Womb Cancer

Womb cancer usually affects the endometrium – the womb’s lining. This is called endometrial cancer. Around 95 out of 100 endometrial cancers are adenocarcinomas. This means that the cancer is in the glandular tissue cells, and that is started in a surface layer of the cells. There are three main types of adenocarcinomas.

• Endometrioid adenocarcinomas: Accounts for more than three in four womb lining adenocarcinomas
• Papillary serous carcinomas: Around five in a hundred womb cancers are this type. It grows more quickly than other types, and is more likely to come back
• Clear cell carcinoma: A very rare type of womb cancer that accounts for just one or two cases in every hundred.

Other less common types of uterine ancer include:

• adeonocarcinoma with squamous cells (adenoacanthomas)
• sarcoma of the womb (uterine sarcoma).

We don’t know the exact cause of womb cancer, but there are several things that can increase your risk of developing it. Many of them are related to the levels of oestrogen and progesterone in your body.

Growing older and the menopause
Womb cancer is most common in women between 60 and 79 – in the UK, the average age at diagnosis is 63.⁴

Being overweight
Women who are very overweight are around two to three times more likely to develop womb cancer compared to women with a healthy weight. And women who are very obese could be six times more at risk. This could be because larger women have higher levels of oestrogen.⁵

Hormone replacement therapy (HRT)
Oestrogen-only HRT increases the risk of womb cancer. Normally, it’s only given to women who’ve had their womb removed. It helps to control the symptoms of menopause.

Family history or previous cancer
If your mother has had womb cancer, you have twice the risk of developing cancer compared with a woman whose mother hasn’t had womb cancer.

Having certain cancers before – including breast, colon and rectum – increase your risk of womb cancer. Equally, if you have womb cancer you’re more at risk of developing some other cancers.⁶

Not having children
Women who have never been pregnant are more likely to develop uterine cancer than women who have. This has been linked to the levels of oestrogen and progesterone in the body.

Diabetes
Diabetes is often linked to being overweight, so it could be this link that means women with diabetes are twice as likely to develop womb cancer.⁷ Diabetes also increases the levels of insulin in your body, which in turn can increase your oestrogen levels.

Polycystic ovarian syndrome (PCOS)
Women who have cysts in their ovaries are more at risk of womb cancer than women who don’t. But nine in ten women who have PCOS don’t develop womb cancer.⁸

⁴ Cancer Research UK, Womb cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/womb-cancer/about/womb-cancer-risks-and-causes
⁵ Cancer Research UK, Womb cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/womb-cancer/about/womb-cancer-risks-and-causes
⁶ Cancer Research UK, Womb cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/womb-cancer/about/womb-cancer-risks-and-causes
⁷ NHS Choices, Causes of womb cancer http://www.nhs.uk/Conditions/Cancer-of-the-uterus/Pages/Causes.aspx
⁸ Cancer Research UK, Womb cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/womb-cancer/about/womb-cancer-risks-and-causes

It’s important to remember that the symptoms of womb cancer are usually caused by other non-cancerous conditions. Most women who notice these symptoms won’t have womb cancer. If you do notice any symptoms though, you should see a doctor a soon as possible, especially if you’ve been through the menopause.

Screening
At the moment, there aren’t any reliable screening tests that can pick up the early stages of womb cancer.

Around 9 out of 10 womb cancer cases are spotted because women notice irregular vaginal bleeding or bleeding after the menopause. Other common symptoms include:

• unusually heavy bleeding during your period or between periods
• a change in the colour, consistency or smell of vaginal discharge.

Less common symptoms include pain in your lower tummy (abdomen) or pain during sex.

There are often more symptoms in advanced womb cancer and can include:

• loss of appetite
• losing weight
• feeling tired or sick
• constipation
• needing to pee more often
• pain in your back or legs.

Getting symptoms checked
If you notice any of these symptoms, you should see your doctor, who might perform a pelvic examination. They’ll ask you to lie on your back with your knees up so they can fall gently apart. Then your doctor will feel for things like lumps or swellings and changes in shape.

They may also want to look at your cervix – the muscle at the opening of your womb – to see if it looks normal. They’ll use something called a speculum to carefully open your vagina. It shouldn’t be uncomfortable, but let them know if you feel any pain.

Your doctor might refer you to a consultant gynaecologist for further tests.

Womb cancer tests at BMI Healthcare

At BMI Healthcare, we offer specialised tests at our Women’s Health clinics across the country, where you’ll be seen by one of our consultant gynaecologists, who specialise in the female reproductive system.

Because our consultant gynaecologists specialists are highly experienced, you’ll get expert advice and excellent care, with your test results usually delivered within 48 hours.

Blood tests
Womb cancer can sometimes produce a protein called CA125, which is carried in the blood. Your or consultant gynaecologist might ask you to have a blood test to see if your CA125 levels are normal. If your test shows high levels, you’ll need to have further tests to help identify the problem. It can be caused by other conditions ¬– not just womb cancer.

Womb lining biopsy
Taking a sample of the tissue in your womb lining is the only way to give a definite diagnosis of womb cancer. The sample will then be examined in a lab for cancerous or abnormal cells. There are a few different ways to take a sample of cells.

• Endometrial biopsy uses a small plastic tube and syringe to gentle suck cells from your womb by going through your vagina
• Hysteroscopy lets your consultant gynaecologist look inside your womb by using a very thin telescope called a hysteroscope.
• Dilatation and curettage (D and C) happens under general anaesthetic so you’re asleep for the procedure. It lets your doctor sweep for samples of your womb’s lining by opening the entrance to your womb called the cervix. The sample of cells is then checked in a lab.

Ultrasound scan
Ultrasound scans use sound waves to build up a picture of your womb. It shows how thick the womb lining is, and lets your doctor or radiographer check the other organs in your pelvis.

Sometimes, the ultrasound probe will be put inside your vagina. This is called a transvaginal ultrasound. Alternatively, you might have an abdominal ultrasound, which is when the probe goes over your tummy (abdomen).

The stages of womb cancer
Once you’ve been diagnosed with womb cancer, your consultant gynaecologist will give you a stage. The stage tells you the size of the cancer and how far it’s spread. The grade describes what the cells look like.

• Stage 1: The cancer is confined to your womb
• Stage 2: The cancer has spread to your cervix (the neck of your womb)
• Stage 3: The cancer has spread outside your womb and into other tissues in your pelvis
• Stage 4: The cancer has spread to your abdomen or other organs.

For more detailed explanations of each of the stages, please read Cancer Research UK’s stages of womb cancer guide. 

The main treatment for womb cancer is surgery. Women with very early womb cancer might not need any other treatment after that.

If the womb cancer has spread or if you have a certain type, you might need radiotherapy, chemotherapy or hormone therapy as well.

Surgery
Some women with womb cancer will only need both ovaries and the fallopian tubes, or the uterus removing. But most women with womb cancer will need to have a total hysterectomy. This means they’ll have their womb, fallopian tubes and ovaries removed. They might also need some of the glands around your womb called lymph nodes removing and checked for signs of cancer.

There is also the possibility to have a laparoscopic hysterectomy, or keyhole surgery. Laparoscopic hysterectomy is an effective and safe procedure that ensures a faster recovery and minimal scarring. 

Radiotherapy
Radiotherapy uses high-energy rays to get rid of cancer cells. You might need radiotherapy either as your main treatment, before or after surgery.

Radiotherapy is often offered as the main treatment if your cancer is locally advanced. This means that the womb cancer has grown into areas close to the womb making it hard to remove completely with surgery alone.

It’s also common for radiotherapy to be offered after surgery if there’s a risk that the cancer could come back, or if you didn’t have your lymph nodes removed.

Chemotherapy
Some women need chemotherapy before or after their surgery. Chemotherapy usually means you’ll need a drug injecting for a period of time. The aim is to either stop the cancer from coming back after or ¬– if it wasn’t possible to remove it all during surgery ¬– to shrink the cancer that’s left.

Hormone therapy
Women whose uterine cancer is affected by oestrogen might need to have hormone therapy. It usually replaces the naturally occurring progesterone in your body with artificial progesterone given in tablets.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.

Want to know more?
If you’d like to read more about womb cancer, treatment or living with womb cancer, please visit cancerresearchuk.org.uk.