Cancer of the uterus (womb), also known as endometrial cancer, is the most common gynaecological cancer in Australia, affecting approximately 1 in 47 women before the age of 85 years old. (Source: Cancer Australia)
Fortunately, the disease tends to be detected early because of abnormal vaginal bleeding or discharge, and it can be completely cured in about 80% of the cases. Certain factors do increase the risk of developing uterine cancer, which include obesity, having a late menopause, and not having any children. In addition, certain inherited conditions such as Lynch syndrome (also known as hereditary non-polyposis colorectal cancer) can significantly increase risk of developing uterine cancer. In such cases, it may be advisable to undergo a prophylactic hysterectomy once the patient has completed her family.
Patients with uterine cancer usually present with abnormal vaginal bleeding such as heavy or irregular periods in younger pre-menopausal women or, more commonly, post-menopausal bleeding. However, having post-menopausal bleeding does not necessarily mean that uterine cancer is present. While it is the most common symptom of the cancer, only 10% to 20% of those with post-menopausal bleeding will actually have uterine cancer as there may be many other reasons for the bleeding.
Diagnosis of uterine cancer is usually confirmed by an endometrial biopsy, which is a sample of the tissue lining the uterus. This is a simple procedure that can normally be done at WOMEN Centre using a specialised uterine lining sampling device.
In some cases, additional investigation might be necessary – either a hysteroscopy (where a tiny camera is inserted through the cervix to look inside the uterus) and / or a curettage (where the uterine lining is biopsied more extensively using an instrument called a curette, and the biopsy to be tested by a pathologist). These will be done as a day surgery case under a short general anaesthesia.
The results of these investigations will be discussed at the Western Australian Gynaecologic Cancer Service’s Tumour Board Multidisciplinary Team Meeting between our gynaecologic oncologist and a panel of expert gynaecological pathologists and medical oncologists.
Depending on the results, a further X-ray or CT scan of the abdomen and pelvis, and blood tests, may be organised in order to obtain information on whether the cancer has spread and, if so, how far it has spread from the uterus.
Treatment and Surgery
The usual treatment for uterine cancer is a form of surgery called ‘total hysterectomy’ where the entire uterus is removed. Both ovaries and any other visible signs of tumour in the surrounding tissues will be removed.
Hysterectomies can be performed in 3 ways:
One of the first places that uterine cancers spread to is the pelvic lymph nodes, but removing them can lead to increased complications. However, removing these lymph nodes and analysing them help to determine if the cancer has spread and to decide whether it is necessary to have supporting treatment such as chemotherapy or radiation therapy after the surgery. Therefore, the decision on whether or not to remove them will only be made after evaluation of all factors including findings during the surgery.
Chemotherapy and / or Radiation Therapy
In some cases, radiotherapy is a vital part of the treatment of uterine cancer.
Radiation therapy is usually used to treat uterine cancers in more advanced or high-risk cases. The treatment is delivered into the vagina using special applicators, which is less invasive and has fewer side effects. Occasionally for higher risk cases, external beam radiation may be required.
Chemotherapy is usually recommended only for certain types of uterine cancer or if the cancer has spread to the pelvic lymph nodes.
The need for chemotherapy and radiation therapy will be discussed individually for each patient and based on the decision made following discussion between our gynaecologic oncologist and a panel of expert gynaecological pathologists, radiation oncologists and medical oncologists at Western Australian Gynaecologic Cancer Service’s Tumour Board Multidisciplinary Team Meeting.
Note: There are important on-going research trials comparing the effectiveness of different supporting treatments in the fight against gynaecological cancers. Patient enrolment in these trials is very valuable and plays a key role in improving our understanding of cancer and its response to various treatments. You may be invited to participate in a clinical trial; should you have any concern, please do not hesitate to discuss it with our gynaecologic oncologist.
After Surgery and Treatment
Our gynaecologic oncologist will discuss the best follow-up regime that is tailored to suit each individual patient. For patients living outside Perth’s metropolitan area, arrangements can be made for on-going follow-up with their local general practitioner or gynaecologist.
Uterine cancer is completely cured in the majority of cases; however, it is normal for patients to have regular follow-ups for five years after treatment. It is particularly important to be alert of any new symptoms rather than just relying on follow-up visits. If uterine cancer recurs, it almost always presents with vaginal bleeding or other symptoms, so it is usually detected early which allows for fast, effective treatment of the recurrence.
Hormone Replacement Therapy (HRT) After Uterine Cancer
Patients may be worried about the use of HRT after uterine cancer as the endometrial cells in the uterus normally grow in response to estrogen and similar hormones. However, there has been no evidence from research to show that HRT increases the chance of uterine cancer recurring.
Our gynaecologic oncologist firmly believes that if HRT is indicated because of intolerable post-menopausal side effects (eg hot flushes), then HRT can be safely used without concern with the exception of patients who are at high risk of developing breast cancer or who have a history of breast cancer. There are also certain types of rare uterine cancers like endometrial stromal sarcomas where HRT should not be prescribed. Our gynaecologic oncologist will discuss about HRT with the patient during consultation – if further counselling is required, a referral to our women’s health general physician or gynaecologists with the expertise in this field, can be arranged.
More information here on menopause management.