The most common symptom of womb cancer is bleeding from your vagina, particularly if you have been through the menopause. If you haven't 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 include:
- discharge from your vagina
- pain or swelling in your lower abdomen, back or pelvis
- pain or discomfort during sex, or bleeding after sex
- weight loss
- passing urine more often than usual
- changes in your bowel movements
If you have any of these symptoms, see your GP.
Some women get a lump in their pelvis. These lumps are often benign (not cancerous), but some may be cancerous. Ask your doctor for more information.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP may check inside your vagina and do a smear test. This is a test to examine the cells in the neck of your womb (cervix).
If your GP suspects you have womb cancer, he or she will refer you to a gynaecologist (a doctor who specialises in women's reproductive health).
You may have a number of further tests (arranged by your GP or your specialist) which may include the following.
Transvaginal ultrasound scan
In this test, a radiographer (a health professional trained to perform imaging procedures) will place a small ultrasound probe 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.
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.
- In an endometrial biopsy, your doctor will put a thin plastic tube into your womb through your vagina. He or she will use a syringe to gently suck cells from your womb into a tube.
- In a hysteroscopy, your doctor will guide a narrow, flexible tube through your vagina and into your cervix. This has a light and camera on the end so your doctor can examine the inside of your womb and look for signs of cancer.
- In dilatation and curettage (D and C), your doctor will gently open your cervix and take samples from the lining of your womb.
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.
If you're found to have womb cancer, you may need to have other tests to find out how advanced it is. This process, known as staging, takes into account whether the cancer has spread and how big it is. Your doctor will usually advise you to have scans, such as an ultrasound, MRI or CT scan. These will check different areas of your womb, vagina and lymphatic system.
If womb cancer is diagnosed early, treatment can be very effective.
Your treatment for womb cancer will depend on the type of womb cancer you have. It will also depend on how fast it's growing, how far it has spread, your age and your general health. Your doctor will discuss your treatment options with you.
For most women with womb cancer, the first and most common treatment is surgery. Your doctor will probably suggest a hysterectomy – an operation to remove your womb.
If you have a total hysterectomy, your surgeon will usually remove your womb, fallopian tubes and both ovaries. Your surgeon may also remove or examine the lymph nodes around your womb. As well as removing any cancerous cells, checking the lymph nodes can help your doctor to decide if you need other treatment.
The aim of surgery is to remove all traces of the cancer. If your cancer hasn’t spread outside your womb, a hysterectomy is often successful at treating it.
You might be able to have keyhole surgery, which may mean you recover from the operation more quickly. Ask your surgeon for more information.
Non-surgical treatments include the following. You may have these with, or instead of, surgery.
- 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. 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. Chemotherapy is occasionally used to treat cancer that has spread outside your womb or to reduce the chance 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 you may have it to treat womb 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 the cancer has returned. If the cancer has already spread, you can get support from specialist cancer doctors and nurses as well as treatment for any symptoms. This is called palliative care.
The exact reasons why you may develop womb cancer aren't fully understood at present. However, you may be more likely to develop it if you have too much of the hormone oestrogen in your body (in relation to progesterone).
You're also more likely to develop womb cancer if you:
- have polycystic ovary syndrome (PCOS) – a condition in which your ovaries contain many small cysts and don’t work properly
- are older than 50
- are overweight or obese
- have close family members who have had bowel cancer
- have taken oestrogen-only hormone replacement therapy (HRT)
- have taken tamoxifen – a medicine sometimes used to treat breast cancer
- have diabetes or high blood pressure
- have never had children
- started the menopause after the age of 52
The uterine sarcoma type of womb cancer is more common in African-American women, and in women who have previously had radiotherapy to their pelvic area.
What’s the difference between cervical and womb cancer?
Your cervix is 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.
Both cervical and womb cancer start in your womb. However, womb cancer usually starts in the lining of your womb whereas cervical cancer often starts in the cells on the surface of your cervix. Cervical cancer is less common than womb cancer. Around 2,500 women get cervical cancer each year in the UK, compared with 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, you may be more likely to develop it if you have too much of the hormone oestrogen in your body in relation to progesterone.
Abnormal cells in your cervix can be picked up by having a cervical smear test. This test examines the cells in your cervix for any changes. It isn't a test for cancer, but it can pick up changes to cells in your cervix that could become cancer in the future. A smear test may also show signs of cancer in the lining of your womb as womb cancer can spread to the cervix. However, 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 develop 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 will be examined. Treatment for the two cancers can also differ. Ask your doctor to describe tests and treatments in more detail.
Will my womb cancer come back after I've finished my treatment?
It's difficult to answer this question as everybody 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. This is why it's important to keep your follow-up appointments and tell your doctor straight away if you have any symptoms.
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 treatment.
Womb cancer is often found early because women notice the symptom of unusual bleeding. Because of this treatment is often successful. At least eight out of 10 women diagnosed with endometrial womb cancer will live for at least 20 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 what kind you had. It also depends on where it was, whether it had spread and what stage it was when you were diagnosed. If your cancer spread out of the lining of your womb or into your lymph nodes, the chances of it returning are high. This is compared with cancer that stayed 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 doctor or cancer nurse.
Will treatment for womb cancer affect my ability to have children?
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 you start your treatment.
If you have surgery or radiotherapy for womb cancer, it means that you will lose the ability to have children. Radiotherapy in your pelvic area can damage your ovaries. Surgery for womb cancer is usually a hysterectomy and you might also have your ovaries removed. This means you can no longer have children.
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 doctor can put you in touch with support groups or a counsellor.
Will treatment for womb cancer affect my sex life?
Treatment for cancer can affect how you feel about sex as well as how sex feels. You might find that it’s 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 how it was.
Some treatments for womb cancer can have side-effects that may affect your sex life. 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 plastic tubes that 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. You may find it more comfortable to use a lubricant when you insert the dilator.
It's normal to have some light bleeding or spotting after you use a dilator. However, if you have heavier bleeding or pain, stop using the dilator and see your GP.
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. However, depending on how often you have sex, you may not need to keep using it.
Vaginal dryness can make sex uncomfortable and infections more likely. If vaginal dryness is a problem, your doctor may prescribe you a cream or lubricant gel to put directly into your vagina.
Having cancer can have an enormous impact on every area of your life and your relationships with the people close to you. You may 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 need more help, your GP can put you in touch with a sex therapist.
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