Chapter 01
What is uterine cancer?
Uterine cancer begins when abnormal cells develop in the uterus (womb). It may also be called endometrial cancer. The uterus is a hollow organ in a woman’s pelvis. It’s where a fertilised egg implants during pregnancy and then develops until birth. The endometrium is the lining of the uterus.
Types of uterine cancer
There are two main types of uterine cancer.
- Endometrial cancer This begins in the lining of the uterus and is the most common type of uterine cancer1.
- Uterine sarcomas This is a rare type of cancer which begins in the muscle tissue of the uterus.
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Symptoms of uterine cancer
Symptoms may include:
- unusual vaginal bleeding, particularly after menopause
- a change in periods or periods getting heavier
- periods that don’t stop
- watery discharge that smells
- unexplained weight loss
- change in bowel habits
- problems or pain urinating
- pain during sex
- pain in your lower back or between the hip bones
- swelling in the pelvis
Having any of these symptoms doesn’t mean you have uterine cancer, but you should see your doctor for a check-up.
What causes uterine cancer?
There is no clear reason for uterine cancer. However, some factors appear to increase the risk. These include:
- a thickened endometrial lining (endometrial hyperplasia)2
- having diabetes3
- not having had children4
- being overweight5
- certain genetic conditions, including Cowden syndrome6
- taking certain medications for breast cancer, such as Tamoxifen7
- having polycystic ovarian syndrome (PCOS)8
- oestrogen-only HRT9
- menopause10
- radiation therapy to the pelvis11
Having any of these risk factors doesn’t mean you will develop uterine cancer, but you should see your GP if you are worried.
Chapter 02
Diagnosing uterine cancer
There are no screening tests for uterine cancer. For example, the cervical screening test doesn’t screen for uterine cancer.
Your GP will probably refer you to a specialist if they’re concerned about your symptoms and risk factors for uterine cancer. They may also do an initial physical examination to check for swelling or pain. Other tests may include:
- Pelvic ultrasound – An ultrasound can provide pictures of the uterus. You may have an abdominal ultrasound, where a handheld device is rubbed over your stomach. Or you could have a transvaginal ultrasound, where a lubricated probe is gently inserted into your vagina to examine inside your uterus. It might be slightly uncomfortable but shouldn’t be painful.
- Endometrial biopsy – A thin plastic tube is used to gently suck a sample of cells from the lining of your uterus. The cells are then examined under a microscope to see if they are abnormal. The procedure takes just a few minutes and may cause period-type discomfort.
- Hysteroscopy and biopsy – This procedure involves a telescopic device with a light and camera being inserted into your vagina so a doctor can see inside your uterus. Your doctor will take a biopsy at the same time. It’s usually performed under general anaesthetic.
If you are diagnosed with uterine cancer, your doctor will explain which of the four stages you have and how far your cancer has progressed. Stage 1 is the least advanced, and Stage 4 is the most advanced. Uterine cancer can also be graded from 1 to 3 according to how quickly it is expected to grow.
Chapter 03
Treatments for uterine cancer
Your treatment for uterine cancer will depend on how advanced it is and whether you would like to have children. Treatments that may be offered include:
- Chemotherapy
- Hormone therapy
- Radiation therapy
- Surgery
Chemotherapy can involve a single drug or a combination of drugs. These drugs are often injected directly into a vein, although your doctor may prescribe oral medication. Chemotherapy may be used in uterine cancer if cancer comes back after surgery or if your body isn’t responding to hormone therapy.
Hormone therapy may be given if the cancer has come back after surgery or has spread to other parts of the body. It may also be offered if the cancer is low-grade and you are trying to avoid a hysterectomy. It can help control some symptoms and shrink some cancers. In uterine cancer, the most common hormone given is progesterone.
Radiation therapy uses Xrays to damage or kill cancer cells. Radiation therapy is usually given after surgery. The area that is treated with radiation depends on the extent of the cancer. In early stages the upper part of the vagina that remains after surgery is targeted with internal radiation (brachytherapy). In later stages of the disease the upper part of the vagina and the pelvic lymph nodes at risk of recurrence are targeted with external radiation. Internal radiation may be given after a hysterectomy, where the radiation is delivered through a tube in the vagina.
Surgery is the most common treatment in the early stages of uterine cancer and may be the only treatment needed. Depending on how advanced the cancer is and whether you would like to have children in the future, you may have a total hysterectomy. This removes the uterus and cervix. In addition, you may need a bilateral salpingo-oophorectomy (BSO) which also removes the fallopian tubes and ovaries. It’s sometimes possible to keep your ovaries if the cancer is low-grade and in early stages. If the cancer has spread, the surgeon may also remove a small piece of the upper vagina.
Chapter 04
Your treatment with GenesisCare
We understand that a cancer diagnosis can be emotional and life-changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.
Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re with GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.
Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.
Chapter 06
Helpful services
Other information, resources and support services are available to assist you during your cancer journey. These include:
Cancer Council Australia
13 11 20
Australian Cancer Research Foundation
02 9223 7833
References
- Uterine Cancer. https://www.ncbi.nlm.nih.gov/books/NBK562313/
- The Connection between the Endometrial Thickness and the Risk of Endometrial Malignancy in Postmenopausal Women. Open Access Maced J Med Sci. 2019 Jul 30; 7(14): 2263–2266. Published online 2019 Jul 28. doi: 10.3889/oamjms.2019.639. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765086/
- The effect of diabetes on the risk of endometrial Cancer: an updated a systematic review and meta-analysis. BMC Cancer volume 19, Article number: 527 (2019) https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5748-4
- Pregnancy history and risk of endometrial cancer. Epidemiology. 2011 Sep; 22(5): 638–645. doi: 10.1097/EDE.0b013e3182263018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152311/
- Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. J Clin Oncol. 2016 Dec 10; 34(35): 4225–4230. Published online 2016 Nov 7. doi: 10.1200/JCO.2016.69.4638. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455320/
- Genetic basis of Cowden syndrome and its implications for clinical practice and risk management. Appl Clin Genet. 2016; 9: 83–92. Published online 2016 Jul 13. doi: 10.2147/TACG.S41947. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948690/
- Tamoxifen treatment for breast cancer and risk of endometrial cancer: a case-control study. J Natl Cancer Inst. 2005 Mar 2;97(5):375-84. doi: 10.1093/jnci/dji057. https://pubmed.ncbi.nlm.nih.gov/15741574/
- Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer. Medicine (Baltimore). 2018 Sep; 97(39): e12608. Published online 2018 Sep 28. doi: 10.1097/MD.0000000000012608. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181615/
- Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 2005 Apr 30-May 6;365(9470):1543-51. doi: 10.1016/S0140-6736(05)66455-0. https://pubmed.ncbi.nlm.nih.gov/15866308/
- Age at Menopause and Risk of Developing Endometrial Cancer: A Meta-Analysis. Biomed Res Int. 2019; 2019: 8584130. Published online 2019 May 29. doi: 10.1155/2019/8584130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560333/
- Pelvic radiation therapy: Between delight and disaster. World J Gastrointest Surg. 2015 Nov 27; 7(11): 279–288. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663381/
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