Endometrial cancer

What is endometrial cancer?

Endometrial cancer develops when the lining of the cells of the uterus — known as the endometrium — grows in an abnormal, uncontrolled way. Around 1,900 Australian women are diagnosed with endometrial cancer each year, making this the most common gynaecological (women’s health) cancer in Australia.

Endometrial cancer is more common in women over 50 years who have gone through menopause, but younger women can also develop endometrial cancer.

What are the symptoms of endometrial cancer?

A common early sign of endometrial cancer is abnormal vaginal bleeding, especially after menopause.

Other symptoms include:

• a watery vaginal discharge (which may have an unpleasant smell)
• unexplained weight loss
• difficulty urinating (weeing)
• abdominal (tummy) pain

If you have one or more of these symptoms, it doesn’t necessarily mean you have endometrial cancer, since these symptoms can occur for many other reasons. However, it’s still important to see a doctor for a health check.

When should I see my doctor?

If you experience abnormal or unexpected vaginal bleeding, it is important to see a nurse, GP or gynaecologist. Remember that while other symptoms of endometrial cancer are common, if they are unusual for you, or if any symptom doesn’t go away its best to have a health check. You can always ask to see a female doctor if you would prefer.

Before your appointment, it’s a good idea to create a list of questions. This preparation will help you get more out of the time with the health professional and help you to remember everything you want to ask. Use the Healthdirect question builder, which you can print or email so it’s convenient for you to take to your appointment.

What causes endometrial cancer?

The cause of endometrial cancer is unclear, but there are known risk factors, some of which can be reduced by making changes to your lifestyle.

Known risk factors include if you:

• are overweight or obese
• have high blood pressure (hypertension)
• have diabetes
• are over 50 years of age and have gone through menopause
• have a condition known as endometrial hyperplasia (thick endometrium)
• have a family history of endometrial, bowel, breast or ovarian cancer, or Lynch syndrome (known as hereditary non-polyposis colorectal cancer – HNPCC)
• take an oestrogen hormone replacement with no progesterone
• take the drug tamoxifen (for breast cancer)
• have never had children
• are having pelvic radiation (to treat another cancer)
• have a tumour in an ovary
• have polycystic ovary syndrome (PCOS)

How is endometrial cancer diagnosed?

If you have symptoms that might be linked to endometrial cancer your doctor will most likely ask you questions about your health, and any history of cancer in your family.

In addition to your doctor doing a general examination, you will need to have a blood test, an examination of your vagina and cervix (using a speculum to open your vagina, similar to that used for a cervical screening), and a special ultrasound to take an image of your cervix, uterus, endometrium and ovaries). Remember, you can always ask to see a female doctor if you would prefer.

Your GP may do some of these tests, or they may refer you to a gynaecologist or gynaecological oncologist.

Your doctor might also need to refer you for an endometrial biopsy, where a small sample of cells is taken for examination in a laboratory. Sometimes a procedure known as a dilatation and curettage (‘D&C’) is also recommended. This is done in a day surgery clinic under anaesthetic so you won’t feel the procedure.

How is endometrial cancer treated?

If tests confirm endometrial cancer, your specialist will discuss treatment options with you.

Surgery

Your doctor may discuss the need for a total hysterectomy (an operation to remove your uterus and cervix), a salpingectomy (removal of the fallopian tubes) and an ovariectomy (removal of ovaries).

Depending on the stage and grade of the cancer, you may be advised to also have your pelvic lymph nodes removed, known as a lymphadectomy. This is sometimes carried out using ‘keyhole’ surgery, with a device called a laparoscope.

Radiotherapy

If the cancer has spread, your specialist may recommend radiotherapy.

Radiotherapy, sometimes called radiation therapy, uses x-ray beams to kill or damage cancer cells so they cannot grow, multiply or spread, while limiting damage to healthy organs of the body.

This therapy usually starts around 6 to 8 weeks after surgery, and may be external (when you lie near a machine that aims x-rays at your cancer), or internal (also known as brachytherapy, where a small radioactive device is placed inside or next to the cancer).

Radiotherapy is usually, but not always, done after surgery. Most centres in Australia use high-dose-rate brachytherapy, which delivers treatment in minutes and does not require an overnight hospital stay. Brachytherapy is effective in reducing the likelihood of the cancer recurring, while the chance of side effects is low.

Hormone therapy

Hormones such as oestrogen and progesterone, occur naturally in the body, and have many health functions, including controlling the growth and activity of cells. Sometimes a cancer uses the body’s own hormones to grow. These are called hormone-sensitive cancers and they may also be treated with hormone therapy. The therapy can be taken as tablets, injections or if you have not had a hysterectomy, through a hormone-releasing intrauterine device (IUD) which is fitted into the uterus by your doctor.

Chemotherapy

Chemotherapy uses strong medicines to kill or slow the growth of cancer cells, while aiming to cause minimal damage to healthy cells. Chemotherapy is used on some types of endometrial cancer and your doctor will tell you if chemotherapy is right for you. If you do need chemotherapy, you will need to receive the medicines directly into your vein and you will need several treatments over weeks or months. Usually, you can be treated as an outpatient, and you won’t need to stay in hospital overnight.

The sort of treatment you have will depend on several factors, including the type of endometrial cancer, its size and whether it has spread — and your personal preferences will also be considered. Talk to your doctor and health team about the risks and benefits of the different treatments so you can better understand your options and choose the best possible approach for you.

Can endometrial cancer be prevented?

There is no way to ensure you won’t get endometrial cancer, but there are steps you can take to minimise your risk, including maintaining a healthy weight.

The use of combined oral contraceptives (‘the pill’) for at least 5 years will significantly decrease a woman’s chance of developing endometrial cancer.

Some women with a significant family history of endometrial cancer might consider a hysterectomy for preventative reasons, or preventative hormone therapy. If you are considering this, you should discuss the risks and benefits of the approach with specialists in this area, such as healthcare professionals at a familial cancer clinic.

What are the complications of endometrial cancer?

Any complications you experience will depend on the type of endometrial cancer you have and your treatment. Surgery, chemotherapy, radiotherapy and hormonal therapy all have different side effects. A cancer care nurse can help you understand these side effects and support you to remain as comfortable as possible during your treatment.

If you have not yet been through menopause, your endometrial cancer treatment may bring on menopause quite suddenly.

If you have already been through menopause, the treatments may cause the symptoms of menopause to return. Your healthcare team will advise you on how to take care of yourself during the treatment itself and afterwards.

After your treatment is complete, it’s important to continue to see a doctor for monitoring and follow-up for at least 5 years.

This is so the doctor can check that your cancer has not come back or spread to other parts of the body. Ask your doctor how often you should return for follow-up visits, and the symptoms you should watch out for. Early detection is important for your long-term health, so these checks can be very reassuring.

Other questions you might have

Can I still become pregnant?

If your cancer has been caught early, you may be able to have it treated and still get pregnant. Speak with your health team about fertility-sparing treatment. For some women, in vitro fertilisation (IVF) can help.

Does an endometrial biopsy hurt?

During an endometrial biopsy, your doctor takes a sample of endometrial cells using a thin plastic tube, which is inserted into your vagina and through the cervix to gently suck cells from the lining of the uterus. This can cause minor pain similar to period cramps. You can take over the counter pain medicines such as ibuprofen before the procedure to reduce this discomfort.

Are endometrial biopsies accurate?

The sample of cells collected during an endometrial biopsy is sent for examination under a microscope. Sometimes the results are unclear, and you may need another type of biopsy, called a hysteroscopy. This is usually performed in hospital under a general anaesthetic.