Womb cancer

Published by Bupa's Health Information Team, April 2010.

This factsheet is for women who have cancer of the womb (uterus) or people who would like information about it.

Womb cancer is the fourth most common cancer in women in the UK. About 7,000 women were diagnosed with womb cancer in 2006. It's most common in women over the age of 50 and rare in women younger than 35.

About womb cancer

The womb (uterus)

The womb is a pear-shaped, muscular organ in a woman's lower abdomen. It's where babies develop when a woman is pregnant.

The lining of your womb is called the endometrium or endometrial layer. As your menstrual cycle progresses, the endometrium thickens and becomes full of blood vessels. During your menstrual cycle 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, also called uterine cancer, develops in the lining or the wall of your womb. It's caused by an abnormal and uncontrolled growth of cells. It can be malignant or benign.

Malignant tumours are cancerous. They spread to other parts of your body and invade surrounding tissue. A malignant tumour can grow through your womb and spread to other parts of your body through your bloodstream or lymph system. This spread of cancer is called metastasis.

Benign tumours aren't cancerous. They don't spread to other parts of the body and don't invade surrounding tissue.

How cancer develops

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Types of womb cancer

There are two main types of womb cancer. These are described below.

• Endometrial cancer. This type of cancer is the most common womb cancer and starts in the endometrial lining of the womb. It's often diagnosed early in its development and treatment is usually successful.
• Uterine sarcoma. This type of cancer develops in the muscle wall of the womb. It's a less common type of womb cancer and it's harder to treat.

Symptoms of womb cancer

The most common symptom of womb cancer is bleeding from the vagina, particularly in older women who 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.

There are a number of other symptoms that might be caused by cancer of the womb. These include:

• discharge from your vagina
• pain in your lower abdomen (tummy), back or legs
• pain or discomfort during sex

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

Causes of womb cancer

No one knows exactly what causes womb cancer, but it's thought that if you have too much of the hormone oestrogen in your body, you may be more at risk of developing the condition. There are a number of factors that increase your risk of developing womb cancer including:

• being older than 50
• going through the menopause after the age of 52
• being overweight or obese (very overweight)
• having close family members who have had womb, bowel (colon), ovarian or breast cancer
• having polycystic ovary syndrome
• having oestrogen-only hormone replacement therapy (HRT)
• having diabetes
• never having children

Tamoxifen, which is used to treat breast cancer, can slightly increase the risk of developing endometrial cancer. However, the benefits from taking tamoxifen will far outweigh any risks.

Uterine sarcoma is more common in African-Caribbean women, and in women who have previously had radiotherapy in the pelvic area.

Diagnosis of womb cancer

Your GP will ask about your symptoms and examine you. 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 gynaecologist (a doctor who specialises in women's reproductive health). You may have a number of tests to confirm or rule out womb cancer. Some of these are listed below.

Transvaginal ultrasound scan

A small ultrasound probe is gently put into your vagina. An ultrasound uses sound waves to produce an image of the inside of your womb. Measuring the thickness of the womb lining 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 (not cancerous) or cancerous. This is the only way to definitively diagnose womb cancer. There are several different ways to take a biopsy. You may have an aspiration biopsy, a hysteroscopy or a dilation and curettage (D&C)

Aspiration biopsy

Your doctor will put a thin plastic tube into your womb through your vagina. He or she will gently suck cells into the tube using a syringe. This is usually done whilst you're awake.

Hysteroscopy

A narrow, bendable tube with a light and camera on the end is guided through your cervix so that your doctor can examine the inside of the womb and look for signs of cancer. It's sometimes carried out with a local anaesthetic to prevent pain. Your doctor may also take a biopsy at the same time.

Dilation and curettage (D&C)

This operation is carried out under general anaesthesia, which means you will be asleep during the procedure. It involves gently stretching your cervix so that samples can be taken from the lining of the womb for examination in a laboratory.

Blood tests

A blood test can be used to see whether a chemical called CA125 is in your blood stream. CA125 is a chemical produced by cancer cells usually in ovarian cancer but sometimes in womb cancer.

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. The tests you may need are described below.

• Computerised tomography (CT) scan. This uses X-rays to make a three-dimensional picture of your body or part of your body. This can be useful in checking how far cancer has spread.
• Magnetic resonance imaging (MRI) scan. This uses magnets and radiowaves to produce images of the inside of your body.
• Chest X-ray. You might have a chest X-ray to check if your lungs are clear, as sometimes the cancer can spread to your lungs.
• Blood tests. 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.

If you're diagnosed with womb cancer, there are several treatment options. Your treatment will depend on a number of factors including the grade of cancer (how fast it's growing) and stage of cancer (the size and whether it has spread). Endometrial cancer and uterine sarcoma are treated in similar ways.

Surgery

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

Your surgeon may also remove or examine the lymph nodes around your womb. Lymph nodes are glands throughout the body that are part of the 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 with your womb then a hysterectomy is often successful at curing womb cancer.

Radiotherapy

Radiotherapy is a treatment to destroy cancer cells with radiation. It can be given externally or internally. In external radiation, a beam of radiation from a powerful X-ray machine is targeted on the cancerous cells. This shrinks the tumour. Internal radiotherapy is where a radiation source is temporarily put inside your womb so that a high dose of radiation can be targeted accurately. This may be used instead of surgery and involves a short stay in hospital.

You may have radiotherapy if your cancer has spread and surgery isn't possible. Radiotherapy can also be used after surgery if there is a risk that the cancer may come back.

Chemotherapy

Chemotherapy is a treatment to destroy cancer cells with medicines. It's sometimes used to treat cancer that has spread outside the womb or to reduce the chances of the cancer coming back. Chemotherapy can be given alongside radiotherapy. Clinical trials are being carried out to find out the best way to use chemotherapy for womb cancer.

Hormone therapy

Progesterone is a natural hormone in women that, among other things, helps regulate the menstrual cycle and pregnancy. Progesterone can also affect the growth of cancer cells.

You may be given progesterone 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 your treatment

After your treatment has finished, your doctor will ask you to have regular check-ups. He or she will ask if you have any symptoms and may also arrange for you to have blood tests, examinations or scans. This is to check for signs of the cancer coming back.

If you are 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. If you have any symptoms between your appointments or you're worried at all, speak to your GP.

Prevention of womb cancer

Eating a healthy, well-balanced diet, and exercising regularly will help you to maintain a healthy weight. This can reduce your risk of developing womb cancer.

Getting enough vitamin D may reduce your risk of developing a number of cancers, including womb cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.