Uterine Cancer

Endometrial cancer and cancer of the womb are two different terms for the same condition, uterine cancer. It’s a common cancer affecting around one in a hundred women. Every year, nearly nine thousand women in the UK are diagnosed with the disease [1].

Expert support and surgery will help you fight the cancer, but as with most malignancies, it’s better if the condition is picked up at an early stage. There will be a wider range of treatment options and a better chance of survival. The good news is, most uterine cancers are caught quickly and are curable. However, in women who are unwell or who have more aggressive forms of the disease, treatment can be more challenging.

Mr Thomas Ind is an experienced gynaecological surgeon with a special interest in women’s cancer care. He works with a team of health professionals who will support and guide you through your uterine cancer surgery and help you make a safe recovery.

What is the uterus?

The uterus is a muscular organ in the pelvis. It’s an important part of a woman’s reproductive system. It contains and protects a baby in pregnancy and, during birth, the cervix opens to allow the muscles of the womb to contract and propel the baby into the world. The lining of the womb is known as the endometrium. This is what bleeds during the monthly period. The majority of womb cancers originate in this lining, which is why health-professionals often refer to the disease as endometrial cancer.

Who is at risk of uterine cancer?

Each woman’s risk of developing cancer depends on several factors. These can include their age, their lifestyle and their genetic make-up. Research suggests that certain medications, lifestyle factors or a family history of the condition can make some women more vulnerable to the disease.

Too much of the female hormone oestrogen can increase the chance of uterine cancer developing, especially if there is not enough of the hormone progesterone. This means that women receiving hormone replacement therapy (HRT) containing oestrogen and no progesterone can be at risk.

Womb cancer is also more common in women who are overweight. The fat tissue, or adipose, produces oestrogen, which can increase the danger of endometrial cancer developing.

Other conditions associated with being overweight including hypertension and diabetes are also linked with the development of womb cancer. However, this may just be an association and not a direct cause of the condition.

Does age affect the chance of developing uterine cancer?

Endometrial cancer is commonest in women in their mid to late fifties. Around three quarters of women are between 40 and 74 at diagnosis and the condition is rare before the age of 40.

Most women with uterine cancer have had their menopause. This is why any woman who notices abnormal vaginal bleeding after the menopause should have expert assessment and investigation. Although this cancer is very unusual in younger women, it does happen. More than 1 in 100 cases occur in women under 40, so no one should ignore troubling symptoms [2].

What are the symptoms of uterine cancer?

Unusual vaginal bleeding is the most common symptom of uterine cancer. Look out for:

  • Any vaginal bleeding after the menopause.
  • Abnormal or heavier vaginal bleeding before the menopause, this may include bleeding between periods.
  • Vaginal discharge, which may be pink, dark or unpleasant smelling.

Cancers within the walls of the uterus, known as sarcomas, can be more aggressive and often present with different symptoms. These include:

  • A lump or fullness in the lower abdomen.
  • Bloating
  • Change of bowel habit.
  • Pressure on the bladder leading to needing to pass water more frequently.

All of these symptoms can also be caused by other, much less serious conditions, so there’s no need to panic. However, it’s important to see a doctor quickly. With any cancer, catching it quickly is the key to having the best chance of curing the disease.

What causes uterine cancer?

Uterine cancer is believed to be linked to the female hormone oestrogen. It is produced by the ovaries and is a normal and natural chemical messenger with a vital role in menstruation, fertility and pregnancy. However, oestrogen makes the endometrial cells divide, if this process goes wrong the cells can become cancerous. Too much oestrogen without enough of the moderating influence of its opposing hormone progesterone can increase the risk of womb cancer. So, anything that boosts the level of oestrogen, or increases lifetime exposure, could be linked to the condition. This includes:

  • Some forms of HRT: Oestrogen is a component of hormone replacement therapy drugs. If it is given without progesterone there is an increasing danger of cancer developing.
  • Obesity: Fat cells can produce oestrogen.
  • PCOS: Polycystic Ovarian Syndrome.
  • Early age of first menstruation and late menopause.

Prevention of uterine cancer

A number of lifestyle and reproductive factors can have an impact on your risk of developing uterine cancer. You may be able to protect yourself from the disease in a number of ways:

  • Eat a healthy diet which is low in fat and sugar
  • Exercise regularly
  • If you are overweight, try and get to a healthy BMI
  • Taking the pill: The combined pill can protect against uterine cancer, with better effects the longer it is taken
  • Pregnancy: Having children can drop your risk of endometrial cancer by a third- and the more you have, the lower the risk.

Diagnosing uterine cancer

If you see your doctor with abnormal bleeding, they will examine you and arrange for some tests to be done. The first investigation is usually an ultrasound scan. The sonographer can take measurements of the thickness of the lining of the womb. A thickened endometrium could indicate endometrial cancer and further investigations may be necessary.

At this stage, your GP may refer you to an accredited gynaecological oncology surgeon, such as Mr Thomas Ind. Mr Ind can check for the presence of cancer cells by taking a biopsy. This is done by inserting a small plastic device through the vaginal and cervix, a little like a smear test. Some tissue is extracted from the womb lining and the cells are examined under a microscope.

If there is still doubt as to the possible cause of any abnormal bleeding, a telescope will be used to examine the lining of the womb. This test is called hysteroscopy. Find out more about the procedure, recovery and potential complications here.

Cancer or endometrial hyperplasia?

Endometrial hyperplasia is an overgrowth of the tissue lining the womb. It can be diagnosed by endometrial biopsy or examination of samples taken during hysteroscopy.

Endometrial hyperplasia can cause similar symptoms to those of uterine cancer. If left untreated, the condition could lead on to cancer. But if it’s identified at an early stage, it is completely treatable with the hormone progesterone. When the hyperplasia is more advanced, a hysterectomy is required.

Treatment of uterine cancer

The best treatment for your uterine cancer will depend on the size, severity and extent of the disease.  Mr Thomas Ind will talk you through all the options and make his therapeutic recommendation, taking into account your personal feelings and your general health and wellbeing.

Hysterectomy: Treatment is initially by surgery to remove of the womb and ovaries. Sometimes it is necessary to remove the glands in the pelvis. This is a big operation which will be done under general anaesthetic. Such extensive surgery is always associated with some risk.

Non-surgical treatment for uterine cancer:  Depending on the stage and severity of your cancer, you may need further treatment to destroy any remaining cancer cells, prevent spread and decrease the risk of the disease recurring.

A number of women need Radiotherapy, which uses high strength radiation to destroy cancer cells. Two types of radiotherapy commonly used.

  • Vaginal radiotherapy: A probe is placed into the vagina to target the radiation at the affected area. This treatment is usually repeated two or three times. It can be uncomfortable but the therapist will be supportive and sensitive to your needs.
  • Pelvic radiotherapy: The irradiation is applied from the outside. This is used in more advanced forms of womb cancer and usually involves daily treatment for five or six weeks.

Chemotherapy may be used for uterine cancer that has spread. A combination of specialist drugs is given, usually in a dedicated ward on an outpatient basis. These can help prevent the cancer cells dividing and proliferating.

Radiotherapy and chemotherapy can both cause serious side effects and may affect your general health and wellbeing. Find out more at Macmillan.org.uk.

Recovery from uterine cancer

Most endometrial cancers present at an early stage before they spread beyond the womb. These are often curable with surgery in expert hands, in fact 95% of women will be cancer-free after five years [3].

If a woman is obese or has other chronic conditions such as diabetes or high blood pressure, then surgery may be hazardous. This can increase the risk of complications and may also reduce the risk of a cure.

Advanced cancers and most uterine sarcomas which develop in the muscle of the womb are more challenging to treat and, sadly, often have worse outcomes. The overall uterine cancer statistics suggest that ten years after diagnosis, three quarters of women treated for the condition will have survived [4].

Recurrence of uterine cancer

Unfortunately, womb cancer that returns after treatment has a poor prognosis. Finding out your cancer has come back can be shattering, but there will be a team of health professionals to manage your symptoms and support you at this difficult time.

Careful assessment and consultation will help Mr Ind and his team work out the best therapeutic options for you. If the cancer has recurred in a single spot, at the top of the vagina, it may be possible to excise it surgically. Alternatively, radiotherapy can help if it you haven’t already had it. Other treatments for recurrent womb cancer include chemotherapy and hormone treatment.

[1] http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer/incidence

[2] http://www.cancerresearchuk.org/about-cancer/womb-cancer/about

[3] http://www.cancerresearchuk.org/about-cancer/womb-cancer/survival

[4] http://www.cancerresearchuk.org/about-cancer/womb-cancer/survival