm. So the majority of uterine cancers are of one kind. Are there symptoms we should look out for?

Heather Williams, MD (Guest): Yes. So the number one symptom for uterine cancer or endometrial cancer, is bleeding. Most often we see this in women who have gone through menopause. And so we call that postmenopausal bleeding. But we can also see it in younger women who have not gone through menopause, who are having abnormal periods, meaning that they don't have a cycle each month or they may go several months without having a cycle.

Host: So postmenopausal women, what about other risk factors for uterine cancer?

Heather Williams, MD (Guest): Women who have a family history of uterine cancers are obviously potentially at risk for developing this type of cancer. Women who have never had children are at increased risk. Obesity is also a risk factor as well. And then like I said, women with a history of irregular menstrual cycles.

Host: And what about genetics? Do women have a genetic predisposition to uterine cancer?

Heather Williams, MD (Guest): Some women do, if certain cancers run in their family. A lot of times this is cancers that are associated with colon cancer. There is a condition called Lynch syndrome, that can make a woman more likely to get uterine cancer if her family had that.

Host: So those are the risk factors we can identify. Can we control them in any way?

Heather Williams, MD (Guest): There are a few that we can, like I said, uterine cancer is affected by obesity, and so if women can work to achieve a more normal weight for themselves or have a healthy, active lifestyle, then that can decrease their risk for developing this cancer. And then the other thing is just being period aware.

So if you are past the age of menopause, you should not have any bleeding. If you are still young and not gone through menopause yet, then you should be having a period at least, every six weeks. Otherwise, what happens is the lining of the uterus kind of grows too much um, and then these abnormal or cancer cells have an opportunity to form.

Host: So it sounds like you have a little bit of control over risk factors, but you wouldn't say uterine cancer is preventable, would you?

Heather Williams, MD (Guest): No. There are certainly patients who don't have any risk factors and are still developing this type of cancer, so there's still a lot to learn about it.

Host: But the most common type of uterine cancer is highly curable, usually because it's caught on the early side. So why is the rate of occurrence of this cancer going up?

Heather Williams, MD (Guest): That's a good question. We think it's because the increasing rates of obesity, both here in Arkansas and across the United States, because there is a relationship between obesity and the development of uterine cancer. And so that is potentially one explanation.

Host: So like you said, there's a lot still to learn, but as we are now, what are the treatment options?

Heather Williams, MD (Guest): So the most common treatment option is surgery. And so most women will be cured with surgery. There is, of course, a subset of women who will also need chemotherapy and or radiation to complete their treatment. But for most, the prognosis is good because there is a sign or a warning that something is wrong. Like I said with either bleeding when they shouldn't be or if their periods are not regular.

Host: So, don't be complacent about abnormal or irregular bleeding, is what I'm hearing.

Heather Williams, MD (Guest): Yes. It's very important to go ahead and reach out to your primary care doctor, or your regular OBGYN, if you start seeing any bleeding when you've gone through menopause.

Host: And it seems it would be wise, just as a preventive measure, to make sure you do see your gynecologist somewhat regularly, yearly, perhaps.

Heather Williams, MD (Guest): Yes, um, I, every woman should have a annual well woman exam at least every one to two years, because they need an exam. They need to make sure they're up to date on their PAPsmears, which screens for a different cancer, cervical cancer, but also at the OBGYN, they can make sure that they're up to date on say mammograms, and things like that.

So a well woman exam every one to two years, and that way if you are having any problems, then of course you can talk to your doctor about it.

Host: And lastly, Doctor, what are the common misconceptions about uterine cancer, making people miss the early signs that will get them the quicker, easier way to cure?

Heather Williams, MD (Guest): I think a lot of women go off of what they've seen their family members go through or what their friends have, or what other women in their close knit community have. And so sometimes, they may think something is normal, when in reality, it needs to be examined further or they need to be checked on.

 A lot of women go for months without having periods when they're younger, and they tell us, well, that's what my mom and my grandma told me that was their periods were like, so I just thought it was normal. So, I think that we say being period aware, to really understand, what is normal, and when you should see a doctor is important.

Host: So make sure you're aware of when you're bleeding and whether that's normal or not for your cycle and maybe those wellness checkups, whether or not you're noticing that will also help you on the path to avoid having uterine cancer develop or if it develops from it, going any further.

Heather Williams, MD (Guest): That is correct.

Host: Because you can have uterine bleeding without having uterine cancer, right?

Heather Williams, MD (Guest): Yes, of course. The key thing is determining, you know, what is normal. Really, the take home point is that women who are still pre menopause or haven't gone through the change yet, they should be having a period every four to six weeks. If you're not, then that is not normal, and you should see your doctor.

If you're, of course, bleeding more frequently than that, then of course that's not normal either. And again, see your doctor to discuss, um, further kind of workup of what is going on with your bleeding. And then for women who have gone through menopause, any bleeding needs to be evaluated by a doctor or your primary care provider because really you shouldn't have any vaginal bleeding, at that point.

Host: Dr. Williams, thank you so much for educating us today and raising awareness about the facts about uterine cancer.

Heather Williams, MD (Guest): You are so welcome, and thank you for having me.

Host: To make an appointment at the UAMS Women's Cancer Clinic, please call 501-296-1200. This is UAMS Health Talk from the University of Arkansas for Medical Sciences.