Uterine Cancer

Facts about uterine (endometrial) cancer

Q 1 What is uterine (womb) cancer? 

Most womb (uterus) cancers begin in the cells that make up the lining of the womb (the endometrium). This is why cancer of the womb is often called endometrial cancer.

The uterus, or womb, is part of a woman’s reproductive system. The lining of the uterus is called the endometrium. It is made up of tissue with many glands. The lower part of the uterus is called the cervix. The cervix leads into the vagina

Q 2 What causes uterine cancer? 

  • Estrogen-only hormone replacement therapy (HRT)

HRT with estrogen alone (without progesterone) increases the risk for uterine cancer. Taking estrogen combined with progesterone (called combined HRT) does not increase a woman’s risk for uterine cancer.

  • Early menstruation (before age of 12) or late menopause (after the age of 55) 
  • Never giving birth
  • Overweight or obesity
  • Polycystic ovarian syndrome (PCOS)
  • Diabetes
  • Radiation therapy to the pelvis
  • Low levels of physical activity
  • Family history of colon cancer and breast cancer 

Q 3 What are the types of endometrial cancer?

A cancerous tumor of the uterus 

  • Endometrial carcinoma

It is the most common type which starts from cells in the lining of the uterus (called the endometrium)

  • Uterine sarcoma 

Develops in the supporting tissues of the uterus, including muscle, fat, fibrous tissue

  • Carcinosarcoma 

It has features of both carcinomas and sarcomas.

Non-cancerous tumors of the uterus

Non-Cancerous tumors are also called benign tumors. A benign tumor is a growth that does not spread to other parts of the body. Non-cancerous tumors are not usually life-threatening

  • Uterine fibroids are the commonest non-cancerous tumor of the uterus.

Q 4 What are the symptoms of uterine cancer? 

  • Abnormal vaginal bleeding 

The most common symptom of womb cancer is unusual (abnormal) bleeding from the vagina.

This includes a change in menstruation such as heavier periods, periods that last longer, bleeding between periods, bleeding after menopause.

  • Unusual vaginal discharge, which can be foul-smelling, pus-like or blood-tinged
  • Pain during intercourse 
  • Pain or feeling of pressure in the pelvis, lower abdomen, back or legs
  • Pain during urination, difficult urination or blood in the urine
  • Pain during bowel movements, difficult bowel movements or blood in the stool
  • The buildup of fluid in the abdomen (called ascites) or in the legs (called lymphedema)
  • Weight loss & lack of appetite

It’s important to remember that these symptoms can be caused by many different conditions and are not usually the result of cancer.

Q 5 How is uterine cancer diagnosed? 

  • Health history:  family history of colon or breast cancer, infertility
  • Physical examination:

Pelvic and rectal examination to check the uterus, vagina, ovaries, bladder, and rectum for any unusual changes. Feel the abdomen for lumps, bloating, or enlargement of organs such as the liver or spleen.

Ultrasound is the first investigation to be done

  • Hysteroscopy and biopsy

If the ultrasound detects changes in the thickness of the lining of your womb, you’ll usually be offered a hysteroscopy. This is where a thin type of telescope (hysteroscope) is inserted through your vagina and into your womb, allowing a doctor to look at the lining of the womb and take a biopsy. 

  • Dilation and curettage (D&C) 

It is a procedure in which the cervix (the lower, narrow part of the uterus, or womb) is widened (dilated) so that a curette (a spoon-shaped instrument with a sharp edge) can be inserted into the uterus to remove cells, tissues or growths from the endometrium. 

A word of caution 

  • There is a common myth that taking biopsy leads to the spread of cancer cells in the body. This is not true. Taking biopsy does not lead to the spread of cancer cells in the body.
  • Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly.  
  • Further testing

If the results of the biopsy confirm uterine cancer, then the doctor may advise having additional tests to assess how widespread the cancer is. These tests may include:

  • Blood tests – To assess the state of liver, kidneys and bone marrow
  • CT/MRI scan – To find out the local spread of disease 
  • Chest X-ray – To check if cancer has spread to the lungs or not 
  • Sometimes a PET scan – To know the distant spread of disease 

Q 6 What is uterine cancer staging?

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread

The most common staging system for uterine cancer is the FIGO system. 

  • Stage 1 Cancer is limited to the uterus
  • Stage 2 Cancer has grown into the cervix.
  • Stage 3 Cancer has involved ovaries, vagina, and lymph nodes in the pelvis
  • Stage 4 Cancer has involved bladder or intestines or has spread to other parts of the body (called distant metastasis), such as to the lungs, liver, or bone. 

Q 7 How is uterine cancer treated? 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • Your personal preferences
  • For stage 1, 2 and 3 

Surgery followed by +/- radiation therapy +/- chemotherapy 

The decision for radiation and chemotherapy depends on the final pathology report after the operation. 

  • For Stage 4

Chemotherapy +/- surgery  

Surgery 

Surgery is the only curative option for endometrial cancer. 

  • A total hysterectomy removes the cervix and uterus. The surgeon may also remove nearby lymph nodes.
  • A radical hysterectomy removes the cervix, the uterus, some of the structures and tissues near the cervix and upper vagina and nearby lymph nodes.
  • Bilateral salpingo-oophorectomy removes both ovaries and fallopian tubes. It is usually done at the same time as a hysterectomy.
  • A pelvic exenteration removes the cervix, uterus, vagina, ovaries, fallopian tubes, and lymph nodes. The rectum, bladder, or both may also be removed. Pelvic exenteration is sometimes done when uterine cancer recurs, or comes back, in the pelvis after it has been treated with radiation therapy.
  • Tumour debulking is surgery to remove as much of the tumor as possible. It may be used for advanced uterine cancer.
  • Hormonal therapy may be given after surgery for some stages of uterine cancer. It may also be used as the main treatment for advanced or recurrent uterine cancer.