Understanding Uterine Cancer

This information has been prepared to help you understand more about uterine cancer. The information is an introduction to the diagnosis, treatment and effects of uterine cancer but is by no means exhaustive. We cannot advise about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors.

• The uterus
• What is uterine cancer?
• How common is it?
• Risk factors
• Symptoms
• Prevention and detection
• Diagnosis
• Further information

The uterus

• Part of the female reproductive system.
• Also called the womb.
• About the size and shape of an upside-down pear.
• Sits quite low in the abdomen and is held there lightly by muscle.
• Joined to the vagina by the cervix, or neck of the uterus.

The uterus’ roles

Each month, in women who are able to have children, hormones are released in the body that cause ovulation and menstruation.

In ovulation, an egg travels from one of the ovaries down the Fallopian tube. If the egg is fertilised, it implants in the lining of the uterus, where it grows into a baby.

The lining of the uterus is called the endometrium. The endometrium is made up of several layers that include skin-like cells (surface epithelium), blood vessels, tissue spaces and glands. Each month the endometrium grows thicker to prepare for pregnancy. If a woman does not become pregnant, the top layers of the endometrium are shed and flow out through the vagina in the monthly period.

Menopause is when a woman’s periods stop and she is no longer able to have a baby. Her body stops releasing the hormones that cause ovulation and periods. When these hormones are no longer being produced, the uterus becomes smaller and the endometrium becomes thinner and inactive.

What is uterine cancer?

Uterine cancer is the most common gynaecological cancer. Most cancers of the uterus are cancers of the lining of the uterus (the endometrium). Cancer can also develop in the muscle layers of the uterus. There are several types of uterine cancer.

• Adenocarcinoma of the endometrium - This cancer starts in glandular tissue. About 85% of women who are diagnosed with cancer of the uterus have this type of cancer.
  
  
• Other types of cancer of the uterus - The less common types of cancer of the uterus are adenosquamous carcinoma, serous carcinoma and, rarely, clear cell carcinoma or uterine sarcoma. These cancers are more likely to spread.

How common is it?

Cancer of the uterus (or womb) is a relatively common gynaecological cancer, with around 1,300 women diagnosed in Australia each year. It is more common in women aged over 50 than in younger women.

Most cancers of the uterus are cancers of the lining of the uterus (the endometrium). Cancer can also develop in the muscle layers of the uterus.

Risk factors

The exact cause of cancer of the uterus is not known, but some factors seem to increase risk:

• Age (it is more common in women aged over 50)
• Endometrial hyperplasia (a condition that occurs when the endometrium – the lining of the uterus – grows too thick)
• Never having children
• Being menopausal (it is most common in postmenopausal women)
• Being overweight
• High blood pressure and diabetes
• A family history of ovarian, endometrial, breast or bowel cancer
• Taking oestrogen hormone replacement without progesterone
• Taking tamoxifen for the treatment of breast cancer. If you are taking tamoxifen, you should discuss this risk with your doctor.

Remember, most women who have known risk factors don’t get cancer of the uterus, and many women who do get cancer of the uterus have none of these risk factors. Uterine cancer is not caused by sexual activity and cannot be passed on this way.

Symptoms

The most common symptom of uterine cancer is unusual bleeding. Occasionally women experience a watery, bloody discharge from the vagina. Sometimes this discharge can be smelly.

Unusual bleeding or discharge can happen before and after menopause. It is usually not due to cancer of the uterus. However, all women with unusual bleeding or discharge should see their doctor for a check-up.

Other symptoms can include:

• Discomfort or pain in the abdomen
• Difficult or painful urination
• Pain during sex

These symptoms may be due to another condition and do not mean that you have uterine cancer. Only tests can confirm the diagnosis.

Prevention and detection

Prevention is better than cure, so The Cancer Council Australia and its state members work to raise awareness of women’s cancers and to educate women about how to lower their cancer risk.

You and your circle of friends can greatly reduce your risk of developing cancer by:

• Learning what the risk factors are and where possible taking steps to decrease your risk
• Knowing the early warning signs and monitoring your health
• Leading a healthy lifestyle.

Detection

At the moment there is no test to check healthy women for early signs of uterine cancer. Unlike Pap tests, which test for cervical cancer before symptoms appear, there is no screening test for uterine cancer. The Pap test does not detect uterine cancer.

See your GP if you experience any of the symptoms above. If your doctor suspects you have uterine cancer, he or she will refer you for tests, such as an ultrasound. If the tests show you have or may have cancer, your doctor will refer you to a specialist who will advise you about treatment options.

Diagnosis

Your GP will arrange the first tests to check out your symptoms. This can be a worrying and tiring time, especially if you need several tests. If these tests do not rule out cancer, you will usually be referred to a gynaecological oncologist, a specialist in treating women with uterine cancer. This specialist will arrange further tests and advise you about treatment options. Some of the tests that you may require are:

• Physical examination - Your doctor will feel your abdomen to check for swelling. Your doctor may also look at your vagina and cervix using a speculum. This is like having a Pap test.
  
  
• Transvaginal ultrasound - This test uses sound waves to create a picture of internal organs. A small device called a transducer is put into your vagina. It makes sound waves and receives echoes. A computer makes a picture of the echoes produced when the sound waves meet something dense, such as an organ or a tumour. Using the ultrasound, the doctor can look at the size of your ovaries and uterus and the thickness of the endometrium. If there is anything unusual, your doctor will suggest you have a biopsy.
  
  
• Hysteroscopy and biopsy - You will have a hysteroscopy and biopsy if your doctor thinks that cancer could be present. A hysteroscopy is a procedure that allows your doctor to see inside your uterus by stretching and opening the cervix and inserting a telescope-like device called a hysteroscope. At the end of the procedure, the doctor will remove some tissue to be sent to the laboratory for examination under a microscope. This is called a biopsy.
  
  There are different ways of taking tissue samples from the inside of the uterus:
  • Tissue can be snipped out, or a spray of fluid may be used to dislodge cells.
    
    
  • Tissue can be removed using a suction device. This method is called endometrial aspiration.
    
    
  • Sometimes most of the uterus lining is scraped out. This is called a D&C (dilatation and curettage). This is the most common and accurate way to remove tissue for a biopsy.
    
    
  These procedures are usually done in a few hours in hospital or at a day procedure centre. You will probably have a light general anaesthetic. There are the normal risks involved with any anaesthetic. Ask your doctor about these risks.
  
  Afterwards, you may have period-like cramps and light bleeding that can last for a few days.

Further information

For further information on cervical cancer, call The Cancer Council Helpline on 13 11 20 or contact your local state or territory office of The Cancer Council (see the contact us page for details)

© 2008 Cancer Council