Womb cancer is the fourth most common cancer in women in the UK, and the most common type of gynaecological cancer.
There are several different treatment options for womb cancer depending on the type of cancer you have and what stage it's at. However, when caught at an early stage, most cases are curable.
What is womb cancer?
Womb cancer develops in the uterus, which is the medical name for the womb. This is why you may also see it referred to as ‘uterine cancer’.
The womb is a muscular organ that forms part of the female reproductive system. It is hollow, so that it can hold a foetus during pregnancy. The lining of the womb is called the endometrium, and the muscle is called the myometrium.
Most womb cancer starts in the endometrium, which is called endometrial cancer.
Endometrial cancer
The most common type of womb cancer is endometrial cancer (cancer that begins in the lining of the womb).
Most endometrial cancers are adenocarcinomas. The word ‘adeno’ means that the cancerous cells are in the glandular tissue of the womb lining and ‘carcinoma’ means that the cancer has originated in the tissues lining or covering internal organs.
There are other types of endometrial cancer – such as serous carcinoma and clear cell carcinoma – but these are much rarer.
Endometrial cancer is sometimes labelled as either type 1 or type 2:
- Type 1 cancers, like endometrioid adenocarcinomas, are linked to an excess of oestrogen in the body. They are usually slow growing and don’t spread to other areas of the body.
- Type 2 cancers, like serous or clear cell carcinomas, are not linked to excess oestrogen. They grow faster and are more likely to spread.
However, new molecular classification has superseded this old terminology.
Cervical cancer
Cancer of the cervix is not considered to be a type of womb cancer, although womb cancer can extend to the cervix.
What causes womb cancer?
Womb cancer more commonly develops after the menopause. However, with a population with increasing BMI, the incidence of womb cancer in pre-menopausal women is rising.
The biggest preventable risk factor for developing womb cancer is being overweight or obese. This is because being overweight increases your levels of oestrogen, which causes the womb lining to build up.
When more womb lining cells are being produced, there is an increased chance that there will be improper repair of some of the cell damages, resulting in cancerous transformation.
Other risk factors include:
- oestrogen-only hormone replacement therapy (HRT) – due to the risk of womb cancer, this will often only be prescribed to menopausal women who have had their womb removed (hysterectomy)
- Tamoxifen hormone therapy – a treatment used for some types of breast cancer
- diabetes
- endometrial hyperplasia – benign (non-cancerous) thickening of the womb lining
- polycystic ovary syndrome (PCOS)
- a family history of womb cancer
Women who have had children or are taking the combined contraceptive pill have a decreased risk of developing womb cancer.
Womb cancer symptoms
The most common symptom of womb cancer is abnormal bleeding from the vagina. This includes:
- bleeding after the menopause
- heavy or persistent bleeding between periods
- abnormal vaginal discharge – particularly if it’s pink in colour
Heavy bleeding can be common in other conditions, such as endometriosis, fibroids, endometrial hyperplasia, and polyps (growths in the womb lining).
Other symptoms of womb cancer include:
- blood in the urine (haematuria), with either accompanying anaemia, high platelet count (thrombocytosis), or high blood sugar levels
- stomach pain
- bloating
- a lump or swelling in your stomach or pelvis
- pain in your lower back or pelvis
- pain during sex
- a change in bowel or bladder habits
- a new, unexplained cough
Womb cancer is most effectively treated when caught early, so you should visit a specialist as soon as you spot any warning signs.
How is womb cancer diagnosed?
At your appointment, you will be asked about your symptoms and medical history as well as your family’s medical history. Your consultant will also carry out a physical examination, to check for swelling, and usually a pelvic examination, too. A pelvic examination is similar to a cervical screening, with a speculum used to look at the vagina and cervix.
There are several diagnostic tests that may be used to confirm or rule out womb cancer:
- blood tests
- ultrasound scan – transvaginal, where the probe is inserted into the vagina
- biopsy – a sample of womb tissue is collected and sent to a laboratory for analysis, to confirm the presence of womb cancer. The sample is usually collected via aspiration biopsy in an outpatient clinic.
- CT scan – this may be used to see if your cancer has spread
- MRI scan – this may be used to see where your cancer is and how big it is
Womb cancer stages
If you are diagnosed with womb cancer, it will be staged to determine the best course of treatment. There are four stages:
- Stage 1 means that the cancer is in only in the womb.
- Stage 2 means that the cancer has grown into the cervix (neck of the womb), but not spread outside the womb.
- Stage 3 means that the cancer has spread outside of the womb but remains within the pelvis.
- Stage 4 means that the cancer has spread to other parts of the body.
Surgery for womb cancer
A hysterectomy is a surgical procedure to remove the womb. It’s the main treatment for womb cancer, especially if your cancer is caught at an early stage. Your cervix is also removed.
You will need your ovaries and fallopian tubes removed as part of staging. You may also have your lymph nodes sampled as part of staging. Very occasionally, if your cancer returns after the initial treatment, your bladder or rectum may be removed as part of surgical treatment if the cancer has spread to these organs.
There are different methods of removing the womb, such as laparoscopically/robotically (keyhole or minimally invasive surgery) or through an incision in the abdomen or vagina.
Most hysterectomies are done robotically at the Cromwell Hospital, requiring an overnight stay. You will also undergo surgical menopause immediately following the surgery if you are pre-menopausal.
Radiotherapy for womb cancer
Radiotherapy uses high-energy beams to destroy cancer cells. It may be used following surgery to remove any remaining occult cancer cells; as a form of management in advanced cancer cases; or as a treatment option if you're unable to have surgery.
There are two types of radiotherapy: external and internal. External radiotherapy is delivered from outside of the body, while internal is delivered vaginally as brachytherapy.
Radiotherapy is often delivered in combination with other treatments, such as surgery or chemotherapy, depending on what stage your cancer is at.
Cromwell Hospital provides advanced radiotherapy services in partnership with GenesisCare.
Chemotherapy for womb cancer
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cromwell Hospital has access to the most established and very latest drugs available.
Chemotherapy may be used to treat cancer or to help manage symptoms. It may also be used as an adjuvant therapy, to help destroy any remaining cancer cells following surgery to prevent recurrence.
Patients at Cromwell Hospital can benefit from access to technologies like DigniCap™, which helps prevent chemotherapy-induced hair loss.
Hormone therapy for womb cancer
Hormone therapy is used to help balance the amount of oestrogen in the body, a hormone which can encourage the growth of womb cancer cells. This is done using progesterone, which counteracts the effects of excess oestrogen.
Hormone therapy is often recommended for younger women with early-stage womb cancer who wish to preserve their fertility.
Immunotherapy for womb cancer
Immunotherapy is a type of cancer treatment that encourages the immune system to fight cancer. It works by helping the immune system recognise and destroy cancer cells.
You may be recommended immunotherapy if you have advanced cancer, or if your cancer has returned.
Is womb cancer hereditary?
Around 5% of women who develop womb cancer will have genetic factors, particularly if close family members have previously had bowel, breast, ovarian, or womb cancer.
There are some genetic conditions that increase your risk of developing womb cancer, such as Lynch syndrome and Cowden syndrome.
How long does it take for endometrial hyperplasia to turn into cancer?
Women with a condition called endometrial hyperplasia (thickening of the womb lining) are at a slightly higher risk of developing womb cancer.
There are two types:
- hyperplasia without atypia, where the cells are thicker but normal
- atypical endometrial hyperplasia, where the cells are not normal (atypical)
Women with atypical hyperplasia are more likely to develop womb cancer than those with the type without atypia.
About the consultant
Professor Jay Chatterjee is a senior Consultant Gynae-oncologist at the Royal Surrey County Hospital NHS Foundation Trust (Guildford) – associated with the renowned St Luke's Cancer Centre – and sees patients at the Cromwell Hospital.
Professor Chatterjee provides all aspect of surgical gynaecological and gynaecological-oncological care. He is internationally known for his surgical expertise in advanced open abdominal and laparoscopic/robotic operative skills. He is presently working to develop genomic, proteomic and immunomic characterisation of tumours, so that novel therapies can be applied as part of personalised cancer care to improve survival from gynaecological cancers.
Known for his patient-centred focus, Professor Chatterjee employs the most up-to-date clinical techniques in order to ensure that he can provide the utmost in patient care.
