Endometrial cancer

The endometrium is the lining of the uterus or womb. Also known as uterine cancer, endometrial cancer is the most common gynaecological cancer with 1900 Australian women diagnosed each year.

Because endometrial cancer is often discovered at an early stage of its development in the body, most women are cured. Even if the disease is not discovered until after it has advanced, treatment is still possible but the likelihood of a long-term cure is lower.

Causes

It is not usually possible to say what causes cancer in a particular woman but known risk factors are:

• you are overweight or obese
• you are over 50 years and have gone through menopause
• your endometrium grows too thick (known as endometrial hyperplasia)
• one or more people in your family has had endometrial, bowel, breast or ovarian cancer, or Lynch syndrome (known as hereditary non-polyposis colorectal cancer – HNPCC)
• you take an oestrogen hormone replacement that does not have progesterone
• you are taking the drug tamoxifen (which is used to treat breast cancer)
• you have high blood pressure (known as hypertension) and diabetes
• you have never had children
• you have had pelvic radiation in the past to treat another cancer
• you have a tumour in one of your ovaries
• you have polycystic ovary syndrome (PCOS).

Endometrial cancer is rising in incidence and is most likely due to the rising incidence of obesity.

Symptoms

If you are concerned about symptoms it is important that you see a nurse, doctor or gynaecologist (specialist doctor in women’s health). It is more likely that your symptoms are not related to cancer but it is important to have any symptoms checked.

Symptoms of endometrial cancer include:

• bleeding after you have been through menopause (once your periods have stopped for twelve months)
• unusually heavy periods and bleeding inbetween your periods
• an unusual fluid or discharge from your vagina that is watery, bloody or smelly
• pain in your belly or abdomen
• trouble going to the toilet to pass urine (wee) or pain when you do go.

See a doctor if you have any of these symptoms and they don’t go away and/or are unusual for you.

Diagnosis

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

• ask you questions about the history of the health of you and your family
• examine you
• do a blood test
• examine your vagina and and cervix using a speculum (like that used in a cervical screening test) to open your vagina
• do an ultrasound of your uterus by putting a small wand (called a transducer) into your vagina to take a picture of your cervix, uterus, endometrium and ovaries
• they may also need to take and test a sample (or biopsy) of your endometrium. This can be done without anaesthetic in a day clinic with a thin tube (or pipelle) which is put into your uterus (through your vagina) and gently sucks up a small sample of cells. Sometimes you will be given an injection of medicine (or anaesthetic) to put you to sleep so they can scrape part of your endometrium (also known as a dilation and curettage or D&C).

Treatment

The kind of treatment you have will depend upon:

• the size of the cancer and where it is in your body (this is known as the stage of cancer)
• how quickly it is growing (the grade of cancer)
• where in the endometrium it started (the 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.

Treatment options

• Surgery to remove your uterus and cervix (this is known as a total hysterectomy), your fallopian tubes (a salpingectomy) and usually your ovaries (an oophorectomy). Your lymph glands may also be removed to check for signs the cancer has spread to other parts of the body. If the cancer has spread you may have surgery to remove these other cancers.
• Radiotherapy aims to control or kill the cancer. If you have external radiation you will lie or sit 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 is medicine that aims to control or kill the cancer. Usually this involves being connected to an IV or drip for a few hours so the drugs can be released slowly into your body.
• Hormonal therapy drugs to stop the hormones that help your cancer to grow from being made or reaching your cancer.

Hormone treatment using a progestogen IUD

If you have endometrial cancer your doctor will usually recommend that you have an operation to remove your endometrium, uterus and cervix (known as a total hysterectomy), your fallopian tubes (a salpingectomy) and usually your ovaries (an oophorectomy). This is the most common treatment because it is the only way to be sure the cancer has been removed.

In some cases treatment involves the use of a progestogen intrauterine device (IUD). This treatment is unusual but it may be an option if you:

• strongly want to avoid or delay a hysterectomy so you can have (more) children
• have other health problems (such as obesity) or diseases (particularly heart disease) that would make surgery unsafe for you.

Using a progestogen IUD to treat endometrial cancer will not be possible if:

• your endometrial cancer has invaded the wall of your uterus or moved beyond your uterus
• tests suggest there is cancer in your ovaries.

The safety and success of this treatment for endometrial cancer is not yet really known as it is a relatively recent treatment.

At the Women’s we have used a progestogen IUD to treat endometrial cancer in more than 16 women. Most of these women were pre-menopausal (they had not been through menopause). Of the 16 women:

• ten had an endometrium that became less abnormal or cancer which seemed to disappear
• two became pregnant after treatment.

For most women there was a change to their endometrial cancer around six months after having the IUD inserted.

What if I want to become pregnant?

Pregnancy is not recommended when you have endometrial cancer. Treatment with an IUD may help your endometrium return to normal. During this time the IUD also acts as a contraceptive. Under usual circumstances, once the IUD has been removed, pregnancy may be possible.

Treating endometrial cancer with an IUD is not a long term treatment option as it is not known if it will permanently arrest cancer. Once you have completed your family, and you have no desire to be pregnant again, it is likely that a hysterectomy will be recommended.

After treatment 

Eating well and being active after treatment for endometrial cancer is important for your recovery. It improves your health and wellbeing and reduces your risk of developing conditions such as heart disease and diabetes. Keeping a healthy weight, eating well and leading an active lifestyle may even lower your risk of other cancers developing in the future.

Questions to ask your doctor or oncologist

• How big is my cancer and where exactly is it?
• Does endometrial cancer show up in a cervical screening test?
• Is my daughter more likely to have endometrial cancer if I have it?
• What if I want to become pregnant?
• Is there a risk that any children I have after being treated will get cancer?
• Will I still be able to have sex?
• What are the side effects of the treatment you are recommending?
• Why is the treatment you are recommending best for me?
• Will I have all my treatments at this hospital?
• How often will I need to have checkups?
• Will treatment stop my periods and start menopause?
• Can you write down what you have told me so that I can read it again later?

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