Womb cancer

About womb cancer

The womb

Your womb is a pear-shaped, muscular organ in your lower abdomen (tummy). Its lining is called the endometrium or endometrial layer. As your menstrual cycle progresses, the endometrium thickens and becomes 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 your menstrual cycle begins again.


Womb cancer develops in the lining or the wall of your womb. It’s the fourth most common cancer in women in the UK – about 7,800 women are diagnosed each year. Womb cancer is most common in women over the age of 50.

Sometimes, the cancer starts in your womb and invades surrounding tissue or spreads through your bloodstream or lymph system to other parts of your body. This spread of cancer is known as metastasis.

How cancer develops

Types of womb cancer

There are two main types of womb cancer.

  • Endometrial cancer is the most common type and starts in the endometrial lining of your womb.
  • Uterine sarcoma, which is less common, develops in the cells in the muscle wall of your womb.

Symptoms of womb cancer

The most common symptom of womb cancer is bleeding from your vagina, particularly if you have been through the menopause. If you haven't yet been through the menopause, you may find that you have unusually heavy bleeding during your period or bleeding between periods.

Other, less common, symptoms of womb cancer may include:

  • discharge from your vagina
  • pain or swelling in your lower abdomen, back or legs
  • pain or discomfort during sex
  • weight loss
  • tiredness
  • feeling sick or vomiting
  • passing urine more often than usual
  • changes in your bowel movements

These symptoms may be caused by problems other than womb cancer. If you have any of these symptoms, see your GP for advice.

Some women can get a lump in the inner lining of their womb called an endometrial polyp. These lumps are often benign (not cancerous), but some may contain cancer cells. Ask your doctor for more information.

Causes of womb cancer

The exact reasons why you may develop womb cancer aren't fully understood at present. However, it's thought that if you have too much of the hormone oestrogen in your body in relation to progesterone, you may be more at risk of developing the condition.

Other factors that may increase your risk of developing womb cancer include:

  • polycystic ovary syndrome (PCOS) – a condition in which your ovaries contain many small cysts and don’t work properly
  • endometrial hyperplasia – a condition where the lining of your womb becomes thicker
  • being older than 50
  • being overweight or obese
  • having close family members who have had womb or bowel cancer
  • having taken oestrogen-only hormone replacement therapy (HRT)
  • having taken tamoxifen – a medicine sometimes used to treat breast cancer
  • having diabetes
  • never having children

The type of womb cancer known as uterine sarcoma is more common in African-Caribbean women and in women who have previously had radiotherapy to their pelvic area.

Diagnosis of womb cancer

Your GP will ask about your symptoms and examine you, which may include an internal pelvic examination. He or she may also ask you about your medical history.

If your GP suspects that you have womb cancer, he or she will refer you to a specialist clinic or to a gynaecologist (a doctor who specialises in women's reproductive health). You may also have a number of tests to diagnose womb cancer. Some of these are listed below.

Transvaginal ultrasound scan

In this test, a small ultrasound probe is gently placed into your vagina. Ultrasound uses sound waves to produce an image of the inside of your womb. This will measure the thickness of your womb lining, which can help to diagnose womb cancer.

Biopsy

A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign or cancerous. There are several different ways to take a biopsy.

  • An endometrial biopsy is where your doctor will put a thin plastic tube into your womb through your vagina. Cells from your womb are gently sucked into the tube using a syringe.
  • A hysteroscopy is where your doctor will guide a narrow, flexible tube with a light and camera on the end through your cervix (the neck of your womb) to examine the inside of your womb and look for signs of cancer.
  • Dilation and curettage (known as D and C) is where your doctor will gently open your cervix and take samples from the lining of your womb for examination in a laboratory. This test is usually done under general anaesthesia.

Blood tests

CA125 is a chemical produced by cancer cells usually in ovarian cancer, but sometimes in womb cancer. Blood tests can check if CA125 is in your bloodstream.

Staging

If you're found to have cancer, you may need to have other tests to assess if the cancer has spread. The process of finding out the stage of a cancer is called staging.

  • Scans – you may have a CT or MRI scan. These will check to see if your cancer has grown into your cervix or into the muscle wall of your womb, and if so, how far.
  • A chest X-ray – to check your lungs, as sometimes womb cancer can spread to your lungs.
  • You may have more blood tests to check your general health and to see if your kidneys and liver are working well.

Treatment of womb cancer

Womb cancer often causes symptoms quite early. If it's diagnosed early, treatment can be very effective.

Your treatment for womb cancer will depend on the type of womb cancer you have, the grade of cancer (how fast it's growing), how far it has spread, your age and your general health. Endometrial cancer and uterine sarcoma are treated in similar ways. Your doctor will discuss your treatment options with you.

Surgery

For most women with womb cancer, the first and most common treatment is surgery. Your doctor is likely to suggest a hysterectomy – an operation to remove your womb.

If you have a total hysterectomy, your womb, fallopian tubes and both ovaries are usually removed. Your surgeon may also remove or examine the lymph nodes around your womb. Lymph nodes are glands throughout your body that are part of your immune system. As well as removing any cancerous cells, checking lymph nodes can help your doctor to decide whether you need other treatment.

The aim of surgery is to remove all traces of the cancer. If your cancer is contained within your womb, then a hysterectomy is often successful at treating womb cancer.

Non-surgical treatments

Non-surgical treatments include the following.

  • Radiotherapy is a treatment to destroy cancer cells with radiation. You can have external or internal radiotherapy. In external radiation, a beam of radiation will be targeted on the cancerous cells, which will shrink the tumour. In internal radiotherapy (brachytherapy), a radiation source will be put inside your womb. This may involve a short stay in hospital. You may have radiotherapy if your cancer has spread and surgery isn't possible. You may also be offered radiotherapy after surgery to reduce the chance of the cancer coming back.
  • Chemotherapy uses medicines to destroy cancer cells. They are usually injected into a vein, but sometimes you may be given chemotherapy as tablets. Chemotherapy is occasionally used to treat cancer that has spread outside your womb or to reduce the chances of the cancer coming back. It can be used alongside radiotherapy.
  • Hormone therapy uses progesterone, which is a natural hormone in women that can affect the growth of cancer cells. You may have progesterone treatment to help slow the growth of womb cancer that has returned after other types of treatment, or cancer that has spread to other parts of your body.

After treatment for womb cancer, you will have regular check-ups with your doctor to see if there is any evidence that the cancer has returned. If the cancer has already spread, you will regularly see doctors or specialist nurses to get treatment for any symptoms you might have.

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

Will treatment for womb cancer affect my sex life?

Answer

It could do. Treatment for cancer can affect how you feel about sex as well as how sex feels. You might find that sex feels uncomfortable or painful, or you may lose the desire to have sex. There are treatments available to help ease these symptoms and with time you should find that your sex life returns to what it was.

Explanation

Some of the treatments for womb cancer can have side-effects, which may make sex uncomfortable.

For example, if you have radiotherapy to your pelvis, your vagina may become narrower and less stretchy, which can make sex uncomfortable and sometimes painful. Your vagina may also become drier and the skin inside more delicate. These symptoms can be long term, but there are ways to ease them.

To prevent narrowing, you can use a dilator regularly to gently stretch your vagina and make it more supple. Dilators are made of plastic or metal, are cone- or penis-shaped, and are available in different sizes. You put the dilator gently into your vagina three times a week for between five and 10 minutes.

This will help to stretch your vagina and make sex more comfortable. It's important not to force this and if the dilator seems too big, switch to a smaller size. A little light bleeding or spotting after using a dilator is usual, but if you have heavier bleeding or pain, stop using the dilator and see your GP. You may find using a lubricant helps to make inserting the dilator more comfortable.

You can start using a dilator between two and eight weeks after you finish radiotherapy treatment. You may need to carry on using it for the rest of your life, but if you're having sex at least twice a week, you won't need to use it.

Vaginal dryness can make sex uncomfortable and make infections more likely. If vaginal dryness is a problem, your doctor may prescribe a hormone cream to put directly into your vagina. Using a lubricant gel can also help.

Having cancer can have an enormous impact on every area of your life and your relationships with the people close to you. You’re likely to need time to come to terms with everything that has happened to you. It's important to talk to your partner so that he or she knows how you’re feeling. If you think you need more help, your GP can put you in touch with a sex therapist.

Will my womb cancer come back after I've finished my treatment?

Answer

It's difficult to answer this question as every woman is different. Generally, womb cancer has one of the best recovery rates for any type of cancer and many women are completely cured after treatment. However, as with any cancer, it's always possible that it will return, which is why it's important to keep your follow-up appointments and tell your doctor straight away if you have any symptoms.

Explanation

If you’re well, you will need fewer check-ups as time goes on. If womb cancer is going to come back, it usually does so within three years of your diagnosis.

Womb cancer is often found early because of its symptoms and therefore treatment is often successful. Of those women diagnosed with endometrial womb cancer, at least eight out of 10 will live for at least five years after their diagnosis. Many of these women will be completely cured and the cancer won't come back.

Whether or not your cancer comes back after your treatment will depend on the kind of cancer you had, where it was, whether it had spread and what stage it was when you were diagnosed. If your cancer had spread out of the lining of your womb or into your lymph nodes, the chances of it returning are higher than if your cancer was just in the lining of your womb.

If you have any symptoms between your check-up appointments or you're worried about your cancer coming back, speak to your GP or cancer nurse.

Will treatment for womb cancer affect my ability to have children?

Answer

Treatment for womb cancer means that you're unlikely to be able to have children. For most women, the main options are surrogacy or adoption. Talk to your doctor for advice before starting your treatment.

Explanation

If you have surgery or radiotherapy for womb cancer, it will mean that you will lose the ability to have children. Radiotherapy affects the lining of your womb and the ability of your ovaries to produce eggs. Surgery for womb cancer is usually a hysterectomy and you might also have your ovaries removed. This means you can no longer have children yourself.

Losing your ability to have children can be very hard to come to terms with, especially on top of a diagnosis of cancer. Having a hysterectomy can lead to grief and feelings of bereavement for women who have had their menopause as well as for women who haven't. It can take time to come to terms with your feelings and you may find you need help to cope with them. You might find it helpful to talk to other women who have been through similar experiences or to see a counsellor. Your nurse or GP can put you in touch with support groups or a counsellor.

What’s the difference between cervical and womb cancer?

Answer

The cervix is the name for the neck of your womb, where your womb opens into your vagina. Although your cervix is part of your womb, cervical cancer is very different to womb cancer and each condition has a different cause.

Explanation

Both cervical and womb cancer start in your womb. However, womb cancer usually starts in the endometrial lining of your womb whereas cervical cancer most commonly starts in the cells on the surface of your cervix. Cervical cancer is less common than womb cancer – around 3,400 women get it each year in the UK, compared to 7,800 women who are diagnosed with womb cancer.

Womb cancer and cervical cancer have different causes. The main cause of cervical cancer is the human papilloma virus (HPV). The exact reasons why you may develop womb cancer aren't fully understood at present. However, it's thought that if you have too much of the hormone oestrogen in your body in relation to progesterone, you may be more at risk of developing it.

Abnormal cells in your cervix can be picked up by having a cervical smear test. This is a test to examine the cells in your cervix for any changes. Cervical screening isn't a test for cancer, but it can pick up changes to cells in your cervix that could, if left untreated, become cancer in the future. During a cervical screening test, a small sample of cells is taken from an area on the surface of your cervix and these are sent to a laboratory to check for any changes. A smear test may also show signs of cancer in the lining of your womb (womb cancer can spread to the cervix), but it’s unusual for a smear test to detect womb cancer and this isn’t the purpose of the test. Womb cancer is usually diagnosed after you start to have symptoms.

Symptoms of womb and cervical cancer can be similar. With both conditions you can have bleeding between periods and pain or discomfort during sex, as well as a discharge from your vagina. These symptoms aren’t always caused by cancer but if you have them, see your GP. You will have further tests to determine if you have cancer, and what type. Tests for cervical and womb cancer are different because different areas of your womb are examined. Treatment for the two cancers can also differ. Ask your doctor to describe tests and treatments in more detail.