Womb Cancer

Cancer of the womb can be called several different names by your healthcare professional including uterine cancer because this is the medical name for the womb, or endometrial cancer which is cancer within the lining of the womb.

Womb cancer is the fourth most common cancer in women in the UK and the most common of the five gynaecological cancers, with over 9,300 women diagnosed every year in the UK.

How does it develop?

Most womb cancers begin in the endometrium (womb lining), where the cells that grow are then shed each month as menstrual loss (a period)

When a womb cancer starts, the normal cells change their appearance, increasing in size and shape, until they become cancer cells that divide and grow into a tumour.

As the cancer develops, it often causes an unexpected vaginal bleed. Womb cancer is more common amongst post-menopausal women and therefore any vaginal bleeding should be reported to your GP immediately. Yet, if you’re a woman who is still menstruating and experience an unexpected bleed, whilst it could be a less serious issue e.g. hormonal imbalance, it is still important to see your GP to find the cause of the problem.

Key signs and symptoms

The most common symptom of womb cancer is abnormal vaginal bleeding – especially for women who have been through the menopause.Around 90% of endometrial cancer diagnoses are reported due to post-menopausal or irregular vaginal bleeding.

Please note though that most people with abnormal bleeding will not have a gynaecological cancer.

This irregular bleeding might be:

  • Vaginal bleeding after the menopause
  • Bleeding between periods
  • Bleeding that is unusually heavy
  • Vaginal discharge – from blood-stained to a light or dark brown

For post-menopausal women it can take a while to adjust to what is now ‘normal’ in terms of your vaginal discharge. If you are uncertain, the best course of action is to approach your doctor or nurse to ask: “Is this normal?”

Risk Factors

There are many different types of womb cancer. The majority occur with no obvious cause, however we know that an excess of oestrogen (female hormone) increases your risk as it can actively promote unwanted cell changes.

A very small percentage of womb cancers are linked to a genetic (hereditary) condition called Lynch Syndrome.

A number of things can cause excess oestrogen such as an elevated Body Mass Index (BMI), as oestrogen is stored in the body’s fat cells. It’s not always possible to prevent womb cancer, but some things are thought to reduce your risk, for example maintaining a healthy weight.

How is it diagnosed?

You should visit your GP if you have abnormal vaginal bleeding. While it’s unlikely to be caused by cancer of the womb, it’s best to be sure.

Sometimes women will ignore their uterine cancer symptoms because they have recently had a cervix cancer smear and it was clear. However, the condition cannot be picked up by the cervical smear because the smear test only looks for abnormalities at the neck of the womb, looking for problems with the cervix; whereas womb cancer develops deeper into the body in the womb lining: the endometrium.

So even if you have recently had a clear smear test, if you are bleeding erratically or experiencing unusual discharge, your womb could be signalling there’s a problem, so it’s important to get it checked.

To do so, your GP will most probably carry out a physical examination of your pelvic area, including your vagina, womb, ovaries, and bladder. They will ask about the nature of your womb cancer symptoms, when they happen, and how often.

You may be referred for further tests which include a Transvaginal Ultrasound and a biopsy:

Transvaginal ultrasound (TVU)
Another test you may have is called a transvaginal ultrasound (TVU). TVU is a type of ultrasound scan that uses a small scanner.

Placed directly into the vagina to obtain a detailed picture of the inside of the uterus, the probe can feel a little uncomfortable for those yet to have sex or women with vaginismus, but shouldn’t be painful.

The TVU checks whether there are any changes to the thickness of the lining of your uterus that could be caused by the presence of cancerous cells.

Biopsy
If the results of the TVU detect changes in the thickness of the lining of the womb, you will usually have a biopsy to get a diagnosis.

A biopsy involves removing a sample of cells from the inside of the womb (the endometrium). The sample is then checked at a laboratory to get a diagnosis.

This involves a minor surgical procedure carried out under general anaesthetic, where some tissue from the womb lining is biopsied. Sometimes it is not possible to take a biopsy in the outpatient clinic and some women choose to have this done with an anaesthetic.

In some cases, a hysteroscopy (internal examination of the womb) may be conducted before under-going dilation and curettage.

Treatment

The most common treatment for endometrial cancer is the surgical removal of the womb (hysterectomy). If you report your uterine cancer symptoms soon enough treatment can be curative because the cancer will not have invaded the womb lining. When diagnosed early, cancer of the womb can often be cured by surgery alone, without the need for chemotherapy.

A hysterectomy can cure womb cancer in its early stages, but you will no longer be able to menstruate or get pregnant. Surgery for cancer of the womb is also likely to include the removal of the ovaries and fallopian tubes.

Radiotherapy or chemotherapy are also sometimes used, often in conjunction with surgery.

A type of hormone therapy may be used if you are yet to go through the menopause and would still like to have children. Although this is not normal practice, it can be used for a type of womb cancer and only after you’ve fully understood the risks.

Even if your cancer is advanced and the chances of a cure are small, treatment can still help to relieve the uterine cancer symptoms and prolong your life.