Friendly Print preview

• What treatments are available?

• What happens after treatment?

• What help is available?

Cancer of the uterus

What is the uterus?

The uterus (also known as the womb) is part of the female reproductive system. It looks about the size and shape of an upside down pear and sits quite low in the abdomen. It is in the uterus that a fertilised egg grows into a baby.

What is cancer of the uterus?

Cancer of the uterus is the most common gynaecological cancer affecting women. There are several types of cancer of the uterus, depending in which part of the uterus the cancer occurs. The majority are actually cancers of the endometrium, the lining of the uterus. Cancers can also develop in the muscle layers of the uterus.

Endometrial hyperplasia

Occasionally some women develop a very thick lining of the uterus (hyperplasia) which can result in very heavy periods or bleeding at irregular times or a watery, bloody discharge, even after menopause (the ceasing of periods).

Some types of endometrial hyperplasia may be a pre-cancerous condition. If you have finished child-bearing, your doctor may advise you to have a hysterectomy, the removal of the uterus by surgery.

Abnormal bleeding before menopause, and in all women who recommence bleeding after the menopause is clearly over (more than 12 months after the end of the last monthly period), must be investigated by your doctor.

Adenocarcinoma of the endometrium

An adenocarcinoma is a cancer that starts in glandular tissue. Most women (about 85 per cent) with cancer of the uterus are diagnosed with this form of endometrial cancer.

Other types of cancer of the uterus

The less common types of cancer of the uterus are adenosquamous carcinoma, papillary serous carcinoma and, rarely, clear cell carcinoma or uterine carcinoma. They are called high-risk cancers because they may be more likely to spread.

Stages of cancer of the uterus

Cancer of the uterus generally starts in the lining of the uterus and if untreated will fill up the uterus. It is a cancer that generally stays in the pelvic cavity, and can also affect the cervix and less commonly, the vagina, the Fallopian tubes and the ovaries.

However, cancers which develop in the uterus may spread to other parts of the body via the lymph system—one of your body's natural defences against infection.

Cancer cells from the primary tumour in the uterus can also escape into the abdomen.

Depending on how much cancer you have, you will be said to have a certain 'stage' of cancer of the uterus. Sometimes endometrial hyperplasia is called 'cancer in situ' and is named a Stage 0 cancer. Cancer which is confined to the uterus is called Stage I; if it has spread to the cervix it is called a Stage II cancer. Stage III cancer has extended from the uterus to the Fallopian tubes, ovaries or pelvic and abdominal lymph glands. Cancer that extends outside the pelvis or that involves the rectum or bladder and has spread to distant sites is called Stage IV cancer.

How common is cancer of the uterus?

• In Victoria each year, there are approximately 350 women diagnosed with cancer of the uterus.

• About 80 per cent of these women will have undergone menopause.

• Most will be aged in their sixties and seventies when they are found to have cancer of the uterus.

What causes cancer of the uterus?

The causes of cancer of the uterus are only just beginning to be understood. There needs to be more investigation before doctors can explain why some women get this disease. More research is being carried out in Australia and overseas. However, there are some things that are known about this cancer.

• Cancer of the uterus is not caused by sexual activity and can not be passed on by sexual activity.

• The uterus is hormone-sensitive and can sometimes be over-stimulated by oestrogen. Women who take long-term oestrogen therapy need to talk with their doctors about how to protect themselves. Women on hormone replacement therapy (HRT) usually take oestrogen together with progesterone. This combination reduces a woman's likelihood of getting cancer of the uterus.

• Using the contraceptive pill seems to provide some protection against cancer of the uterus. The longer the pill has been used, the greater the degree of protection.

• Women who have developed hyperplasia of the uterine lining are believed to be at an increased risk.

• Women who have gone through menopause, who are infertile or who have never had children seem to have a higher risk than other women. Women with problems with high blood pressure (hypertension) and diabetes also seem at risk.

• Some women who are overweight may be at an increased risk of cancer of the uterus because fatty tissue makes a form of the oestrogen hormone.

• Cancer of the uterus seems to be more common in families who have a history of endometrial, breast or colon cancer.

Having one or more of the risk factors does not mean you are going to get cancer of the uterus; some women diagnosed with the disease do not have any known risk factors.

What does my future look like?

The vast majority of women with early cancer of the uterus will be cured of their disease. For women with more advanced cases of the disease, a cure may still be possible. For other women, treatment can keep the disease under control for long periods of time.

You will need to talk with your gynaecologist-oncologist about what your own outlook is. Your own medical history is unique to you, so you will need to discuss with someone who knows your medical history what you can expect and the treatment options best for you.

How is cancer of the uterus diagnosed?

Abnormal bleeding must always be followed up with a thorough investigation that includes taking a sample of the lining of the uterus. A Pap test checks for cancer of the cervix. It does not investigate or protect against cancer of the uterus and is an unreliable guide to the presence or absence of cancer of the uterus.

What are the symptoms of cancer of the uterus?

Unusual bleeding or a watery, bloody discharge from the vagina is the most common symptom. Occasionally, this discharge can be smelly. Other symptoms may include a feeling of bloatedness and discomfort in the abdomen.

In women who have not gone through menopause, the unusual bleeding and discharge can happen between periods, or lead to erratic and/or heavy periods. Bleeding or discharge in women who are past menopause (12 months since last bleeding) is not normal and should always be checked. While the most common explanation is due to vaginal dryness associated with menopause, the only way to be sure whether cancer is present or not is to take a sample of the lining of the uterus for testing in a laboratory.

What tests are available for cancer of the uterus?

If cancer of the uterus is suspected or has been diagnosed you will need to be referred to a gynaecological-oncologist. Your specialist will arrange a number of tests and examinations for you.

Physical examination

A physical examination will include an internal pelvic examination where the doctor checks for a mass or lump in the uterus and lower abdomen. Some women may also need to have procedures that check on the health of the bladder and bowel as part of their pre-operative assessment.

Dilatation and curettage (D&C)/Hysteroscopy

A D&C or endometrial sampling are essential to making a correct diagnosis and this may be combined with a hysteroscopy, a procedure for looking closely at the uterus. These simple procedures may be carried out while you are under a light general anaesthetic and you should only be required to spend a few hours in hospital or at a specialist day procedure centre.

Doctors can look inside the uterus by stretching the cervix opening and inserting a device like a telescope (a hysteroscope). There are several different ways of taking biopsy tissue samples from inside the uterus—by snipping out some tissue or by a spray of fluid to dislodge cells. Some of the womb lining may be removed using a suction device in a method called endometrial aspiration.

X-ray studies

Routine chest x-rays may be taken and a CT scan of the pelvis is often done. Sometimes special x-rays using dye or barium are taken to test how well your kidneys, bladder or bowel are working.

Blood tests

Blood tests may also be taken to assess your general state of health and to help you with making decisions about your treatment.

Once a diagnosis of cancer of the uterus is confirmed, treatment will be recommended by your doctor. It is important that you let your doctor know how you feel about your treatment options and that you understand enough about your illness and the treatment before you have surgery or other treatment.