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Womb cancer

About 6,000 women develop womb cancer in the UK every year. It's most common between the ages of 50 and 64.

  • About womb cancer
  • Types of womb cancer
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • After your treatment
  • Prevention
  • Further information
  • Sources
  • Related topics

About womb cancer

The womb is a pear-shaped, muscular organ in a woman's lower abdomen. It's where babies develop when a woman is pregnant. The lining of the womb is called the endometrium or endometrial layer. As the menstrual cycle progresses, the endometrium becomes increasingly thick and full of blood vessels.

If an egg is fertilised, it implants in the endometrial layer where it receives nourishment and begins to develop into a baby. If you don't become pregnant, you have a period: the thickened endometrial layer is shed, and the menstrual cycle begins again.

Womb cancer develops in the lining or the wall of the womb. It's caused by an abnormal and uncontrolled growth of cells. It can be malignant (cancerous) or benign (not cancerous).

Malignant tumours can grow through your womb and spread to other parts of your body through the bloodstream or the lymph system. If these cells start to grow in other areas, they can form secondary tumours. When cancer spreads in this way it's called a metastasis.

Benign tumours don't spread to other areas of the body.

Womb cancer often causes symptoms quite early and so treatment can be very effective.

Types of womb cancer

There are two types of womb cancer:

  • endometrial cancer, which starts in the endometrial layer of the womb
  • uterine sarcoma, which develops in the muscle wall of the womb, is a rarer type of womb cancer that is harder to treat

Eight out of 10 cancers of the womb are endometrial cancers.

Symptoms

There are a number of symptoms that might be caused by cancer of the womb. These include:

  • bleeding after the menopause
  • bleeding between periods
  • unusually heavy vaginal bleeding
  • vaginal discharge
  • pain in the lower abdomen (tummy), back or legs
  • loss of weight or appetite
  • changes in bowel habits or passing water more frequently
  • pain or discomfort during sex

If you notice any of these symptoms, talk to you GP. It's important to remember that cancer isn't the only cause of these symptoms. However, early diagnosis makes it easier to treat womb cancer so it's worth seeing a doctor quickly.

Causes

No one knows exactly what causes womb cancer. However, there are a number of factors that increase your risk of developing it.

  • Endometrial cancer is most common among women aged between 50 and 64, or after the menopause. Three-quarters of women who develop endometrial cancer have gone through the menopause.
  • Going through the menopause after the age of 52 increases the risk of endometrial cancer.
  • Being obese (very overweight) puts you at higher risk of developing endometrial cancer.
  • If other close family members have had bowel, stomach, ovarian or womb cancer, you may have a slightly increased risk of developing endometrial cancer.
  • Hormone replacement therapy (HRT) slightly increases the risk for endometrial cancer, especially when taken in the long-term.
  • Unknown factors in the environment - for example, the incidence of endometrial cancer is higher in the US and Europe compared to the rest of the world.
  • Having diabetes increases the risk of endometrial cancer.
  • Never having children makes you more likely to develop womb cancer.
  • If you have had breast or bowel cancer, there is a slightly increased risk.
  • Tamoxifen, which is used to treat breast cancer, can slightly increase the risk of developing endometrial cancer. However, the benefits from taking tamoxifen will far outweigh any risks.

These risk factors also make some types of uterine sarcomas more likely. Uterine sarcoma is also more common in African-Caribbean women, and in women who have previously had radiotherapy in the pelvic area.

Diagnosis

If your GP suspects that you have womb cancer, he or she will refer you to a specialist. You may have a number of tests to confirm or rule out womb cancer. Some examples are listed below.


Hysteroscopy

A narrow, bendable tube with a light and camera on the end is guided through the cervix so that the doctor can examine the inside of the womb and look for signs of cancer. It's sometimes carried out with a local anaesthetic to prevent pain. Your doctor may also take a biopsy at the same time (see below).

Biopsy

Your doctor may want to take a small sample of the womb lining. A narrow, bendable tube is guided through the cervix. Some cells from the endometrium are removed using light suction, and these are sent to the laboratory to be checked.

Dilation and curettage (D&C)

If the biopsy doesn't provide enough tissue to make a diagnosis, your doctor may want to carry out a procedure called dilation and curettage. This is carried out under general anaesthesia, which means you will be asleep during the procedure and feel no pain. It involves stretching the cervix so that larger samples can be scraped from the lining of the womb for examination in a laboratory.

Vaginal ultrasound

A small ultrasound probe is gently put into your vagina. This emits ultrasound waves. Using the echoes produced, a computer creates an image of the inside of your womb. Measuring the thickness of the womb lining can help to diagnose womb cancer.

If you are diagnosed with womb cancer, you might need to have some further tests.

Computerised tomography (CT) scan

CT scan uses X-rays to make a three-dimensional picture of the body/or part of the body. This can be useful in checking if or how far cancer has spread. You may also be given an injection of a dye into a vein in your arm, which makes the image clearer.

Magnetic resonance imaging (MRI) scan

An MRI scan uses magnets and radio waves to produce two- and three-dimensional pictures of the inside of your body. You may also be given an injection of dye, which helps to produce clearer images. MRI scans can be useful for seeing if womb cancer has spread.

Chest X-ray

You might have a chest X-ray to check if your lungs are clear, as sometimes the cancer can spread to your lungs.

Blood tests

You may have a blood test to check kidney function and to check the amount of different types of blood cells present.

Treatment

If you are diagnosed with womb cancer, there are several treatment options. Your treatment will depend on a number of factors including the grade of cancer (how fast it's growing) and stage of cancer (the size and whether it has spread). Endometrial cancer and uterine sarcoma are treated in similar ways.

Surgery

Hysterectomy

The most common method of treating womb cancer is a hysterectomy - the surgical removal of the womb. The aim is to remove all traces of the cancer. Hysterectomy is often successful at curing womb cancer if the cancer is found at an early stage.

Non-surgical treatment

Radiotherapy

Radiotherapy involves using radiation to kill the cancer cells. It may be used after surgery to try and prevent the cancer coming back. It might also be used to shrink a tumour before surgery is carried out (neo-adjuvant treatment).

There are two types of radiotherapy, which are listed below.

  • External radiotherapy. A machine that creates a narrow beam of radiation is directed at the cancerous area of the womb. You will usually have to go to hospital for treatment every day on Monday to Friday for a few weeks.
  • Internal radiotherapy. This involves implanting radioactive material in the uterus, to kill the cancer. The radioactive material is implanted in the womb using an applicator inserted through the vagina and cervix. This is carried out under general anaesthetic. You will have to stay in hospital for a few days while you have this treatment.

Chemotherapy

Chemotherapy is sometimes used to treat cancer that comes back or cancer that has spread to other parts of the body.

Chemotherapy medicines are given to destroy the cancer cells. However, they can also have side-effects such as making you feel tired or ill, or cause nausea or hair loss.

There are lots of different types of chemotherapy drugs; usually they are injected into a vein but sometimes tablets are used. Chemotherapy is usually given as a series of treatments.

The side-effects will go away when your treatment is stopped, and any lost hair will usually grow back.

Hormone therapy

Progesterone is a natural hormone in women that, among other things, helps regulate the menstrual cycle and pregnancy. Artificial progesterone is sometimes given as it can help slow the growth of womb cancer if it returns after other types of treatment, or if it has spread to other parts of the body. It can be given as a tablet or by injection. This type of treatment has very few side-effects.

After your treatment

After your treatment has been completed your doctor will want to see you in clinic regularly. You may have blood tests, examinations or scans and he or she will ask if you have any symptoms. This is to check for signs of the cancer coming back.


Prevention

Eating a healthy, well balanced diet, and exercising regularly so that you are not obese will help to keep your risk of womb cancer at a minimum.

Further information

Cancerbackup

Cancer Research UK

Sources

  • Cancer of the womb. Cancerbackup. www.cancerbackup.org.uk, accessed 28 June 2007
  • Rose PG, Endometrial carcinoma. N Engl J Med, 1996. 335: 640-649
  • Souhami R and Tobias J, Cancer and its management. 5th ed. Vol. 291-294: Blackwell publishing Ltd, 2005
  • Cassidy J, Bissed D, Roy AJ, et al. Oxford handbook of oncology: Oxford University Press, 2002: Oxford: 422
  • Womb cancer at a glance. Cancer Research UK. www.cancerhelp.org.uk, accessed 2 July 2007
  • Amant F, Moerman P, Neven P, et al. Endometrial cancer. Lancet 2005; 366: 491-505
  • Detailed Guide: Uterine Sarcoma. American Cancer Society. www.cancer.org, accessed 02 July 2007

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