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Womb cancer is the fourth most common cancer in women in the UK and the most common of the five gynaecological cancers, with over 9,700 people diagnosed every year in the UK. Its incidence in the UK has increased by 12% in the last 10 years.
How does it develop?
Most womb cancers begin in the endometrium (womb lining), where the cells shed each month when menstruating (a period).
Womb cancer is more common in post-menopausal women (when you have not had a period for 12 months), although it can affect anyone with a womb at any age.
Key signs and symptoms
The most common symptom of womb cancer is abnormal vaginal bleeding – especially after the menopause.
This irregular bleeding might be:
- Vaginal bleeding after the menopause
- Bleeding between periods
- Bleeding that is unusually heavy
- Vaginal discharge that is blood-stained (pink, brown, red)
Any post-menopausal bleed is abnormal, and although it may not be womb cancer, it is important to get any new bleeding checked by your GP. Womb cancer is often detected early, when it is highly treatable, as a consequence of abnormal bleeding.
For post-menopausal women and people with wombs it can take a while to adjust to what is now ‘normal’ in terms of your vaginal discharge. If you are uncertain, do speak to your GP or practice nurse.
Risk Factors
There are many different types of womb cancer. The majority occur with no obvious cause, however we know that an excess of oestrogen (a hormone) can increase your risk.
Fat cells in the body store oestrogen, even after the menopause. Obesity has been linked to womb cancer more than any other cancer, which is likely due to its effect on oestrogen levels. It’s not always possible to prevent womb cancer, but some things are thought to reduce your risk, for example maintaining a healthy weight.
Other risk factors include increasing age, oestrogen only HRT, tamoxifen (used to treat breast cancer), diabetes and polycystic ovaries (PCOS).
How is it diagnosed?
You should visit your GP if you have abnormal vaginal bleeding. While it’s unlikely to be caused by womb cancer, it’s best to be sure and get checked.
Sometimes people will ignore their symptoms because they have recently had a clear cervical screening test. However, womb cancer cannot be picked up by a cervical screening appointment, so it’s important to still go to the doctor with any abnormal symptoms.
Your GP will probably carry out a physical examination of your pelvic area (between your hip bones and the lower part of your tummy). They will ask about your symptoms, when they happen, and how often. It can be helpful to keep a diary of your bleeding so that you can give your doctor a full and accurate picture, when you bleed, how heavily, for how long, and any other noticeable symptoms such as pain levels, we have some tips on how to track your bleeding which you can find here.
You may be referred for further tests which include a Transvaginal Ultrasound and a biopsy, this may take place at a one-stop clinic.
Transvaginal ultrasound
This is a type of ultrasound scan that uses a small scanner probe, placed into the vagina to obtain a detailed picture of the inside of the womb. The probe may feel a little uncomfortable for those who have not had penetrative sex or have any vaginal or vulval health conditions such as vaginismus, but it shouldn’t be painful. Always let the clinician know if this is painful or you are worried.
The ultrasound checks whether there are any changes to the thickness of the lining of your womb that could be caused by the presence of cancerous cells and for any other abnormalities
Biopsy
If the results of the scan show changes in the thickness of the lining of the womb (usually above 4.5 mm), you will have a biopsy to understand the diagnosis. This is done with a hysteroscopy, which takes place in an outpatient department. A hysteroscopy is a narrow telescope with a light and small camera at the end which is placed into your vagina, passed through your cervix and into your womb. The doctor or nurse can see the inside of your womb on the screen. Sometimes the biopsy is taken by a fine tube known as a pipelle. Taking some painkillers, such as paracetamol and ibruprofen before your procedure can help make the hysteroscopy more comfortable.
If the procedure is too painful in the outpatient setting, you can discuss with your doctor or nurse about having this undertaken with a short general anaesthetic.
The biopsy removes a sample of cells from the inside of the womb (the endometrium). The sample is then checked at a laboratory to get a diagnosis.
Treatment
The most common treatment for womb cancer is the surgical removal of the womb, ovaries, fallopian tubes and cervix (called a total hysterectomy and bi-lateral salpingo-oophorectomy). This surgery will remove your ability to become pregnant and in younger women will lead to an early menopause.
If your cancer is detected early, you may only need surgery. However, whether you need further treatment will depend on the results of the tissues taken from your operation. These decisions are made by your clinical team and will be discussed with you.
Some women and people with womb cancer are treated after surgery with brachytherapy – a small radioactive device, which is put into the vagina for a short period of time – normally a few hours.
Depending on the stage of the cancer, some people may undergo what is known as external beam radiotherapy. This comes from a machine which beams high-energy rays at your vagina and pelvis from outside your body.
Chemotherapy has a much smaller part to play in the treatment and management of womb cancer. This is because research has shown it has not been particularly effective. However, newer treatments are now being seen and these include targeted immunotherapies (use the immune system to kill the cancer cells), although more research is still required to assess their overall longer-term efficacy.
In some cases, hormone treatment may be used, usually in pre-menopausal women and people who wish to try and have a family later down the line, or those with more advanced disease.
We have developed a resource for people who have been recently diagnosed with womb cancer or are worried about the signs and symptoms. Please click here to find out more.
If you would like to talk more about womb cancer or have any questions, you can contact our specialist nurse at Ask Eve for free and confidential advice and information on nurse@eveappeal.org.uk or 0808 802 0019.