Endometrial cancer

Endometrial cancer is a type of cancer that starts in the lining of the uterus (womb), called the endometrium. The endometrium thickens during ovulation, when an egg is released from your ovaries. If you don’t become pregnant, the top layers come out during your period.

Endometrial cancer is also called uterine cancer. It’s the most common gynaecological cancer, with around 1,900 Australians diagnosed each year.

Endometrial cancer is often found early, so most people recover. If it’s found later, when it’s more advanced, treatment is still possible, but a long-term cure is less likely.

Causes

We’re not exactly sure what causes someone to get endometrial cancer. However, there are common factors, known as risk factors, that increase the chance of someone getting it. They include::

• being overweight or obese
• being over 50 years and have gone through menopause
• having a thickened endometrium (endometrial hyperplasia) https://www.thewomens.org.au/health-information/womens-cancers-pre-cancers/endometrial-cancer#a_downloads 
• having one or more family members who’ve had endometrial, bowel, breast, or ovarian cancer, or Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC)
• using oestrogen hormone replacement without progesterone
• taking tamoxifen, a medicine used to treat breast cancer
• having high blood pressure (hypertension) and diabetes
• never having had children
• having had pelvic radiation for another cancer
• having a tumour in one of your ovaries
• having polycystic ovary syndrome (PCOS).

The number of cases of endometrial cancer is increasing. This is most likely due to the rising rates of obesity.

Symptoms

If you’re concerned about any symptoms you’re having, you should see your nurse, doctor, or gynaecologist (a doctor who specialises in the uterus and reproductive system). Even though your symptoms may not be related to cancer, it’s important to have them checked out.

Symptoms of endometrial cancer include:

• bleeding after you’ve been through menopause (when your periods have stopped for twelve months)
• unusually heavy periods and bleeding in between your periods
• unusual fluid or discharge from your vagina that is watery, bloody, or smelly.

Less commonly, you might also have:

• pain in your belly or abdomen
• trouble going to the toilet to pass urine (wee) or pain when you do go.

If you have any of these symptoms and they don’t go away or are unusual for you, see your doctor.

Diagnosis

If you have symptoms that might be linked to endometrial cancer, your doctor will most likely:

• ask you about your medical history
• do a physical examination
• do a blood test
• use a speculum, like those used for cervical screening, to examine your vagina and cervix 
• do an ultrasound of your uterus by putting a small wand, called a transducer, into your vagina to take pictures of your cervix, uterus, endometrium, and ovaries.

They may also need to take a sample (biopsy) of your endometrium for testing. This can be done in a day clinic without needing anaesthesia. A thin tube (pipelle) is put into your uterus through your vagina to collect a small sample of cells. Sometimes, you might receive medicine or anaesthesia to make you sleep while they scrape part of your endometrium. This procedure is called a dilation and curettage or D&C.

Treatment

The kind of treatment you have will depend on:

• the size of the cancer and how far it has spread (stage of cancer)
• how quickly it’s growing (grade of cancer)
• where in the endometrium it started (type of cancer)
• your age, health, and medical history.

Your doctors will discuss these things with you and help choose the best possible treatment for your particular cancer, lifestyle and wishes.

They’ll recommend one or more of the following options.

Surgery

Surgery to remove your uterus and cervix (total hysterectomy), your fallopian tubes ( salpingectomy) and ovaries (an oophorectomy) is the standard treatment. Your lymph glands may also be removed to check if the cancer has spread to other parts of your body. If it has, you may need surgery to remove the cancer from those areas well.  

Radiotherapy

Radiotherapy aims to control or kill the cancer. It can be external (outside your body) or internal (inside your body). 
If you have external radiation, you’llbe near a machine that directs radiation beams at your cancer. If you have internal radiotherapy (known as brachytherapy), a small radioactive device will be put inside or next to the cancer in your uterus. This is usually given after surgery.

Chemotherapy

Chemotherapy (or chemo) is medicine that aims to control or kill the cancer. The medicine is usually given through an IV or drip, slowly releasing it into your body over  a few hours.

Hormonal therapy

Hormonal therapy may be used to block the hormones that help cancer grow. This may be an option to treat your cancer temporarily so you can still have a baby or if you’re too unwell for surgery or other standard treatments.

Hormone treatment using a progestogen IUD

If you have endometrial cancer, your doctor will usually recommend surgery to remove your uterus, including the lining (endometrium), your cervix, fallopian tubes, and usually your ovaries. This type of surgery is called a hysterectomy with salpingo-oophorectomy. It’s the most common treatment because it’s the only way to make sure all the cancer has been removed.

In some cases, treatment might involve using a hormone-releasing intrauterine device (IUD), called a progestogen IUD. An IUD is a small, usually plastic device that is put inside your uterus. This is a less common treatment, but it may be an option for you if you:

• want to avoid or delay a hysterectomy so you can have children
• have other health issues, like obesity or heart disease, that would make surgery unsafe for you.

This treatment is not an option if:

• the cancer has spread to the wall of your uterus or beyond it
• tests suggest there is cancer in your ovaries.

The safety and success of this treatment for endometrial cancer is not really known, as it is relatively new.

At the Women’s, we have used a progestogen IUD to treat endometrial cancer in more than 16 people. Most had not been through menopause. Of the 16:

• 10 saw their cancer improve or disappear
• 2 became pregnant after treatment.

For most people, changes in their endometrial cancer were seen around 6 months after the IUD was inserted.

What if I want to become pregnant?

Pregnancy is not recommended if you have endometrial cancer. An IUD may help your endometrium return to normal and also prevent pregnancy while it’s in place. Once the IUD is removed, pregnancy may be possible.

Treating endometrial cancer with an IUD isn’t a long-term solution, as it’s not clear if it will stop the cancer permanently. Once you have completed your family, and no longer want to become pregnant, a hysterectomy may be recommended.

After treatment 

Eating well and being active can help you recover. It improves your health and wellbeing and lowers your risk of heart disease, diabetes, and other health problems. Maintaining a healthy weight, eating nutritious foods, and staying active may also lower your risk of developing other cancers in the future.

Questions to ask your doctor, oncologist, or gynaecologist

• How big is my cancer and where exactly is it?
• Can endometrial cancer show up in a cervical screening test?
• Is my child more likely to have endometrial cancer if I do?
• What if I still want to have children?
• Is there a risk of cancer in any children I have after cancer treatment?
• Will I still be able to have sex?
• What are the side effects of the treatment you’re recommending?
• Why is the treatment you’re recommending the best option for me?
• Will all my treatments be at this hospital?
• How often will I need check-ups?
• Will treatment stop my periods and start menopause?
• Can you write down what you have told me so I can read it later?

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