WHAT IS CANCER OF THE UTERUS?
There are two main types of uterine cancer. Endometrial cancers begin in the lining of the uterus (endometrium) and account for about 75% of all cases; and uterine sarcomas, which develop in the muscle tissue (myometrium), and is a rarer form of uterine cancer.
Also called cancer of the uterus, it is the most diagnosed gynaecological cancer in Australia. The risk of a woman in Australia being diagnosed with cancer of the uterus by the age of 85 is 1 in 43.
In 2014, 2614 women were diagnosed with cancer of the uterus, and it is more common in women aged over 50.
In 2016, there were 527 deaths in Australia, caused by uterine cancer.
The five year survival rate for cancer of the uterus is 83%.
UTERINE CANCER SYMPTOMS
Unusual vaginal bleeding is the most common symptom of uterine cancer. Some women experience a watery discharge, which may have an offensive smell.
Although abnormal bleeding or discharge can happen for other reasons, you should talk to your GP if you have either of these symptoms.
CAUSES OF UTERINE CANCER
Some factors that can increase your risk of uterine cancer include:
- being postmenopausal, or reaching menopause late (after age 55)
- a thickened wall lining (endometrial hyperplasia)
- never having children or being infertile
- starting periods early (before age 12)
- having high blood pressure or diabetes
- being overweight or obese
- family history of ovarian, uterine, breast or bowel cancer
- previous ovarian tumours, or polycystic ovary syndrome
- oestrogen only hormone replacement therapy
- previous pelvic radiation for cancer
- taking tamoxifen to treat breast cancer (the benefits of treating breast cancer usually outweigh the risk of uterine cancer. Talk to your doctor if you are concerned).
DIAGNOSIS FOR UTERINE CANCER
Tests to diagnose uterine cancer include:
The doctor may check your abdomen for swelling. To check your uterus, the doctor will place two fingers inside your vagina while pressing on your abdomen, or they may use an instrument (a speculum) that separates the walls of the vagina (similar to a Pap test).
Using ultrasound with a device called a transducer, the doctor can see the size of your ovaries, uterus, and the thickness of the endometrium. If anything appears unusual, the doctor may suggest a biopsy.
HYSTEROSCOPY AND BIOPSY
A hysteroscope is a telescope-like device which is inserted through your vagina into your uterus, and allows a gynaecologist or gynaecological oncologist to see inside your uterus. During this procedure, tissue can also be removed (biopsy) and sent for further testing in a laboratory.
BLOOD AND URINE TESTS
Blood and urine tests may be used to assess your general health, and inform treatment decisions.
If cancer is detected in your uterus, you may have other scans to see if the cancer has spread to other parts of your body, such as an X-ray, CT scan or MRI scan. For particular types of uterine cancer, such as sarcoma, a PET scan may be used.
TREATMENT FOR UTERINE CANCER
For most women with uterine cancer, surgery will be the only treatment required, particularly if the cancer is diagnosed early and has not spread to other parts of the body.
SURGERY (HYSTERECTOMY AND BILATERAL SALPINGO-OOPHORECTOMY)
The most common form of treatment for cancer of the uterus is surgically removing the uterus and cervix. This procedure is called a total hysterectomy. If the fallopian tubes and both ovaries are also removed, it is called a bilateral salpingo-oophorectomy.
Ovaries are often removed to reduce the risk of the cancer coming back, as ovaries produce oestrogen, a hormone that may cause the cancer to grow.
The surgery can be performed through a cut in the abdomen (laparotomy) or using keyhole surgery (laparoscopic surgery). You will be given a general anaesthetic. During the procedure, the surgeon may remove additional tissue if the cancer has spread, or to remove lymph nodes in your pelvis.
For women who were not menopausal before treatment who then have a bilateral salpingo-oophorectomy, they will experience menopause with the removal of their ovaries. Therefore, if you are concerned about how surgery will affect your fertility, it is important to talk to your specialist before treatment begins.
The treatment team will advise you of how to take care of yourself following surgery, including avoiding lifting, driving and sexual intercourse for a short period of time during your recovery.
Radiotherapy, the use of X-rays to kill or injure cancer cells, is commonly used as an additional treatment to reduce the chance of the cancer coming back. It may be recommended as the main treatment if you are not well enough for surgery.
Radiotherapy is given either externally, where a machine directs radiation at the cancer and surrounding tissue; or from inside the body (brachytherapy), where radioactive material is put in thin tubes and placed near the cancer internally.
Radiotherapy to the pelvic region may cause menopause, therefore, if you are concerned about how treatment will affect your fertility, it is important to raise your concerns with your treatment team before treatment commences.
Hormone treatment is usually given if the cancer has spread or if the cancer has come back (recurred). It is also sometimes used if surgery is not an option. Progesterone is the main hormone treatment for women with uterine cancer, and it is available in tablet form or by injection by a GP or nurse. It helps shrink some cancers and to control symptoms.
Chemotherapy is used to treat certain types of uterine cancer, or when cancer comes back after surgery or radiotherapy, or if the cancer is not responding to hormone treatment. It can be used to control the cancer and to relieve symptoms. It is usually given as a drug that is injected into a vein (intravenously). The doctor will explain the chemotherapy treatment course and how long it will last.
Depending on your treatment, your treatment team may consist of a number of different specialist staff, such as:
- a GP who can assess initial symptoms and coordinate with your specialists
- a gynaecological oncologist, who specialises in treating women with cancers of the reproductive system
- a radiation oncologist, who prescribes and coordinates radiotherapy treatment
- a medical oncologist, who prescribes and coordinates the course of chemotherapy
- a radiologist, who interprets diagnostic scans (including CT, MRI and PET scans)
- cancer nurses, who assist with treatment, provide information and support throughout your treatment
- other allied health professionals, such as dieticians, psychologists, and social workers.
In some cases of uterine cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
As well as slowing the spread of uterine cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
SCREENING FOR UTERINE CANCER
There is currently no screening for uterine cancer available in Australia.
A Pap test (or Pap smear test) is used to check the cells inside the vagina and cervix. Occasionally, uterine cancer cells are detected in a Pap test.
PROGNOSIS FOR UTERINE CANCER
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of uterine cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
In most cases, early diagnosis of uterine cancer has a good prognosis.
In 2014, there were 494 deaths in Australia, caused by uterine cancer.
PREVENTING UTERINE CANCER
As there is no known cause for uterine cancers, it is not possible to prevent most cases of this disease.
However, you may be able to minimise your risk factors, such as maintaining a healthy weight, and being vigilant about any abnormal vaginal bleeding.