What is uterine cancer?

Uterine cancer is cancer that affects the uterus (womb).

The uterus is part of the female reproductive system. It is located low in the abdomen between the bladder and the rectum.

Cancer of the uterus can affect the lining of the uterus (endometrial cancer) or the connective tissue or muscle (known as uterine sarcoma). Endometrial cancer is the most common form of uterine cancer.

What are the symptoms of uterine cancer?

The most common symptom of uterine cancer is unusual vaginal bleeding, which may include:

• heavier bleeding during your period
• bleeding between periods
• persistent bleeding or spotting
• bleeding or spotting after menopause

A less common symptom of uterine cancer is smelly, watery vaginal discharge.

Rarer symptoms include:

• abdominal pain
• unexplained weight loss
• difficulty urinating (weeing)
• changes in bowel movements (poo)

What causes cancer of the uterus?

The cause of uterine cancer is unknown, but factors that can increase your risk include:

• older age (especially being post-menopausal)
• obesity
• previous radiotherapy to the pelvis
• a family medical history of cancer of the uterus, ovary or bowel
• inherited conditions such as Lynch syndrome or Cowden syndrome
• endometrial hyperplasia — thickening of the lining of the uterus

Hormonal factors also play a role. You are more likely to develop uterine cancer if you:

• have never been pregnant
• started periods relatively early (before the age of 12 years)
• experienced menopause relatively late (age 55 years or older)
• have taken some types of hormone therapy in the past

When should I see my doctor?

If you have any symptoms of uterine cancer or endometrial cancer, you should visit your doctor. Your doctor will ask about your symptoms and your medical history. They will also perform a physical examination.

Your doctor will want to rule out other conditions that can cause abnormal vaginal bleeding. These can include:

• polyps
• endometrial hyperplasia (thickening of the uterine lining)
• fibroids
• endometriosis

Your doctor will talk with you about tests to confirm a diagnosis. They may also refer you to a specialist for further tests.

How is uterine cancer diagnosed?

Your doctor will usually start with a pelvic examination and an ultrasound.

During a pelvic exam, your doctor will examine your abdomen and uterus for any swelling or lumps. They may also place two gloved fingers inside your vagina while pressing on your abdomen.

A pelvic ultrasound uses soundwaves to create images of your organs.

The pelvic ultrasound can be done in 2 ways.

• Abdominal ultrasound — where the scan is performed with an ultrasound probe placed on your abdomen.
• Transvaginal ultrasound — where, with your consent, the scan is performed using an ultrasound probe placed gently inside your vagina.

In many cases, the sonographer will perform both types of scans, to get the best images of your uterus. If you feel discomfort, speak to your doctor or the sonographer before the scan. It may help to choose a sonographer that you are comfortable with. You may also choose to have someone familiar in the room with you.

If these tests detect a tumour, your doctor will refer you for a biopsy, during which a specialist will take a sample of cells from your uterus to be examined in a lab. In some cases, the biopsy can be performed by your doctor in their office.

In other cases, your doctor may recommend biopsy during hysteroscopy. This is a day procedure performed under general anaesthetic, where a thin tube with a camera and light is inserted through your cervix to examine the lining of your uterus for abnormalities.

Depending on your situation, your doctor may also recommend other tests, such as an:

• x-ray
• MRI scan
• CT scan
• PET scan

How is cancer of the uterus treated?

Cancer of the uterus is normally treated with surgery to remove your uterus and cervix, along with both fallopian tubes and ovaries. This operation is called a total hysterectomy with bilateral salpingo-oophorectomy. In some cases, you may be able to keep your ovaries. Your doctor will talk you through the procedure and what is involved.

Uterine cancer is often diagnosed early and surgery is the only treatment needed.

If the cancer is more advanced, your doctor may recommend additional treatments such as:

• radiotherapy
• chemotherapy
• hormone therapy
• immunotherapy
• targeted therapy

Side effects

Removing your uterus will mean that you cannot become pregnant. If fertility is important to you, be sure to discuss your options with your doctor before you start treatment. You can also seek emotional support from your doctor, a cancer nurse or counsellor.

Treatments for uterine cancer can also cause other side effects — in particular, changes to your bladder, bowel and sexual function.

If you have your ovaries removed during surgery, you will go through menopause. Symptoms of menopause caused by cancer treatment can be more severe than those of people who experience menopause naturally, because your hormone levels will decrease more suddenly.

You can discuss ways to minimise or treat some of these side effects with your doctor.

Follow-up

After you finish treatment, you should see your doctor regularly for follow-up, which may include:

• pelvic examinations
• pelvic ultrasound or other imaging tests

Seeing your doctor for the recommended follow-up means that if the cancer comes back, it can be treated early. Early treatment lowers the risk of complications.

Can uterine cancer be prevented?

Because the cause of uterine cancer is not known, there are no specific prevention strategies.

Managing your risk factors and maintaining a healthy lifestyle can help reduce your risk.

The use of some oral contraceptive pills can also reduce the risk of having cancer of the uterus.

Resources and support

If you are living with cancer, there are services that can help. These include:

• support groups and programs
• home nursing
• meals on wheels

Visit the Cancer Australia website for fertility and sexuality support and advice for living with cancer.

If you are caring for someone with uterine cancer, you can find support through the Cancer Council website.