A B C D E F G H I J K L M N O P R S T U V W

CANCER OF THE UTERUS (WOMB)

What is Cancer of the Uterus ?

Cancer of the womb usually arises in the cavity of the womb. It starts in the cells which line the womb, called endometrial cells. These cells are stimulated to grow by the female hormone, oestrogen. Their growth is suppressed by the other main female hormone, progesterone. Most women who develop cancer of the womb do so after the menopause. It is possible to develop it before or round the time of the menopause but it is very uncommon for this time happen before the age of 40. The womb has a wall of muscle about a centimetre thick. The growth starts in the cavity of the womb and causes abnormal bleeding or discharge quite early on. These symptoms start before the growth extends through the muscle wall. Because of this, if symptoms are reported early, treatment is very successful: the growth has not got outside the cavity of the womb. After the menopause, the symptoms will be bleeding and perhaps a smelly discharge. If not yet menopausal, irregular bleeding may occur. There may also be a smelly discharge and occasionally just much heavier periods.

How does Cancer of the Uterus occur ?

As with all cancers, exactly how a woman gets cancer of the womb is not known. Oestrogen makes the endometrium grow. The endometrium is where the cancer starts. It is therefore likely that oestrogen plays an important part in developing the disease.

Why does Cancer of the Uterus occur ?

Cancer of the womb occurs most commonly in women over the age of 55. It is commoner in women with no children or very small families. It is also commoner in the overweight and in people with diabetes. This may be because they have more oestrogen in their bodies. Women with ovarian cysts which make oestrogen are at risk. Women who were given oestrogen by itself as hormone replacement had a high risk of uterine cancer. This is not done any more. Women who are taking the drug tamoxifen for breast cancer are increased risk.

Treatment Involved for Cancer of the Uterus

Any woman with bleeding after the menopause or abnormal bleeding must see a gynaecologist urgently. A smear test is always done but this may be negative even if there is cancer. The gynaecologist may manage to get a sample of tissue from inside the womb in the clinic. An ultrasound scan may arranged to measure the thickness of the lining of the womb. If this is less than 3mm cancer is unlikely. More likely, an examination of the lining of the womb with a fine telescope (hysteroscopy) and sampling of the lining of the womb (D & C) will be arranged. This may be done as a day case operation under general anaesthetic or in the clinic under local anaesthetic. There are three ways in which this disease may be treated: all may be used together.

HYSTERECTOMY The operation is done through the abdomen. It is a more extensive operation than a hysterectomy for a benign condition. In this case the operation removes the womb, both tubes and ovaries. In some cases it may also involve the removal of some of the lymph glands in the pelvic cavity.

DRUGS Because progesterone tends to suppress growth of the endometrium, progesterone tablets may be given. These are no longer given routinely after surgery but may help control symptoms if the cancer recurs or too advanced for surgical treatment.

RADIOTHERAPY The doctor might suggest some radiotherapy after the operation. This may be given as x-rays to the abdomen. Alternatively a source of radiotherapy may be put at the top of the vagina a few weeks after the operation. It will only be left there for about 15 minutes once a week for 4 to 5 weeks. There may be slight variations on this plan at different hospitals.

During Treatment for Cancer of the Uterus

It is always difficult to accept being told you have cancer. It is important to realize this type of cancer responds very well to treatment. Often just a hysterectomy is enough to cure the patient completely. Radiotherapy to your abdomen will last some weeks. It may make patients feel sick, produce diarrhoea and make the skin feel sunburnt. All these symptoms settle down after the treatment is finished. If given some radiation to the top of the vagina, it may cause a discharge. This should not last more than a few weeks after the last treatment.

After Treatment for Cancer of the Uterus

The specialist must be seen very regularly. There will be a check 6 weeks after the operation and then every 3 to 4 months. Patients are advised not to take hormone replacement therapy. If given radiotherapy, the diarrhoea may persist, but the doctor can give you tablets to help this.

If Cancer of the Uterus is Left Untreated

If the early symptoms of cancer of the womb are ignored, it will spread. It can grow through the walls of the womb to the other organs after a long time. It is then much more difficult to treat.

Effects on Family of Cancer of the Uterus

Anyone who has had cancer needs sympathy and understanding. Most people these days prefer to be told if they have cancer and doctors respect that request. This cancer carries a good prognosis. Most women are happier if they confide in their family and friends. This can only be done if they are told what the problem is. There is no greater risk of any other member of the family getting this disease. All abnormal bleeding, especially after the menopause, must be reported immediately.