CANCER OF THE WOMB (UTERUS)

( By JASCAP )

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Causes & diagnosis

Causes of womb cancer

Approximately 6000 women in the UK develop endometrial cancer each year. The exact cause of womb cancer is not yet known. It most commonly occurs in women between the ages of 50 and 64 and after the menopause. Womb cancer rarely affects women under 40.

Being overweight is an important risk factor for developing womb cancer. The more overweight or obese you are, the greater your risk. As many as four out of ten womb cancers may be caused by obesity.

Women who have had their menopause and who take oestrogen-only HRT (hormone replacement therapy) for a long time may have a slightly increased risk of developing the disease. Women who have not had their womb removed and are taking HRT should make sure that they are taking a combination of the hormones oestrogen and progesterone, rather than oestrogen on its own. Taking combined oestrogen and progesterone HRT for up to five years does not increase the risk of developing womb cancer, but if it is taken for more than five years the risk may be slightly increased.

Although most womb cancers are not caused by an inherited faulty gene, in some women they may be. In a small number of families, a gene fault HPNCC (hereditary non-polyposis colorectal cancer) can be present that raises the risk of family members developing bowel or womb cancer.

If you have several close family members who have bowel or womb cancer (especially if these were developed at a young age) this could be due to an inherited faulty gene. If you are worried that other family members may have an increased risk of cancer you can talk to your GP, who can refer you to a family cancer clinic if they think this is necessary.

Some other possible risk factors that may increase the chance of developing womb cancer include:

Taking tamoxifen (a hormonal therapy sometimes taken to treat breast cancer) over a long period of time. The increase in risk from this is so slight, however, that the benefits of taking tamoxifen to treat breast cancer are considered to outweigh the risk.
If you have not had children or been pregnant.
Having had Cowden syndrome or polycystic ovary syndrome.

Women who are still having periods, and who take the contraceptive pill, are believed to have a lower risk of developing womb cancer.

Womb cancer, like other cancers, is not infectious and cannot be passed on to other people.

Symptoms of womb cancer

The most usual early symptom of cancer of the womb is abnormal vaginal bleeding. This may occur as:

bleeding which starts after the menopause (in post-menopausal women)
bleeding between periods
heavier periods than normal (in pre-menopausal women)
abnormal vaginal discharge.

Abnormal vaginal bleeding may be due to many causes other than cancer, but you should always see your GP about it.

Having had a recent normal cervical screening test (smear test) does not mean that you do not have cancer of the womb. A smear test involves a scrape of cells from the surface of the cervix. The cervix is the lower part womb. Occasionally a smear test may show signs of a cancer of the lining of the womb, but this is unusual.

Other symptoms of womb cancer might be:

pain in the lower abdomen (tummy), back or legs
discomfort or pain during sexual intercourse.

How womb cancer is diagnosed

Usually you begin by seeing your GP (family doctor) who will examine you and can arrange for any other tests or x-rays that may be necessary. They may need to refer you to hospital or to a clinic for these tests, and for specialist gynaecological advice and treatment.

You may have one or more of the following tests:
Vaginal ultrasound
Hysteroscopy
Biopsy
Dilatation and curettage (D&C)

Vaginal ultrasound

Sound waves are used to make up a picture of the inside of your womb. It will be done in the hospital scanning department. A small device is gently put into your vagina. The device produces sound waves, which are then converted into a picture by a computer. This may be uncomfortable but should not be painful.

Hysteroscopy

A thin, flexible tube with a light at the end (a hysteroscope) is passed through your vagina into your womb. This allows doctors to look inside the womb and take tissue samples (see biopsy). You may have this test as an outpatient under a local anaesthetic. But sometimes, a general anaesthetic is needed so you may have to stay in hospital overnight.

After a hysteroscopy you may have some bleeding and period-type pains for a day or so, which can be controlled with painkillers.

Biopsy

A small sample of cells may be taken from the lining of your womb by a gynaecologist or specialist nurse. This will be carried out in the outpatients department and you will not need an anaesthetic. A fine tube is passed into the womb, and gentle suction is used to remove a sample of the lining. The sample is sent to the laboratory for examination under a microscope.

Dilatation and curettage (D&C)

You may have a procedure called dilatation and curettage which is carried out under a general anaesthetic. Your cervix is stretched so that the gynaecologist can insert an instrument to remove samples of tissue from the inner lining of the womb. These samples can then be examined under a microscope. After a D&C, most women have period-type pains for a day or so. These can be controlled with painkillers.

Further tests for womb cancer

If the tests show that you have womb cancer, your gynaecologist or surgeon will probably want to do further tests to see if the disease has spread. These tests help the doctor to decide on the best type of treatment for you. The tests may include:

Blood tests
Chest x-ray
CT scan
MRI scan

Blood tests
Samples of your blood will be taken to check your general health, the number of cells in your blood (blood count), and to see how well your kidneys are working.

Chest x-ray
This is taken to check that your lungs and heart are healthy.

CT scan

A CT (computerised tomography) scanner takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes longer than an x-ray (from 10-30 minutes). It may be used to find the exact area and size of the cancer, or to check for any spread of the disease. Most people who have a CT scan are given a drink or injection of iodine to allow particular areas to be seen more clearly. For a few minutes this may make you feel hot all over.

If you are allergic to iodine or have asthma, it is important to tell your doctor and the person doing the test before you have the injection or drink. It is usually still possible to have the injection, but you will need to have steroid treatment on the day before, and the day of, the injection.


Having a CT scan

The CT scan is painless but it will mean lying still for about 10Ė30 minutes. You will probably be able to go home as soon as the scan is over.

MRI scan

An MRI (magnetic resonance imaging) scan is similar to a CT scan but uses magnetism instead of x-rays to build up cross-sectional pictures of your body. Some people are given an injection of dye into a vein in the arm to improve the image.

During the test you will be asked to lie very still on a couch, inside a long chamber, for up to an hour. This can be unpleasant if you donít like enclosed spaces. If so, it may help to mention this to the radiographer. The MRI scanning process is also very noisy, but you will be given earplugs or headphones to wear, and many hospitals will play music for you during the scan. You can take in your own favourite music.

The scanner is a very powerful magnet, so before going into the room you should remove any metal items you may be wearing. People who have heart monitors, heart pacemakers, or certain types of surgical clips cannot have an MRI because of the magnetic fields.

It will probably take several days for the results of your tests to be ready, and this wait will obviously be an anxious time for you. It may help if you can find a close friend or relative to talk things over with. You can also contact us, or another support organisation.

Staging and grading womb cancer

Staging
Grading

Staging

The stage of a cancer is a term used to describe its size and whether it has spread beyond the original area where it started. Knowing the extent of the cancer, and the grade, helps your specialist to decide on the most appropriate treatment for you.

Womb cancer is divided into four stages.

Stage 1 womb cancer is contained within the womb only. This stage is divided into three:

Stage 1A The cancer is only in the inner lining (endometrium) of the womb.
Stage 1B The cancer has grown into the muscle wall of the womb, but not more than half way.
Stage 1C The cancer has grown more than half way into the muscle wall.

Stage 2 womb cancer has spread to the cervix. This stage is divided in two:

Stage 2A The cancer has grown into the glands covering the cervix.
Stage 2B The cancer has grown into the muscle of the cervix.

Stage 3 womb cancer is more advanced, but is contained within the pelvis. This stage is divided in three:

Stage 3A The cancer has grown towards the ovaries or cancer cells have spread to the abdomen.
Stage 3B The cancer has spread down into the vagina.
Stage 3C The cancer has spread into nearby lymph nodes.

Stage 4 means the cancer has spread beyond the womb into surrounding organs. This stage is divided in two:

Stage 4A The cancer has spread to the bowel or bladder.
Stage 4B The cancer has spread to other parts of the body such as the lungs, bone or the brain. If the cancer has spread to other parts of the body this is secondary (or metastatic) womb cancer.

Recurrent endometrial cancer is when the cancer comes back some time after initial treatment.

Grading

Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how quickly the cancer may develop. There are three grades:

grade 1 (low-grade)
grade 2 (moderate-grade)
grade 3 (high-grade).

Low-grade means that the cancer cells look very like the normal endometrial cells. They usually grow slowly and are less likely to spread.

Moderate-grade means that the cells look more abnormal than low-grade cells. High-grade means that cells look very abnormal. They are likely to grow more quickly and are more likely to spread.

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