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What is Cancer of the Uterus?

Cancer of the uterus occurs when abnormal cells develop in the uterus and begin growing out of control.

There are two main types of uterine cancer. Endometrial cancers begin in the lining of the uterus (endometrium) and account for about 95% of all cases; and uterine sarcomas, which develop in the muscle tissue (myometrium), and is a rarer form of uterine cancer.

Also called cancer of the uterus, it is the most diagnosed gynaecological cancer in Australia. The risk of a woman in Australia being diagnosed with cancer of the uterus by the age of 85 is 1 in 40.

It is estimated that 3267 new cases of uterine cancer will be diagnosed in Australia in 2021.

Uterine cancer is often referred to as endometrial cancer as this is the most common form.  

The chance of surviving cancer of the uterus for at least five years is 83%.

Uterine Cancer Symptoms

Unusual vaginal bleeding is the most common symptom of uterine cancer, particularly any bleeding after menopause. Other common symptoms may include:

  • heavier than usual periods or a change in your periods

  • vaginal bleeding between periods

  • periods that continue without a break.

Less common symptoms include:

  • a watery discharge, which may have an unpleasant smell.
  • unexplained weight loss
  • difficulty urinating or a change in bowel habit
  • abdominal pain.

While these symptoms may be caused by other reasons, check with your GP if you are concerned.

Causes of Uterine Cancer

Some factors that can increase your risk of uterine cancer include:

  • being postmenopausal, or reaching menopause (after age 55)

  • a thickened wall lining (endometrial hyperplasia)

  • never having children

  • starting periods early (before age 12)

  • having high blood pressure or diabetes

  • being overweight or obese

  • family history of ovarian, uterine, or bowel cancer

  • having a genetic condition such as Cowden syndrome or Lynch syndrome

  • previous ovarian tumours, or polycystic ovary syndrome

  • using oestrogen only hormone replacement therapy or fertility treatment

  • previous radiation therapy to the pelvis

  • taking tamoxifen to treat breast cancer (the benefits of treating breast cancer usually outweigh the risk of uterine cancer - (talk to your doctor if you are concerned).

Diagnosis for Uterine Cancer

Tests to diagnose uterine cancer include:

Physical examination

The doctor may check your abdomen for swelling. To check your uterus, the doctor will place two fingers inside your vagina while pressing on your abdomen, or they may use an instrument (a speculum) that separates the walls of the vagina (similar to a cervical screening test).

Pelvic ultrasound

A pelvic ultrasound will use soundwaves to make a picture of your uterus and ovaries. The soundwaves echo when they meet something dense such as a tumour or organ. A computer then makes a picture from these echoes. A pelvic ultrasound can be done in two ways and you often have both types at the same appointment. A pelvic ultrasound usually takes between 15 and 30 minutes. If anything appears unusual, the doctor may suggest a biopsy.

Abdominal ultrasound

In order to get good pictures of the ovaries and uterus in an abdominal ultrasound you will need to have a full bladder so you will be asked to drink water before your appointment. A technician called a sonographer will move a small device called a transducer over your abdomen. 

Transvaginal ultrasound

For a transvaginal ultrasound you do not need a full bladder. The sonographer will insert a transducer wand into your vagina. You may find the ultrasound uncomfortable, but it should not be painful. 

If you feel uncomfortable or embarrassed about having the ultrasound, talk to the technician beforehand. You can ask to have a female sonographer or have someone else in the room with you.

Endometrial biopsy

An endometrial biopsy is done in the specialist’s office. A long, thin tube (pipelle) is inserted into your vagina to gently suck cells from the uterine lining. The cells are sent to a pathologist who examines them under a microscope. There may be some discomfort similar to period cramps so your doctor may suggest taking non-steroidal anti-inflammatory drugs such as ibuprofen, before the procedure.

Hysteroscopy and biopsy

A hysteroscope is a telescope-like device which is inserted through your vagina into your uterus and allows a gynaecologist or gynaecological oncologist to see inside your uterus. During this procedure, tissue can also be removed (biopsy) and sent for further testing in a laboratory.  

Blood and urine tests

Blood and urine tests may be used to assess your general health and inform treatment decisions.

Other tests

If cancer is detected in your uterus, you may have other scans to see if the cancer has spread to other parts of your body, such as an x-ray, CT scan or MRI scan. For particular types of uterine cancer, such as sarcoma, a PET scan may be used.

Treatment for Uterine Cancer

For most women with uterine cancer, surgery will be the only treatment required, particularly if the cancer is diagnosed early and has not spread to other parts of the body.  

Surgery (hysterectomy and bilateral salpingo-oophorectomy)

The most common form of treatment for cancer of the uterus is surgically removing the uterus and cervix. This procedure is called a total hysterectomy. If the fallopian tubes and both ovaries are also removed, it is called a bilateral salpingo-oophorectomy.

Ovaries are often removed to reduce the risk of the cancer coming back, as ovaries produce oestrogen, a hormone that may cause the cancer to grow.

The surgery can be performed through a cut in the abdomen (laparotomy) or using keyhole surgery (laparoscopic surgery). You will be given a general anaesthetic. During the procedure, the surgeon may remove additional tissue if the cancer has spread, or to remove lymph nodes in your pelvis.

For women who were not menopausal before treatment who then have a bilateral salpingo-oophorectomy, they will experience menopause with the removal of their ovaries. Therefore, if you are concerned about how surgery will affect your fertility, it is important to talk to your specialist before treatment begins.

The treatment team will advise you of how to take care of yourself following surgery, including avoiding lifting, driving and sexual intercourse for a short period of time during your recovery.

Radiation therapy (radiotherapy)

Radiation therapy, the use of x-rays to kill or injure cancer cells, is commonly used as an additional treatment to reduce the chance of the cancer coming back.  It may be recommended as the main treatment if you are not well enough for surgery.

Radiation therapy is given either externally, where a machine directs radiation at the cancer and surrounding tissue; or from inside the body (brachytherapy), where radioactive material is put in thin tubes and placed near the cancer internally. 

Radiation therapy to the pelvic region may cause menopause, therefore, if you are concerned about how treatment will affect your fertility, it is important to raise your concerns with your treatment team before treatment commences.

Hormone therapy

Hormone therapy is usually given if the cancer has spread or if the cancer has come back (recurred). It is also sometimes used if surgery is not an option. Progesterone is the main hormone treatment for women with uterine cancer, and it is available in tablet form or by injection by a GP or nurse. It helps shrink some cancers and to control symptoms.

Chemotherapy

Chemotherapy is used to treat certain types of uterine cancer, or when cancer comes back after surgery or radiotherapy, or if the cancer is not responding to hormone treatment. It can be used to control the cancer and to relieve symptoms. It is usually given as a drug that is injected into a vein (intravenously). The doctor will explain the chemotherapy treatment course and how long it will last.

Palliative care

In some cases of uterine cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of uterine cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:

  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Gynaecological oncologist- diagnoses and treats cancers of the female reproductive system
  • Gynaecologist- specialises in treating diseases of the female reproductive system.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Fertility specialist- diagnoses, treats and manages infertility and reproductive hormonal disorders
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.

Screening for Uterine Cancer

There is currently no national screening program for uterine cancer available in Australia.

Prognosis for Uterine Cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of uterine cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

In most cases, early diagnosis of uterine cancer has a good prognosis.

Preventing Uterine Cancer

There are no proven measures to prevent uterine cancer.

However, you may be able to minimise your risk factors, such as maintaining a healthy weight, and being vigilant about any abnormal vaginal bleeding.