What is womb cancer?
Cancer of the womb can be defined as a malignant growth or tumour that has resulted from uncontrolled division of cells within the womb.
The majority womb cancers arise from the lining of the womb called the endometrium and therefore womb cancer is often termed endometrial cancer.
In some rarer cases, womb cancer can arise from the muscular layer of the womb and is termed a uterine sarcoma.
Cancer of the womb or uterus is the most common gynaecological cancer. Usually beginning in the lining of the womb, the endometrium, it is often called endometrial cancer.
Over 9,300 women are diagnosed with endometrial cancer every year, making it the fourth most common cancer in women and the most common gynaecological cancer.
There is no clear cut cause of womb cancer but there are risk factors that can increase your chances of developing the disease. These can include:
- Age – As women get older the risk of endometrial cancer increases. Only 1% of womb cancer is diagnosed in women under the age of 40.
- Oestrogen – the balance of oestrogen and progesterone changes after the menopause. There is a larger reduction in the production of progesterone in comparison to oestrogen. This unbalanced level of oestrogen alone cause the cells of the endometrium to divide which can increase the risk of developing endometrial cancer.
- Drugs – Some medications can slightly increase your risk of developing womb cancer. One of these is the medication Tamoxifen which is used in the treatment of breast cancer.
- Obesity – Women who are overweight are three times more likely to develop womb cancer compared to women who are a healthy weight. Excess fatty tissue produces oestrogen, this increase in oestrogen due to obesity significantly increases the risk of developing womb cancer.
- Polycystic Ovary Syndrome (PCOS) – women with PCOS are at a higher risk of developing womb cancer as they have higher levels of oestrogen production.
- Reproductive history – women who have not had children tend to have a higher risk of developing uterine cancer. This is thought to be due to the protective hormones that are produced during pregnancy.
What are the symptoms of womb cancer?
There are many symptoms of womb cancer, the most common symptom is:
- Abnormal vaginal bleeding is often the first presenting symptom of womb cancer.
- If you are post-menopausal, any vaginal bleeding is considered abnormal.
- If you are not menopausal, a change in your bleeding pattern including heavier periods or inter-menstrual bleeding would be considered abnormal.
Other more general symptoms can include:
- Lower abdominal pain
- Pain during sex
- Pain in the lower back
- Loss of appetite
- Weight loss
- Feeling tired all the time
Seeing your doctor…
Unusual vaginal bleeding can be a symptom not only of womb cancer, but of many conditions. This includes endometriosis, fibroids and other gynaecological cancers.
If you are experiencing any of the symptoms described above and believe that you could have womb cancer, it is important to see your GP as soon as possible. Early diagnosis and treatment are likely to improve disease outcomes.
Your GP will take a full history, including discussing all of the symptoms that you have been experiencing. They are likely to perform an internal examination.
If your GP is concerned and would like to rule out any serious cause of your symptoms they will refer you to a specialist gynaecologist for further tests and treatment.
When seeing your gynaecologist, they may suggest undertaking various tests to further investigate your symptoms. This can include ultrasound, hysteroscopy and biopsy. These are all normally performed as an outpatient and therefore you will not need to stay in hospital.
The biopsy is a small sample of tissue taken from the lining of the womb. This will be sent to a laboratory and checked for any cancerous cells.
If you are diagnosed with womb cancer, you will be offered more tests to further investigate the stage of your cancer. This includes looking at the area of cancer in more detail and looking at the rest of the body.
Tests can include blood tests to assess general health, chest x-rays, MRI scans and CT scans.
What treatments are available?
Treatment of any form of cancer is complex and requires multidisciplinary input from various medical professionals.
Treatment plans are personalised for each patient and take into account the stage of cancer, location and the health and wishes of the patient.
If you are wishing to start a family and have been diagnosed with vaginal cancer you may wish to discuss preserving your fertility with your doctor.
The mainstay of treatment for womb cancer is surgery, however the best treatment for you will depend on your individual circumstances and will be discussed and decided by you and your cancer care team. This may involve a hysterectomy, which is the surgical removal of the womb. Early detection and treatment of endometrial cancer usually means that it can be cured by surgery alone, without chemotherapy. This treatment means that you will no longer be able to menstruate or get pregnant. It is important to discuss all concerns regarding fertility with your doctor before surgery.
All results will be discussed fully with a team of oncologists, surgeons, radiologists and other healthcare professionals to create a personalised treatment plan. Your doctor or nurse will explain the treatment options going forwards, it is important that you ask all the questions you have and explain if you need more information to make an informed decision regarding treatment.
Other members of the cancer care team can include occupational therapists, dieticians and access to mental health support.
“I was only 36 when I was diagnosed with endometrial cancer and had just got married. The symptoms had started 18 months before. I had always had irregular periods but I then began to have bleeding, particularly after sex. Despite reassurance from my GP, I knew something wasn’t right. When I moved to a different area, my new GP referred me for tests, which found cancerous cells in the lining of my womb. Fortunately, the cancer was at an early stage.
“I was told I should have a hysterectomy as soon as possible, and the operation also removed my ovaries. In retrospect, I wished I’d challenged that decision – if I’d kept my ovaries, I might have been able to try IVF or surrogacy – but in the shock of the moment I didn’t question any advice.
“Seven years on I have just qualified as a midwife. My advice to other women is, listen to your body, don’t be put off if you really think something is wrong, ask as many questions as you need to and don’t be afraid to get a second opinion