Womb cancer

Womb cancer (uterine cancer) is a common cancer Most people who get womb cancer are over 50.

Womb cancer happens when cells in your womb (uterus) grow in an abnormal and uncontrolled way, forming a lump or tumour. Your womb is part of your reproductive system and is where a baby develops if you get pregnant. 

Types of womb cancer

There are two main types of womb cancer.

• Endometrial cancer. This is the most common type of womb cancer and starts in the lining (endometrium) of your womb.
• Uterine sarcoma. This is less common and develops in the cells in the muscle wall of your womb. 

Womb cancer can sometimes spread to surrounding tissue or to other parts of your body. This is known as

This topic focuses on endometrial cancer. Other types of womb cancer, such as uterine sarcoma, may be treated differently.

Causes of womb cancer

Doctors don’t know the exact cause of womb cancer yet. But some things make you more likely to develop it. These include having too much of the hormone oestrogen in your body (compared to your levels of progesterone).

You're also more likely to develop womb cancer if you:

• are over 50
• are overweight or obese
• have taken tamoxifen – a medicine sometimes used to treat breast cancer
• have Lynch syndrome – a genetic condition that can be passed down in families
• have polycystic ovary syndrome (PCOS)
• have diabetes or high blood pressure 
• have never had children
• started the menopause after the age of 52
• have had radiotherapy to your pelvis
• have taken oestrogen-only hormone replacement therapy (HRT)
• have people in your family who have had womb cancer or bowel cancer

Symptoms of womb cancer

The first sign of womb cancer is usually bleeding from your vagina, particularly if you’ve been through the menopause. If you haven't been through the menopause yet, you might have unusually heavy bleeding during your period or bleeding between periods. 

Other, less common, symptoms of womb cancer include:

• pain or swelling in your tummy or pelvis
• losing weight
• diarrhoea
• feeling sick or vomiting
• a lump in your pelvis
• tiredness
• a long-lasting cough
• feeling out of breath

If you have any of these symptoms, contact your doctor.

Diagnosis of womb cancer

Your doctor will ask about your symptoms and examine you – this might include examining inside your vagina. They’ll ask about your medical history too. If your doctor thinks your symptoms need further investigation, they’ll refer you to see a gynaecologist. This is a doctor who specialises in reproductive health.

You might need to have some more tests, which may include the following.

Transvaginal ultrasound scan

In this test, a radiographer (a health professional trained to perform imaging procedures) will put a small ultrasound probe into your vagina. Ultrasound uses sound waves to produce an image of the inside of your womb. This test will measure the thickness of your womb lining, which can help to diagnose womb cancer.

Biopsy

A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are cancerous. There are different ways to take a biopsy to help diagnose womb cancer.

• In an endometrial biopsy (aspiration biopsy), your doctor will put a thin plastic tube into your womb through your vagina. They’ll gently suck cells from the lining of your womb into the tube.
• In a hysteroscopy, your doctor will guide a narrow, flexible tube through your vagina and into your cervix (the neck of your womb). The tube has a light and camera on the end that will show the lining of your womb on a monitor. Your doctor will use this to examine the inside of your womb and look for signs of cancer. They can then take a section of tissue for biopsy.

You can usually have a biopsy or hysteroscopy as an out-patient – you don’t need to stay overnight in a hospital. And you won’t usually need to have a general anaesthetic but this may be an option if you need it.

Testing for Lynch syndrome

Lynch syndrome increases your risk of getting certain types of cancer, including womb cancer and bowel cancer. If you’re diagnosed with endometrial cancer, your doctor will offer you a test for Lynch syndrome. This will involve them testing a sample of your tissue. If you do have Lynch syndrome, you may be offered treatment and monitoring to reduce the risk of getting another Lynch syndrome-associated cancer, or to help to diagnose one early. Your relatives may also be offered tests for Lynch syndrome. 

Womb cancer

If you have womb cancer, you may need to have more tests to find out how advanced it is. This process, known as staging, takes into account whether or not the cancer has spread and how big it is.

Your gynaecologist will usually arrange for you to have a scan, such as a magnetic resonance imaging (MRI) scan or a computer tomography (CT) scan, to stage your womb cancer before they do an operation to treat it.

Treatment of womb cancer

If womb cancer is diagnosed early, treatment can work well.

The treatment you will be offered will depend on which type of womb cancer you have. It will also depend on how fast the cancer is growing, how far it has spread, and your age and general health. Your doctor will discuss what your treatment options are with you.

Surgery

The main treatment for womb cancer is surgery, which aims to remove all traces of the cancer. This usually involves having a hysterectomy, which is an operation to remove your womb and cervix. If your cancer hasn't spread outside your womb, a hysterectomy often cures the cancer.

As well as removing your womb and cervix, your gynaecologist will usually remove both your fallopian tubes and ovaries too. This is known as a bilateral salpingo-oophorectomy, or a BSO for short. Your gynaecologist may also remove or check the lymph nodes (organs that are part of your immune system) around your womb. As well as removing any cancerous cells, checking your lymph nodes may help your gynaecologist to decide if you need other treatment.

You may be able to have keyhole surgery, which you usually recover from more quickly than open surgery. In keyhole surgery, your surgeon will do the operation through a number of small cuts rather than one large cut. Check with your gynaecologist if this is an option for you.

Non-surgical treatments

Non-surgical treatments include the following. These treatments won’t cure womb cancer on their own but they may be used alongside surgery. But sometimes you can have them alone to help control the symptoms of womb cancer. 

• Radiotherapy uses radiation to kill cancer cells. You may have external or internal radiotherapy. In external radiation, a beam of radiation is targeted on the cancerous cells to shrink the tumour. In internal radiotherapy, which is called brachytherapy, a radiation source is put inside your vagina. You may have radiotherapy before or after surgery to reduce the chance of the cancer coming back. 
• uses medicines to destroy cancer cells. Chemotherapy is occasionally used to treat cancer that’s spread outside your womb or to reduce the chance of the cancer coming back. It can be used alongside radiotherapy.
• Hormonal therapy can alter the production or activity of certain hormones in your body. In womb cancer, hormone therapy uses progesterone. This is a natural hormone that can affect the growth of cancer cells. You may have progesterone treatment to help slow the growth of womb cancer that’s returned after other types of treatment. Or you may have it to treat womb cancer that’s spread to other parts of your body. 

After treatment for womb cancer, you’ll need to have regular check-ups with your doctor to see if the cancer has returned.

If the cancer has already spread and is advanced, a cure might not be possible. You can get support from specialist cancer doctors and nurses as well as treatment for any symptoms. This is called palliative care.