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Womb cancer


Expert reviewer, Robin Crawford, Consultant Gynaecological Oncologist
Next review due September 2021

Womb cancer (uterine cancer) is the fourth most common cancer in women in the UK – just under 8,000 women are diagnosed each year. Most women who get womb cancer are over 55.

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.

Types of womb cancer

There are two main types of womb cancer.

  • Endometrial cancer. This is the most common type of womb cancer and starts in the lining (endometrium) of your womb.
  • Uterine sarcoma. This type of cancer 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 focuses on endometrial cancer. Other types of womb cancer, such as uterine sarcoma, may be treated differently.

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:

  • Endometrial pain or swelling in your tummy or pelvis
  • Endometrial losing weight
  • Endometrial going to the toilet more often to pee
  • Endometrial diarrhoea
  • Endometrial feeling sick or vomiting
  • Endometrial a lump in your pelvis
  • Endometrial tiredness
  • Endometrial a long-lasting cough
  • Endometrial feeling out of breath

If you have any of these symptoms, contact your GP.

Diagnosis of womb cancer

Your GP will ask about your symptoms and examine you – this might include examining 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 test 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 gently suck cells from the lining of your womb into the 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 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. You can usually have a biopsy or hysteroscopy as an outpatient – you don’t need to stay overnight in a hospital. And you won’t usually need to have a general anaesthetic.

Womb cancer stages

If 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.

Your gynaecologist will usually arrange for you to have a scan, such as an MRI scan, to stage your womb cancer before they do an operation to treat it.

See Related information for more information about staging.

Treatment of womb cancer

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

The treatment you’re offered will depend on which type of cancer 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 and cervix (the neck of your womb). If your cancer hasn't spread outside your womb, a hysterectomy often cures the cancer.

As well as removing your womb and cervix, your gynaecologist will usually remove both your fallopian tubes and ovaries too. This is known as a bilateral salpingo oophorectomy, or a BSO for short. Your gynaecologist 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 gynaecologist 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 gynaecologist if this is an option for you.

Non-surgical treatments

Non-surgical treatments include the following. You usually have these as well as surgery, but sometimes you can have them alone. These treatments won’t cure womb cancer themselves but they may be used alongside surgery. If used alon, they can help control the symptoms of womb cancer.

  • Radiotherapyuses 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.
  • Chemotherapyuses 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.

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:


Frequently asked questions

  • 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 from womb cancer.

    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. Just over 2,500 women get cervical cancer each year in the UK, compared with just under 8,000 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. Bleeding between periods is the most common symptom of both. You’ll have tests to find out if you have cancer and what type.

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

    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.

  • Treatment for cancer can affect how you feel about sex as well as how sex feels

    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 and, with time, you should find that your sex life gets better

    To prevent narrowing, you can use a dilator regularly to gently stretch your vagina and make it more supple. Dilators are plastic or metal 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 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.

    See Related information for more advice about relationships after cancer.

  • 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.

    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. So you’ll usually have check-ups every three to six months for the first two years, then every year.

    Womb cancer is often found early because women notice the symptom of unusual bleeding. Because of this, treatment is often a success. About eight out of 10 women diagnosed with endometrial womb cancer will live for at least 20 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.


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Related information

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  • Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, September 2018
    Expert reviewer, Robin Crawford, Consultant Gynaecological Oncologist
    Next review due September 2021



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