Womb (uterus) cancer

Womb (uterus) cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Womb (uterus) cancer Womb (uterus) cancer About womb cancer Symptoms of womb cancer Causes of womb cancer Diagnosing womb cancer Treating womb cancer Living with womb cancer About womb cancer Cancer of the womb (uterus) is a common cancer that affects the female reproductive system. Its also called uterine cancer and endometrial cancer. Abnormal vaginal bleeding is the most common symptom of womb cancer. If you have been through the menopause , any vaginal bleeding is considered abnormal. If you have not yet been through the menopause, unusual bleeding may include bleeding between your periods. You should speak to your GP as soon as possible if you experience any unusual vaginal bleeding. While its unlikelyto becaused by womb cancer, its best to be sure. Your GP will examine you and ask about your symptoms. They will refer you to a specialist for further tests if they suspect you may have a serious problem, or if they are unsure about a diagnosis. Read more about the symptoms of womb cancer and diagnosing womb cancer Types of womb cancer The vast majority of womb cancersbegin in the cells that make up the lining of thewomb (called the endometrium), which is why cancer of the wombis often called endometrial cancer. In rare cases, womb cancer can start in the muscles surrounding the womb. This type of cancer is called uterine sarcoma and may be treated in a different way from endometrial cancer. This article uses the term womb cancer, andmostly includes information about endometrial cancer. Read more information about soft tissue sarcomas . Womb cancer is separatefrom other cancers of the female reproductive system, such as ovarian cancer and cervical cancer . Why does womb cancer happen? Its not clear exactly what causes womb cancer, but certain things can increase your risk of developing the condition. A hormone imbalance is one of the most important risks for womb cancer. Specifically, your risk is increased if you have high levels of a hormone called oestrogen in your body. A number ofthings can cause this hormone imbalance, including obesity, diabetes, and hormone replacement therapy (HRT) .There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen. Its not always possible to prevent womb cancer, but some things are thought to reduce your risk. This includes maintaining a healthy weight and the long-term use of some types of contraception . Read more about the causes of womb cancer How is womb cancer treated? The most common treatment for womb cancer is the surgical removal of the womb (hysterectomy). A hysterectomy can cure womb cancer in its early stages, butyouwill no longer be able to get pregnant.Surgery for womb cancer is also likely to include the removal of the ovaries and fallopian tubes. Radiotherapy or chemotherapy are also sometimes used, often in conjunction with surgery. A type of hormone therapy may be used if you are yet to go through the menopause and would still like to have children. Even if your cancer is advanced and the chances of a cure are small, treatment can still help to relieve symptoms and prolong your life. Read more about treating womb cancer Living with womb cancer Living with cancer is challenging and womb cancer can affect your life in specific ways. For example, your sex life may be affected if you have a hysterectomy. You may find it physically more difficult to have sex and have a reduced sex drive. You may find it beneficial to talk to other people about your condition, including family members, your partner, or other people with womb cancer. Read more about living with womb cancer Who is affected? Womb cancer is the most commonly occurring cancer of the female reproductive system. Its the fourth most common cancer diagnosedin women after breast cancer , lung cancer , and cancer of the colon and rectum . Womb cancer is more common in women and anyone with a womb who has been through the menopause. Most cases are diagnosed in women and anyone with a womb aged 40 to 74. Symptoms of womb cancer The most common symptom of womb cancer is abnormal bleeding from the vagina, although most people with abnormal bleeding dont have cancer. Bleeding may start as light bleeding accompanied by a watery discharge, which may get heavier over time. Most women and anyone with a womb diagnosed with womb cancer have been through the menopause , so any vaginal bleeding will be unusual. In women and anyone with a womb who hasnt been through the menopause, unusual vaginal bleeding may consist of: periods that are heavier than usual vaginal bleeding in between normal periods Less common symptoms include pain in the lower abdomen (tummy) and pain during sex. If womb cancer reaches a more advanced stage, it may cause additional symptoms. These include: pain in the back, legs, or pelvis loss of appetite tiredness nausea When to seek medical advice If you havepostmenopausal vaginal bleeding, or notice a change in the normal pattern of your period, visit your GP. Only1 in 10 cases of unusual vaginal bleeding after the menopause are caused bywomb cancer, so its unlikely your symptomswill be caused by this condition. However, if you have unusual vaginal bleeding, its important to get the cause of your symptoms investigated.The bleeding may be the result of a number of other potentially serious health conditions, such as: endometriosis  where tissue that behaves like the lining of the womb is found on the outside of the womb fibroids  non-cancerous growths that can develop inside the uterus polyps in the womb lining Other types of gynaecological cancer can alsocause unusualvaginal bleeding, particularly cervical cancer . Read further information: Cancer Research UK: womb cancer symptoms Macmillan: symptoms of womb cancer Causes of womb cancer Its not known exactly what causes womb cancer, but certain things can increase your risk of developing it. Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system. Increased risk A number of things have been identified thatincrease the risk of developingwomb cancer. Age The risk of developingwomb cancer increases with age. The majority of casesoccur in women and anyone with a womb aged 40 to 74. Oestrogen The risk of developing womb cancer is linked to the bodysexposure to oestrogen. Oestrogen is one of the hormones that regulate the reproductive system. oestrogen stimulates the release of eggs from your ovaries and causes the cells of thewomb lining to divide progesterone gets the lining of your uterus ready to receive the egg from the ovaries The levels of oestrogen and progesterone in your body are usually balanced with each other. If oestrogen isnt kept in balance by progesterone, the level in the body can increase. This is called unopposed oestrogen. After the menopause , the body stops producing progesterone. However, there are still small amounts of oestrogen being produced. This unopposed oestrogen causes the cells of the endometrium to divide, whichcan increase the risk ofwomb cancer. Hormone replacement therapy (HRT) Because of the link between increased levels of unopposed oestrogen andwomb cancer, oestrogen-only hormone replacement therapy (HRT) should only be given to those who have had their womb surgically removed (hysterectomy). In all other cases, both oestrogen and progesterone (combination HRT) must be used in HRT to reduce the risk of womb cancer. Being overweight or obese As oestrogen can be produced in fatty tissue, being overweight or obeseincreases the level of oestrogen in your body. This significantly increases your chances of developing womb cancer. Women and anyone with a womb who is overweight is 3times more likely to develop womb cancer compared with those who are a healthy weight. One way to assess whether your weight is healthy is to understand your healthy body mass index (BMI) . Reproductive history Women and anyone with a womb who has not had children are at a higher risk ofwomb cancer. This may be because the increased levels of progesterone and decreased levels of oestrogen that occur during pregnancyhave a protective effect on the lining of the womb. Tamoxifen Women and anyone with a womb who are treated with tamoxifen (a hormone treatment for breast cancer ) can be at an increased risk of developing womb cancer. However, this risk is outweighed by the benefits that tamoxifen provides in preventing breast cancer. Its important to visit your GP if youre taking tamoxifen and experience any abnormal vaginal bleeding. Diabetes Women and anyone with a womb with diabetes are twice as likely to develop womb cancer as those without the condition. Diabetes causes an increase in the amount of insulin in your body, which in turn can raise your oestrogen levels. Many women and anyone with ovaries with type 2 diabetes are also overweight, which further increases the risk. Polycystic ovarian syndrome (PCOS) Women and anyone with ovaries with polycystic ovarian syndrome (PCOS) are at a higher risk of developing womb cancer, as they have high levels of oestrogen in their bodies. PCOS can cause symptoms such as irregular or light periods, or no periods at all, as well asproblems getting pregnant, weight gain, acne, and excessive hair growth (hirsutism). Endometrial hyperplasia Endometrial hyperplasia is when the lining of the womb becomes thicker. Itmay be increase risk of developingwomb cancer. Read further information: Cancer Research UK: womb cancer risks and causes Macmillan: causes of womb cancer Diagnosing womb cancer You should visit your GP if you have abnormal vaginal bleeding. While its unlikely to be caused by womb cancer, its best to be sure. Your GP will probably carry out a physical examination of your pelvic area, including your vagina, womb, ovaries, and bladder. They will ask about your symptoms, when they happen, and how often. You may be referred to a specialist in conditions of the female reproductive organs (a gynaecologist) for further tests. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of gynaecological cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected endometrial cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Transvaginal ultrasound (TVU) Another test you may have is called a transvaginal ultrasound (TVU). TVU is a type of ultrasound scan that uses a small scanner in the form of a probe. This is placed directly into the vagina to obtain a detailed picture of the inside of the uterus. The probe can feel a little uncomfortable, but shouldnt be painful. The TVU checks whether there are any changes to the thickness of the lining of your uterus that could be caused by the presence of cancerous cells. Biopsy If the results of the TVU detect changes in the thickness of the lining of the uterus, you will usually have a biopsy to confirm the diagnosis. Ina biopsy, a small sample of cells is taken from the lining of the womb (the endometrium). The sample is then checked at a laboratory for the presence of cancerous cells. The biopsy can be carried out inseveral ways, including: aspiration biopsy  a small flexible tube is inserted into your vagina and up into your womb, and then sucks up a small sample of cells hysteroscopy  this allows the doctor to look at the inside of the womb using a thin type of telescope called a hysteroscope, which is inserted through your vagina and into your womb, allowing the doctor to look at the lining of the womb and take a sample from it In some cases, a hysteroscopy may be used before dilatation and curettage (D&C). D&C is a minor surgical procedurecarried out under general anaesthetic ,where some tissue from the womb lining is removed. The tissueis then sent off to a laboratory for further testing. Blood test A blood test can sometimes help diagnose womb cancer. This is because some cancerous tumours release certain chemicals into your blood, known as tumour markers, which can be detected during a blood test. However, this type of test isnt very reliable. The presence of these chemicals doesnt mean you definitely have womb cancer. Some people with womb cancer dont have these chemicals in their blood. Read further information: Cancer Research UK: womb cancer tests Macmillan: how womb cancer is diagnosed Tests if you havewomb cancer If youre diagnosed with womb cancer, you may have further teststo help determine the stage of the cancer. Staging the cancer will allow the doctors to work out how large the cancer is, whether or not it has spread, and the best treatment options for you. These tests may include: achest X-ray  where radiation is used to check if the cancer has spread to the lungs magnetic resonance imaging (MRI)  where magnetic fields are used to create adetailed image of the inside of your bodyto check if the cancer has spread a computerised tomography (CT) scan  where a series of X-rays are used to create a detailed image of the inside of your bodyto check if the cancer has spread further blood tests these are usually doneto check your general health and how well some of your organs are functioning Read treating womb cancer for more information about staging. Treating womb cancer Health professionals use a staging system to describe how far womb cancer has advanced. These stages are: stage 1 the cancer is still contained inside the womb (uterus) stage 2  the cancer has spread to the neck of the womb (the cervix) stage 3 the cancer has spread outside the womb into nearby tissues in the pelvis or the lymph nodes stage 4 the cancer has spread to the soft tissues of the abdomen, or into other organs, such as the bladder, bowel, liver, or lungs Your chances of surviving womb cancer depend on the stage at which its diagnosed. Read further information: Cancer Research UK: stages of womb cancer Cancer Research UK: statistics and outlook for womb cancer Treatment overview The main treatment for womb cancer is to remove the womb (hysterectomy), together with the ovaries and fallopian tubes. This is sometimes followed by radiotherapy or chemotherapyto try to kill any possible remaining cancer cells, depending on the stage and grade of the cancer. Treatment if you havent been through the menopause Having a hysterectomy means you willno longer beable to get pregnant. Younger women who havent already reached the menopause may not want to have their womb and ovaries removed if they wish to have children. In this case, under very specific circumstances it may be possible to treat the cancer using hormone therapy. Treating advanced cancer Advanced womb cancerrequires a different course of treatment, usually depending more on chemotherapy. Advanced cancer may not be curable, but the treatment aims to achieve a remission, where the cancer shrinks, making you feel normal and able to enjoy life to the full. Even if theres no chance of a cure, surgery may be carried out to remove as much of the cancer as possible. Radiotherapy, chemotherapy or hormone therapy can reduce symptoms such as pain by shrinking the cancer or slowing its growth. Read further information: Cancer Research UK: controlling symptoms of advanced womb cancer Cancer Research UK: which treatment for womb cancer? Surgery Surgery for stage1womb cancer If you have stage1 cancer, youll probably have a hysterectomy. This involves removing both ovaries and the fallopian tubes in a procedure called a bilateral salpingo-oophorectomy (BSO), as well asthe uterus (hysterectomy). The surgeon may also take samples from the lymph nodes in the pelvis and abdomen and other nearby tissue. These will be sent to the laboratory to see whether the cancer has spread. The most common hysterectomy technique involves using one large cut across your tummy to access the womb and remove it. Its sometimes possible to use a technique called a laparoscopic hysterectomy, also known as akeyhole hysterectomy. This involves using several small cuts so a special type of telescope (laparoscope) and other surgical instrumentscan be used. Thismeans the surgeoncan see inside your body and remove your womb through your vagina with little scarring. Youll probably be ready to go home 3to 5days after your operation, or less if you had keyhole surgery. But it can take many weeks to recover fully. After your operation, youll be encouraged to start moving about as soon as possible. This is very important, and even if you have to stay in bed youll need to keep doing regular leg movements to help your circulation and prevent blood clots. Youll be shown exercises by the nurses or physiotherapist to help prevent complications. When you go home, youll need to exercise gently to build up your strength and fitness. Discuss with your doctor or physiotherapist which types of exercise would be suitable for you. Surgery for stage2 or 3womb cancer If you have stage2 or3 womb cancer and the cancer has spread to the cervix or nearby lymph nodes in the pelvis, you may have a radical or total hysterectomy. This involves the additional removal of the cervix and the top of your vagina, as well as the removal of the pelvic lymph nodes. You may also need radiotherapy or chemotherapy treatment after surgery to reduce the riskof the cancer returning. Surgery for advanced cancer (stage 4) If you have advanced womb cancer, you may have surgery to remove as much of the cancer as possible. This is called debulking surgery. This wont cure the cancer, but it may ease some of the symptoms. Your doctor will discuss whether debulking surgery is suitable for you. Read further information: Cancer Research UK: having your operation for womb cancer National Institute for Health and Care Excellence (NICE): laparoscopic hysterectomy for endometrial cancer Radiotherapy A course of radiotherapy will be recommended if your treatment team thinks theres a significant risk the cancer could return in the pelvis. Radiotherapy may also be used to slow the spread of cancer when a surgical cure is not possible. There are 2types of radiotherapy used to treatwomb cancer: internal radiotherapy (also known as brachytherapy) wherea plastic tube is inserted inside the uterus and radiation treatment is passed down the tube into the womb external radiotherapy wherea machine is used to deliver pulses of radiation to your pelvis A course of external radiotherapy is usually given to you as an outpatient for 5days a week with a break at the weekend. The treatment takes a few minutes. The whole course of radiotherapy may last approximately 4weeks depending on the stage and position of the womb cancer. Some women and anyone with a womb have internal radiotherapy (brachytherapy) as well as external radiotherapy. During brachytherapy, the device that delivers radiation is placed in your vagina. There are different types of brachytherapy, involving either low, medium, or high dose rates. With low dose rate methods the radiation is delivered more slowly, so the device has to stay inside you for longer. Youll have to stay in hospital while you have the treatment. Your doctor will discuss this with you. Radiotherapy has some side effects. Skin in the treated area can become red and sore, and hair loss may occur. Radiotherapy to the pelvic area can affect the bowel and cause sickness and diarrhoea . As your course of treatment progresses, youre likely to get very tired. Most of these side effects will go away when your treatment finishes. Chemotherapy If you have stage3 or4womb cancer, you may be given a course of chemotherapy . Chemotherapy can be used after surgery to try to prevent the return of the cancer. In cases of advanced cancer, it may be used to slow the spread of the cancer and relieve symptoms. Chemotherapy is usually given as an injection into the vein (intravenously). Youll usually be able to go home the same day you have chemotherapy, but sometimes you may need a short stay in hospital. Chemotherapy is usually given in cycles, with a period of treatment being followed by a period of rest to allow the body to recover. Side effects of chemotherapy can include: nausea vomiting hair loss fatigue There is also an increased risk of an infection developing in your bloodstream (sepsis) , as your bodys ability to fight infection is reduced by chemotherapy. The side effects should stop once treatment has finished. Read further information: Cancer Research UK: chemotherapy for womb cancer Macmillan: chemotherapy for womb cancer Hormone therapy Somewomb cancers are affected by the female hormone oestrogen. These cancers may respond to treatment with hormone therapy. Your doctor will discusswhether this is a possible treatment for yourwomb cancer. Hormone therapyusuallyreplacesa hormone called progesterone, which naturally occurs in your body. Artificial progesterone is used and isusually given as tablets. Its mainly used to treat advanced-stagewomb cancers, or cancer that has come back, and can help shrink the tumour and control any symptoms. The treatment may have some side effects, including mild nausea, mild muscle cramps, and weight gain. Your doctor will discuss these with you. Read further information: Cancer Research UK: hormone therapy for womb cancer Macmillan: hormonal treatment for womb cancer Clinical trials A lot of progress has been made in the treatment of womb cancer. More people are living longer with fewer side effects. Some of these advances were discovered through clinical trials,where new treatments and combinations of treatments are compared with standard treatment. All cancer clinical trials in the UK are carefully monitored to make sure the trial is worthwhile and safely conducted. Participants in clinical trials often do better overall than those in routine care. If youre invited to take part in a trial, youll be given an information sheet. If you wish to take part, youll be asked to sign your consent. Youre always free to refuse or withdraw from a clinical trial without it affecting your care. Read further information: Cancer Research UK: trials and research Cancer Research UK: womb cancer research Living with womb cancer Women and anyone with a womb with womb cancer usually have a hysterectomy. This can be a major operation, and recovery may takefrom6 to 12 weeks. During this time you will have to avoid lifting things (for example, children and heavy shopping bags) and doing heavy housework. You wont be able to drive for between 3and 8weeks after the operation. Most people need4 to12 weeks off work after a hysterectomy. The recovery time will depend on the type of surgery you have, whether or notany problems develop, and what type of work you will return to. Some of the treatments for endometrial cancer, particularly radiotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Dont be afraid to ask for practical help from family and friends if you need it. Follow-up After your course of treatment has finished, youll probably be invited back for regular check-ups. At the check-up, your doctor will examine you (this is likely to include an internal examination) and possibly carry out blood tests or scans to see how your cancer is responding to treatment. Read further information: Macmillan: follow-up after treatment for womb cancer Relationships and sex Relationships with friends and family Knowing how to talk to your friends and family about your cancer can be difficult, and they may find it hard to talk to you, too. People deal with serious problems in different ways. Its hard to predict how a diagnosis of cancer will affect you. Being open and honest about how you feel and what your family and friends can do to helpmay put them at ease. But dont feel shy about telling people that you want some time to yourself, if thats what you need. Read further information: Talking to your kids about cancer Macmillan: the emotional effects of cancer Macmillan: telling your friends and family Your sex life Wombcancer and its treatment can affect your sex life. This can happen in several ways. If you havent already had the menopause, removing the ovaries means youll go through an early menopause. Symptoms can include vaginal dryness and loss of sexual desire. Radiotherapy for endometrial cancer can make your vagina narrower and less flexible. Sometimes the vagina gets so narrow that having sex becomes difficult. To stop this happening, you should be offered a set of vaginal dilators, which are plastic cones you put into your vagina to stretch it. You can also stretch your vagina by having sex, or by using your fingers or a vibrator. Its common to lose interest in sex after treatment forwomb cancer. Your treatment may leave you feeling very tired. You may feel shocked, confused or depressed about being diagnosed with cancer, and you alsomay be grieving the loss of your fertility. Its understandable that you may not feel like having sex while having to cope with all this. Try to share your feelings with your partner. If you feel you have problems with sex that arent getting better with time, you may want to speak to a counsellor or a sex therapist. Read further information: Macmillan: how treatment for womb cancer may affect your sex life andrelationships Talk to others Being diagnosed with cancer can be hard, both for patients and their families. Youll need to deal with the emotional and practical difficulties. Withwomb cancer, you have to cope physically with recovering from a hysterectomy, as well asthe possible emotional impact of losing your womb. Younger women may have to face the fact they wont be able to have children and all the grief and anger that may cause. Often, it can help to discuss your feelings and other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various waysto find help and support: your hospital doctor, specialist nurse or GP can refer you to a counsellor if youre struggling with feelings of depression, talk to your GPa course of antidepressant drugs may be helpful, or your GP can arrange for you to get help from a counsellor or psychotherapist it may be helpful to talk to someone whos had the same experience as you many organisations have telephone helplines and forums that may be useful to you, and they can put you in touch with other people who have been through cancer treatment Read further information: Cancer Research UK: coping with cancer Money and financial support If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support. if you have a job but cant work because of your illness, youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance if youre caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home, or you have a low household income Find out what help is available to youearly on. You can ask to speak to the social worker at your hospital, who can give you the information you need. Read further information: Find your nearest Citizens Advice Bureau GOV.UK: benefits Macmillan: financial issues Money Advice Service Dealing with dying If youre told nothing more can be done to treat your womb cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care. Palliative care also includes psychological, social and spiritual support for you and your family or carers. Read further information: Palliative care End of life care Macmillan : support if youre caring for someone with womb cancer (support line: 0808 808 00 00) Marie Curie Cancer Care Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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