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Womb cancer

Womb cancer (uterine cancer) is the fourth most common cancer in women in the UK – about 7,700 women are diagnosed each year. Most women who get womb cancer are over 50.

Womb cancer happens when cells in your womb (uterus) grow in an abnormal and uncontrolled way, forming a lump, or tumour. Your womb is part of the female reproductive system, and is where your baby develops if you get pregnant.

How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the location of the womb and surrounding structures

Details

  • Types Types of womb cancer

    There are two main types of womb cancer.

    • Endometrial cancer is the most common type and starts in the lining (endometrium) of your womb.
    • Uterine sarcoma is less common and develops in the cells in the muscle wall of your womb.

    Womb cancer can sometimes spread to surrounding tissue or to other parts of your body. This is known as metastasis.

    This topic is about endometrial cancer. Other types of womb cancer, such as uterine sarcoma, may be treated differently.

  • Symptoms Symptoms of womb cancer

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

    Other, less common, symptoms of womb cancer include:

    • a discharge from your vagina
    • pain or swelling in your tummy or pelvis
    • bleeding after you have sex
    • losing weight
    • passing urine more often than usual
    • diarrhoea
    • a lump in your pelvis 
    If you have any of these symptoms, contact your GP.

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  • Diagnosis Diagnosis of womb cancer

    Your GP will ask about your symptoms and examine you – this might include checking inside your vagina. They’ll ask about your medical history too. If your GP thinks your symptoms need further investigation, they’ll refer you to see a gynaecologist. This is a doctor who specialises in women's reproductive health.

    You might need to have some more 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 put 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.

    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 different ways to take a biopsy.
    • In an endometrial biopsy, your doctor will put a thin plastic tube into your womb through your vagina. They’ll use a fine plastic tube with a plunger inside to get 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 camera on the end that will show the lining of your womb on a monitor. Your doctor will use this to examine the inside of your womb and look for signs of cancer. They can then take a targeted section of tissue for biopsy.

    Staging

    If the tests above show that you have womb cancer, you may need to have more tests to find out how advanced it is. This process, known as staging, takes into account whether or not the cancer has spread and how big it is. See Related information for more information about staging.
  • Treatment Treatment of womb cancer

    If womb cancer is diagnosed early, treatment can work well. 

    The treatment you’re offered will depend on which type you have. It will also depend on how fast the cancer is growing, how far it has spread, and your age and general health. Your doctor will discuss what your treatment options are with you.

    Surgery

    The most common treatment for womb cancer is surgery, which aims to remove all traces of the cancer. This usually involves having a hysterectomy, which is an operation to remove your womb. If your cancer hasn't spread outside your womb, a hysterectomy often works. 

    As well as removing your womb, your surgeon will usually remove both your fallopian tubes and ovaries too. This is known as a bilateral salpingo oophorectomy, or a BSO for short. Your surgeon may also remove or check the lymph nodes around your womb. As well as removing any cancerous cells, checking the lymph nodes may help your doctor to decide if you need other treatment. 

    You should be able to have keyhole surgery, which you usually recover from more quickly than open surgery. Check with your surgeon if this is an option for you.

    Non-surgical treatments

    Non-surgical treatments include the following. You may have these as well as or instead of surgery.

    • Radiotherapy uses radiation to destroy cancer cells. You may have external or internal radiotherapy. In external radiation, a beam of radiation is targeted on the cancerous cells to shrink the tumour. In internal radiotherapy, which is called brachytherapy, a radiation source is put inside your vagina. You may have 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’s spread outside your womb or to reduce the chance of the cancer coming back. It can be used alongside radiotherapy.
    • Hormonal therapy can alter the production or activity of certain hormones in your body. In womb cancer, hormone therapy uses progesterone. This is a natural female hormone that can affect the growth of cancer cells. You may have progesterone treatment to help slow the growth of womb cancer that’s returned after other types of treatment. Or you may have it to treat womb cancer that’s spread to other parts of your body. 
    After treatment for womb cancer, you’ll need to 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.
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  • Causes Causes of womb cancer

    Doctors don’t yet know the exact reasons why people develop womb cancer. But some things make you more likely to develop it. These include having too much of the hormone oestrogen in your body (compared to your levels of progesterone).

    You're also more likely to develop womb cancer if you:

  • FAQ: Is cervical cancer different? What’s different about 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 they have different causes.

    More information

    Your cervix is the opening into your womb. Cervical cancer often starts in the cells on the surface of your cervix. Womb cancer usually starts in the lining of your womb. Cervical cancer is less common than womb cancer. Around 2,600 women get cervical cancer each year in the UK, compared with 7,700 women who get womb cancer. 

    Womb cancer and cervical cancer have different causes too. Almost all cervical cancer is caused by the human papilloma virus (HPV) but doctors don’t yet know exactly what causes womb cancer. But you might be more likely to develop womb cancer if you have too much of the hormone oestrogen in your body in relation to progesterone. 

    Symptoms of womb and cervical cancer can be similar. You can get bleeding between periods with both, and pain or discomfort after having sex, as well as a discharge from your vagina. You’ll have tests to find out if you have cancer, and what type.

  • FAQ: Clear cell womb cancer What is clear cell womb cancer?

    Clear cell cancer is a rare type of endometrial cancer. Endometrial cancer starts in the endometrium (lining) of your womb.

    More information

    Endometrial cancers are sometimes divided into two groups – type 1 and type 2. Most are type 1, which means they’re linked to having too much of the hormone oestrogen in your body. Cancers that belong to the type 2 group are different because they aren't linked to high levels of oestrogen. An example is clear cell cancer, which is very aggressive. It’s not very common – only one or two women in a hundred who get womb cancer have clear cell cancer. 

    Clear cell cancer is usually treated with a mixture of surgery, radiotherapy and chemotherapy.

  • FAQ: What about sex? 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 it uncomfortable or painful, or you may lose the desire to have sex. There are treatments to help ease these symptoms and, with time, you should find that your sex life returns to how it was.

    More information

    Some treatments for womb cancer have side-effects that may affect your sex life. 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 last a long time, 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 come in different sizes. You can start using a dilator between two and eight weeks after you finish radiotherapy. You might need to carry on using it for two years or more, even if you have regular sex. 

    Vaginal dryness can make sex uncomfortable. Your doctor can prescribe you a cream or lubricant gel to put into your vagina, which should help. 

    Having cancer can have an enormous impact on every area of your life including your relationships with the people close to you. You may need time to come to terms with everything that has happened to you. Try to talk to your partner so they know how you’re feeling. If you need more help, your GP can put you in touch with a sex therapist.

  • FAQ: Will my womb cancer come back? Will womb cancer come back after treatment?

    It's difficult to answer this because everybody’s different. Generally, many women are completely cured after treatment for womb cancer. But as with any cancer, it's always possible it will return. That’s why it's important to have check-ups with your doctor.

    More information

    If you’re well, you’ll need fewer check-ups as time goes on. If womb cancer is going to come back, it usually does so within two years of having treatment. 

    Womb cancer is often found early because women notice the symptom of unusual bleeding. Because of this, treatment is often a success. Almost eight out of 10 women diagnosed with endometrial womb cancer will live for at least 10 years after their diagnosis. 

    Whether or not your cancer comes back after your treatment will depend on what kind of cancer you had. It also depends on where it was, if 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 higher. This is compared with cancer that stayed in the lining of your womb.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Uterine cancer. Medscape. emedicine.medscape.com, updated December 2015
    • Cancer registration statistics, England: first release: 2014. Office for National Statistics. www.ons.gov.uk, release date 23 February 2016
    • Uterine cancer in the United Kingdom: overall trends and variation by age. National Cancer Intelligence Network, October 2013. www.ncin.org.uk
    • Female reproductive organ anatomy. Medscape. emedicine.medscape.com, updated 3 October 2013
    • Uterine sarcomas. The MSD Manuals. www.msdmanuals.com, last full review/revision date May 2013
    • Endometrial cancer. PatientPlus. patient.info/patientplus, last checked 1 December 2015
    • Endometrial cancer. BMJ Best Practice. bestpractice.bmj.com, last updated 26 January 2016
    • Map of medicine. Endometrial cancer. International view. London: Map of medicine; 2016 (Issue 2)
    • Colombo N, Preti E, Landoni F, et al. Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(suppl 6):vi33–38. doi:10.1093/annonc/mdt353
    • Ultrasound – pelvis. Radiological Society of North America. www.radiologyinfo.org, reviewed 12 June 2015
    • Endometrial sampling. PatientPlus. patient.info/patientplus, last checked 12 October 2015
    • Best practice in outpatient hysteroscopy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published April 2011
    • Gynaecological cancers. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published September 2015
    • Information for you after a laparoscopic hysterectomy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published 22 October 2015
    • Radiotherapy. PatientPlus. patient.info/patientplus, last checked 23 December 2015
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 9 May 2016
    • Cervical cancer. BMJ Best Practice. bestpractice.bmj.com, last updated 24 February 2016
    • Uterine cancer survival statistics. Cancer Research UK. www.cancerresearchuk.org, last reviewed 10 December 2014
    • Womb cancer. Cancer Research UK. www.cancerresearchuk.org, last updated 1 October 2014
    • Miles T, Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database of Systematic Reviews 2014, Issue 9. doi:10.1002/14651858.CD007291.pub3
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  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, May 2016

    Peer reviewed by Robin Crawford Consultant, Gynaecological Oncologist

    Next review due May 2019

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