Endometrial cancer

What is it?

The womb (uterus) is where a baby grows during pregnancy. Endometrial cancer starts in the womb's lining, the endometrium. It is the most common kind of womb cancer. The cause is not known, but too much of the hormone oestrogen raises the risk.

It is most common in people who have been through the menopause, but anyone with a womb can get it. Being overweight, some kinds of hormone replacement therapy (HRT), diabetes, never having given birth, a late menopause and the breast cancer medicine tamoxifen raise the risk. It is more likely if close family have had womb, bowel or ovarian cancer, or with an inherited condition called Lynch syndrome. A healthy weight, regular exercise and a balanced diet can lower your chances.

The first signs

The most common sign is bleeding from the vagina that is not normal for you.

• bleeding or spotting after the menopause;
• heavy periods that are unusual for you, or bleeding between periods;
• a change in the discharge from your vagina;
• pain in the lower back or between the hips (pelvis), or pain during sex;
• a lump or swelling in your tummy, or peeing or pooing more or less often than usual.

How doctors find out

Your family doctor asks about your symptoms and may examine your tummy and vagina; you can ask for a female doctor or nurse. If cancer is possible, they send you to a specialist. You may have a scan with a small device placed in the vagina, blood tests, a look inside the womb with a thin camera (hysteroscopy), and a biopsy, where cells are taken from the womb lining. The tests can feel uncomfortable but should not hurt.

Results usually take a few weeks. If it is cancer, more scans (CT, MRI or PET) and genetic tests show how far it has spread. A specialist nurse is your main contact during and after treatment.

Current treatment

Surgery to remove the womb is the main treatment, sometimes followed by radiotherapy or chemotherapy to lower the chance of the cancer coming back; hormone therapy, immunotherapy or targeted medicines are used when it has spread or come back.

Will it get worse?

How serious it is depends on how big the cancer is, whether it has spread, and your general health. Irregular bleeding usually makes people see a doctor early, so most cases are found before the cancer has spread; about two in three are still only in the womb when found. Cancer that has spread to other parts of the body is rarely cured.

Medicines: what helps, and what to watch for

Chemotherapy uses medicines to kill cancer cells. It can be given after surgery to lower the chance of the cancer coming back, together with radiotherapy, or to slow the cancer and ease symptoms if it has spread. Hormone therapy blocks the hormones some of these cancers need to grow; it can help when the cancer has spread or you are not well enough for surgery or radiotherapy. Immunotherapy, which helps your immune system find and kill cancer cells, and targeted medicines may be options for advanced cancer or cancer that comes back.

Good to know:

• Common side effects of chemotherapy are tiredness, feeling sick, a sore mouth, hair loss for a while, and numbness or tingling in the hands or feet;
• Radiotherapy can cause tiredness, diarrhoea (which should go within a few weeks of treatment ending), vaginal dryness or narrowing, and the menopause;
• You do not need to wait for your next check-up to raise a side effect that worries you.

Radiotherapy, for some people

Radiotherapy uses high-energy rays to kill cancer cells. It can come from a machine outside the body or from a source placed inside, near the cancer. It may be given after surgery to lower the chance of the cancer coming back, and it can be the main treatment if you cannot have surgery. It can also ease symptoms.

Surgery, for some people

Surgery is the most common treatment, especially for early cancer. The surgeon removes the womb and the neck of the womb (cervix) in an operation called a hysterectomy. Sometimes the ovaries and fallopian tubes, nearby lymph nodes or the upper part of the vagina are removed too. If the cancer has spread or come back, surgery may also remove nearby parts, such as the ovaries and tubes, the bladder or the rectum. Recovery can take a long time. Your team will talk with you about what treatment means for having children.

Is there a cure?

Yes, often. When the cancer is found early and is only in the womb, treatment usually cures it. When it has spread far, it is rarely cured, and treatment aims to control it. Clinical trials are testing new treatments, and joining one may be an option for some people.

See the 437 trials you can join

Median survival

About 3 years with chemotherapy for stage III or IV

Measured in: Stage III or IV, with chemotherapy: the GOG-0209 trial (1,381 women)

Sources

Written in plain words by Frontlight from these pages:

1. NHS: Womb (uterus) cancer – Overview
2. NHS: Womb (uterus) cancer – Symptoms
3. MedlinePlus: Uterine Cancer
4. NCI PDQ: Endometrial Cancer Treatment (PDQ) – Health Professional Version
5. NHS: Womb (uterus) cancer – Causes
6. NHS: Womb (uterus) cancer – Tests and next steps
7. NCI SEER: Cancer Stat Facts: Uterine Cancer
8. NHS: Womb (uterus) cancer – Treatment
9. NCI PDQ: Endometrial Cancer Treatment (PDQ) – Patient Version
10. NHS: Chemotherapy – Side effects
11. NHS: Radiotherapy – Side effects