Cancer of the uterus – also called uterine cancer or endometrial cancer – is a less common type of cancer that affects a woman’s reproductive system..
In 90% of cases, uterine/endometrial cancer causes abnormal bleeding from the vagina. Bleeding may start as light bleeding accompanied by watery discharge, which may become heavier over time. Most women diagnosed with uterine/endometrial cancer have gone through menopause, so any vaginal bleeding will be abnormal.
For women who have not gone through menopause, vaginal bleeding can usually consist of:
If uterine/endometrial cancer reaches a more advanced stage, it may cause other symptoms:
The exact cause of endometrial cancer is not known, but there are certain factors that increase the risk of developing this type of cancer.
The risk of developing uterine/endometrial cancer increases with age, with most cases occurring in women over 50.
The risk of developing uterine/endometrial cancer is linked to the increased amount of estrogen in the body. Estrogen is one of the hormones that regulate the functions of the reproductive system in women.
Estrogen and progesterone levels in the body usually balance each other out. If estrogen is not kept in balance by progesterone, the level of estrogen in the body may increase, not being compensated by progesterone.
After menopause, the body no longer produces progesterone, but small amounts of estrogen are still produced. This situation where estrogen is not compensated by progesterone causes endometrial cells to divide, which can increase the risk of uterine/endometrial cancer.
Since estrogen can be produced in fat tissue, being overweight or obese increases estrogen levels in the body. Thus, the possibility of developing uterine/endometrial cancer increases significantly.
Women who are overweight are 3 times more likely to get uterine/endometrial cancer compared to women who are of normal weight. Women with a high degree of obesity are 6 times more likely to develop endometrial cancer than women who are of normal weight.
Women who have not had children are at higher risk of uterine/endometrial cancer. This is because, during pregnancy, the woman has higher levels of progesterone and lower levels of estrogen, with a protective effect on the uterine lining compared to non-pregnant women who have higher amounts of estrogen.
Women with diabetes are twice as likely to develop uterine/endometrial cancer as women without diabetes. Diabetes causes an increase in insulin levels in the body, which can increase estrogen levels..
Endometrial hyperplasia occurs when the lining of the uterus thickens. Women with this condition may be at increased risk of developing uterine/endometrial cancer.
You should visit your GP or gynaecologist if you experience vaginal bleeding. Although this bleeding is unlikely to be caused by uterine/endometrial cancer, it is better to make sure.
Sometimes a blood test can help diagnose uterine/endometrial cancer. This is because some cancerous tumours release certain chemicals into the blood, known as ‘tumour markers’ which can be detected in a blood test.
However, this type of analysis is not completely reliable. The presence of these chemicals clearly does not mean you have uterine/endometrial cancer, and some people with uterine/endometrial cancer do not have these chemicals in their blood.
Another test you may need to have is called a transvaginal ultrasound (TVU).
TVU is a type of ultrasound scan that uses a small scanner in the form of an ultrasound probe. The probe is placed directly into the vagina to obtain a detailed image of the inside of the uterus; it may cause some discomfort, but the procedure is not painful.
TVU checks for changes in the thickness of the uterine lining (endometrium) which can be an indicator of uterine cancer in women after menopause. Ultrasound can also determine if the tumour has spread to the uterine muscle (myometrium).
If the ultrasound shows changes in the thickness of the uterine lining, a biopsy is usually performed to confirm the diagnosis.
The biopsy procedure takes a small sample of cells from the membrane lining the uterus (endometrium). This sample is then analysed at a laboratory to check for the presence of cancer cells.
If you are diagnosed with uterine/endometrial cancer, you may have additional tests to help stage the cancer. Staging the cancer will allow doctors to determine how large the tumour is, whether or not it has spread and what the best treatment options are.
These tests may include:
Medical specialists use a staging system to describe how far the uterine/endometrial cancer has advanced. These stages are:
Surgery is the main treatment for uterine/endometrial cancer, although other methods may be used depending on personal circumstances.
If you have stage I cancer, you will probably have a hysterectomy. This involves removal of both the ovaries and fallopian tubes (bilateral salpingo-oophorectomy, or BSO) and the uterus (a procedure called hysterectomy).
The surgeon may also take samples from lymph nodes in the pelvis and abdomen, and from other nearby tissue. These will be sent to the lab to see if the cancer has spread.
The most common hysterectomy technique involves a large cut on the abdomen to access and remove the uterus.
If you have stage II or III uterine/endometrial cancer and the cancer has spread to the cervix or near the lymph nodes in the pelvis, a radical or total hysterectomy may be performed. This additionally involves removal of the cervix and upper part of the vagina, as well as removal of the pelvic lymph nodes. You may also need radiotherapy or chemotherapy treatment after surgery, reducing the risk of cancer recurrence.
If you have advanced uterine/endometrial cancer, you may undergo surgery to remove the tumor volume. This is called tumour-reduction surgery and will not cure the cancer, but may improve some symptoms. Your doctor will tell you if tumour reduction surgery is right for you.
Radiotherapy is often recommended after surgery, but it can also be used as a first-line treatment strategy. Radiotherapy can cure if the cancer is confined to the vagina and can be used at different stages of treatment, depending on the stage and grade of the endometrial cancer.
Radiotherapy for uterine/endometrial cancer may be recommended when there is a significant risk of cancer recurrence in the pelvis. It can also be used to control symptoms and increase patient comfort as well as to slow the spread of cancer when surgical treatment is not possible.
For uterine cancer, brachytherapy (or internal radiotherapy) is mainly recommended, which involves the temporary insertion of a device that emits radiation inside the vagina. This device delivers a high dose of radiation directly to the area where cancer cells are most likely to be found, which helps minimise the effects of radiation on healthy tissue. The device is placed in the vagina for only a few minutes once a day and the treatment is repeated three to five times, making this treatment convenient for patients. The treatment is administered on an outpatient basis, and women who undergo it do not have to stay in hospital overnight and can continue their normal daily activities during treatment.
Radiotherapy can cause side effects, namely:
Most of these side effects will disappear when treatment is completed, but around 5% of women continue to experience long-term side effects following treatment, such as diarrhoea and rectal bleeding.
If you have Stage III or IV uterine cancer, you may be given a session of chemotherapy. Chemotherapy may be used after surgery to try to prevent the cancer from recurring or, in cases of advanced cancer, to slow the spread of the cancer and relieve symptoms.
Chemotherapy is usually given as an injection into the vein (intravenously). Most often you will be able to go home on the same day as your chemotherapy, but sometimes you may need a short hospital stay. Chemotherapy is usually given in cycles, with a period of treatment followed by a period of rest to allow the body to recover.
Side effects of chemotherapy may include:
Certain types of uterine cancer are caused by the female hormone estrogen. These cancers may respond to treatment with hormone therapy. Your doctor will let you know if this is suitable for treating your uterine cancer.
Usually, hormone therapy uses a hormone called progesterone which should be produced naturally by your body. Artificial progesterone is used, usually in tablet form. It is mainly used to treat advanced uterine cancer or cancer that has recurred, and can help shrink the tumour and control any symptoms that may occur. Treatment may have side effects including mild nausea, mild muscle cramps and weight gain. Your doctor will discuss these issues with you.
The main side effects of hormone treatment disappear when treatment is stopped and may include hot flushes, sweating or swelling of the breasts.