Womb cancer is the 6th most common cancer in women worldwide and now the 4th most common in women here in the UK. Incidence has been rising at a startling rate with a 55% increase in cases since the 1990s. So why is this?
As a nation, we are carrying more weight and obesity is a key factor in the development of the womb cancer. Additionally, we are all living longer and womb cancer is most commonly seen in the 75-79 age bracket.
Overall, this is a cancer which can be ‘caught’ early as there are often early symptoms. We know, as with all cancers, when they can be managed at an early stage, they often have a much-improved outlook. This is why it is so important to get checked if you have any unusual bleeding/discharge, particularly if you are post-menopausal – this can be a key sign that something is not quite right.
Perhaps the most significant change in our understanding of this disease (and many other cancers) is in the field of genomics. Understanding genomes and their impact is complex, so let’s give a go, shall we?
Around 3% of all womb cancers are associated with Lynch Syndrome and up to one in 280 people have Lynch Syndrome. What is this, you’ll be asking? It comes from mis-match repair genes- imagine you made a typo on a document, didn’t notice it and in every copy of the document you created, the typo was repeated. That is essentially what has happened to your genes in Lynch Syndrome. With this knowledge, we have opportunity. NICE (National Institute of Clinical Excellence) recommends everyone with womb cancer is tested for Lynch Syndrome. Since Lynch can be associated with other cancers, including bowel cancer, this allows the testing of family members, who if also positive for Lynch Syndrome, can take measures to prevent cancer, or have regular monitoring to detect it as early as possible.
And what about other rogue genes? Loss of expression of the gene p53 tends to show that womb cancer responds less well to chemotherapy. The role of BRCA 1 and 2 genes in womb cancer also remains controversial. These genes have been routinely tested for many years now in breast cancer and ovarian cancer.
These kinds of new genomic developments are giving us a much better understanding of the prognosis for women and are helping us identify new targeted treatments as well as preventing other future cancers.
There is currently no screening programme for womb cancer. However, women with Lynch Syndrome could be offered annual trans-vaginal ultrasound screening (TVS), hysteroscopy and endometrial sampling from the age of 35. Women with Lynch must seek urgent medical attention with any abnormal vaginal bleeding. It is also recommended for women with Lynch who have completed their families to have risk reducing surgery- a hysterectomy and removal of ovaries.
All women diagnosed with womb cancer should be discussed at a specialist clinical meeting – we call this MDT (multi-disciplinary meeting). Here, a range of clinical professionals with different expertise will discuss your case to come up with a plan for your treatment.
For a while there has been debate about the management of lymph nodes. The new guidelines recommend sentinel lymph node biopsy. The sentinel lymph node is the first lymph node or group of nodes draining a cancer. If this proves negative, this preserves more of the lymph chain, reducing side effects like lymphoedema and helping the planning of follow-up treatments after the main treatment eg surgery (called adjuvant treatment).
Women and people with gynae organs wishing to preserve their fertility, where possible, should be treated in specialist centres. Fertility sparing treatments are considered safe in low-grade disease.
For those with more advanced cancer, debulking surgery should be considered if they are fit enough to undergo the surgery and only if it’s believed possible to kill all of the cancer cells (cyto-reduction). Debulking surgery may also be considered in incurable disease to provide symptom relief.
Women and people who present with a high-risk womb cancer are ideally recommended to have surgery (if feasible) followed by external beam radiation treatment with chemotherapy and radiotherapy.
So what does the future hold for those with more advanced disease? A number of promising targeted therapies are currently being researched. With our greater understanding of molecular biology of womb cancer and genomics, a number of new drugs are in clinical trials. This could provide real hope for women and people with more advanced womb cancer.
When cancer comes back (recurrent), it is always harder to treat. The guidelines recommend radiotherapy (if this has not been used previously), and surgery (so long as it is believed they can get clear margins). In some women, very radical surgery may be considered, called exenteration.
The way in which patients are being followed up is changing too. Clinical teams are defining people according to risk, and putting them into follow-up pathways which may suit them better- including telephone/nurse-led clinics as well as patient-led follow-up clinics. This simply means that you would have access to your clinical team at any time with any worrying symptoms you may have– we know symptoms don’t just appear at the time of a follow-up appointment. Alongside this, your clinical team should discuss with you the key signs and symptoms to look out for.
It’s vital all women with womb cancer have access to a Clinical Nurse Specialist (CNS). We know managing cancer and its treatments is hard. Your CNS is there to guide and support you from diagnosis, through to treatment and recovery. They can also help refer you to specialist services such as lymphoedema specialists and psycho-sexual counsellors.
Unfortunately, sometimes, treatments can leave longer-lasting side effects. It is important you raise these issues with your clinical team, so they can do their best to ensure you have all the support and treatment you need.
We have gained important information from the new guidelines and this blog is just a summary of the highlights.
I want to finish on some really important things I want everyone to remember: cervical screening does not look for womb cancer. If you have any abnormal vaginal bleeding, particularly post-menopausal, you must get this checked (regardless of your cervical screening results). In most cases, this won’t be cancer and will be something less serious – but’s it’s better to get it checked than leave it – wouldn’t you agree?
You can find out more about womb cancer by clicking here.
If you have any more questions or need any advice on womb cancer, do get in touch with our Ask Eve team by emailing nurse@eveappeal.org.uk or by calling 0808 802 0019.