Uterine Cancer (Womb Cancer)

Causes of uterine cancer

The exact cause of uterine cancer is not known, but what is known is that cancers happen because healthy cells turn into abnormal cells and grow rapidly. These cells don’t die at a set time, and result in the accumulating abnormal cells forming a mass (tumour).

Risk factors of uterine cancer

• Prolonged exposure to oestrogen as a result of early menarche (first period) and late menopause can increase the risk

• Being overweight or obese increases the level of oestrogen in the body as oestrogen can be produced in fatty tissue

• Polycystic ovary syndrome results in high levels of oestrogen in the body, leading to increased risk of uterine cancer

• Using oestrogen only (without progesterone) hormone replacement therapy or fertility treatment

• Reproductive history. Women who have not had children are at a higher risk of developing uterine cancer

• Age. The risk of uterine cancer increases with age. It mostly occurs in women aged between 40 and 74.

• Family history of uterine (endometrial), ovarian or colorectal cancer

• Endometrial hyperplasia, a condition where the lining of the endometrial wall is thickened

• Medical conditions such as diabetes and hypertension (high blood pressure)

• Breast cancer treatment. Women who take tamoxifen, a hormone treatment for breast cancer, can be at increased risk of developing uterine cancer

Preventing uterine cancer

• Taking birth control pills, which have a combination of oestrogen and progesterone to produce a monthly menstrual cycle reduces the risk of an overgrowth of the uterine lining

• Maintaining a healthy weight to reduce the amount of oestrogen in the body

• Good management of diabetes, such as regularly monitoring blood glucose levels

• Assessing the risk of uterine cancer before starting hormone replacement therapy, especially oestrogen replacement therapy alone

The most common symptom of uterine cancer is abnormal vaginal bleeding, including vaginal bleeding after menopause, periods that are heavier than usual, and bleeding between periods.

Other symptoms include:

• Vaginal discharge ranging from pink and watery to thick, brown and foul-smelling

• Difficult or painful urination

• An enlarged uterus that is detected during a pelvic exam

• Pain during sexual intercourse

• Unexpected weight loss

• Weakness and pain in the lower abdomen, back, or legs

• Occasional pain in the pelvis, lower abdomen, or during sex

Uterine cancer symptoms may appear similar to other conditions. While the most common symptom is unusual vaginal bleeding, most people showing this symptom will not have cancer. Talk to your doctor to further investigate the cause of your symptoms if you have concerns.

Several tests and procedures may be performed to make a diagnosis of uterine cancer.

Pelvic examination

A doctor performs a pelvic exam by carefully inspecting the outer portion of your genitals, as well as your vagina, uterus, and ovaries. A tool may be used to open your vagina to view for abnormalities.

Ultrasound of the vagina

An ultrasound is done to look at the thickness and texture of the endometrium and to help rule out other conditions.

Hysteroscopy

A hysteroscopy is done by inserting a thin, flexible tube through your vagina and cervix into the uterus to examine the inside of the uterus and the endometrium.

Biopsy of the uterus

A sample of the cells inside your uterus is taken for testing in the laboratory.

Dilatation and curettage (D&C)

If the biopsy results are unclear, a procedure called dilatation and curettage is done to scrape the lining of your uterus and examining it under a microscope for cancer cells.

The main treatment for uterine cancer is surgery to remove your uterus, fallopian tubes, and ovaries. The nearby lymph nodes are also likely to be removed. Additional treatments include:

Chemotherapy

Chemicals are used to kill cancer cells. This can be done in many ways, such as using single or multiple drugs, oral or intravenous medications. Chemotherapy may be recommended to reduce the risk of cancer recurrence after surgery or to shrink a tumour before surgery so it can be more easily removed.

Hormone therapy

Medications are taken to lower hormone levels in the body so that cancer cells that rely on the hormones to grow might die.

Radiotherapy

Powerful energy beams are used to kill cancer cells. This may be done to reduce the risk of cancer recurrence after surgery or to shrink a tumour before surgery so it can be more easily removed.

Targeted drug therapy

This treatment targets specific weaknesses present within cancer cells. It is usually combined with chemotherapy to treat advanced uterine cancer.

Immunotherapy

This treatment helps your immune system to fight cancer. It may be considered if the cancer is advanced and other treatments haven’t helped.

Palliative care

This is a specialised medical care that aims to provide pain relief and making you feel comfortable while undergoing aggressive treatments for cancer.

Fertility and sexual health

Cancer treatment may sometimes affect your fertility and sexual health. You may want to opt for treatment that will potentially allow you to get pregnant in the future. These are topics that you can discuss with your doctor before treatment begins to ensure the best outcomes for yourself.

Cancer remission and recurrence

When cancer cannot be detected in the body and you experience no symptoms, you are said to be in remission. A remission may be temporary or permanent. If the cancer returns after the original treatment, it is called recurrent cancer. This may happen in the same place as the original cancer, nearby, or in another place.

Talk to a specialist to learn more about uterine cancer and its treatment options.

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Anaemia

Low red blood cell count and iron deficiency due to excessive bleeding. Symptoms include fatigue, weakness, cold hands and/or feet, irregular heartbeat, and dizziness.

Post-surgery complications

These include bladder instability, bleeding, and pain

Treatment-associated complications

Complications from chemotherapy and radiotherapy may include vaginal damage, sexual dysfunction, and bowel or bladder damage