Cancer of the uterus is the most common gynaecological cancer affecting women. Most cancers of the uterus are cancers of the lining of the uterus (the endometrium). Cancers can also develop in the muscle layers of the uterus. Knowing which type of cancer you have is important because it affects the decisions you and your doctor will make about treatment.
Adenocarcinoma of the endometrium
An adenocarcinoma is a cancer that starts in glandular tissue. Most women (about 87%) who are diagnosed with cancer of the uterus have this type of cancer.
Other types of cancer of the uterus
The less common types of cancer of the uterus are adenosquamous carcinoma, papillary serous carcinoma and, rarely, clear cell carcinoma or uterine sarcoma. If you have uterine sarcoma your treatment options will be different than for other types of cancer of the uterus.
Causes of cancer of the uterus
The exact cause of cancer of the uterus is not known. Some things seem to put women at more risk:
- age: it is more common in women aged over 50 years
- endometrial hyperplasia
- menopause, never having children or being infertile
- being overweight
- high blood pressure and diabetes
- a family history of uterus, breast cancer or bowel cancer: if you think you are at risk you should discuss this with your doctor
- being on oestrogen hormone replacement without progesterone
- being on tamoxifen or anastrozole for treatment of breast cancer. If you are taking tamoxifen or anastrozole, you should discuss this risk with your doctor.
Uterine cancer is not caused by sexual activity and cannot be passed on this way.
Remember, most women who have known risk factors do not get cancer of the uterus. Many women who do get cancer of the uterus have none of these risk factors.
Treatment
Treatment for cancer of the uterus has a very high cure rate.
Surgery
Cancer of the uterus is usually treated by removing the uterus. The operation is called a hysterectomy. The operation also allows the doctors to find out which type of cancer of the uterus you have and see if it has spread.
The cut is made along the pubic hair line or from the pubic area to the belly button. Once the abdomen is open, the surgeon washes out the area with a fluid, which is sent to a pathologist, who checks the fluid for cancer cells.
The surgeon then removes the uterus (hysterectomy). Your Fallopian tubes and ovaries will also be removed. This is called a bilateral salpingo oophorectomy. Sometimes the operation can be done through keyhole surgery, where four or five small holes are made in the abdomen. The surgeon uses a small camera to see inside the abdomen.
If the cancer has spread into the muscle wall of the uterus, this increases the risk of spread to the abdominal lymph nodes. Removal of lymph nodes is called a lymphadenectomy. If you have cancer in the lymph nodes you may benefit from additional therapy.
If the cancer has spread to the cervix, a small part of the upper vagina and the ligaments supporting the cervix are also removed. If this is necessary, the operation will be longer.
Radiotherapy
Radiotherapy treats cancer by using radiation to destroy cancer cells. The radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.
Radiotherapy may be advised if you are not well enough for a major operation. Radiotherapy may also be advised as an additional therapy. Additional therapies are often called adjuvant therapies.
Brachytherapy (internal radiotherapy)
Internal radiotherapy is also called brachytherapy. It is a type of radiotherapy where an implant containing radiation is inserted through the vagina and placed close to the cancer.
Some women may have internal radiotherapy in addition to surgery (adjuvant treatment), if there is a risk of cancer developing in the scar at the top of the vagina after surgery.
External radiotherapy
In external radiotherapy, x-rays from a large machine are directed at the part of the body needing treatment. For cancer of the uterus, the lower abdomen area and pelvis are treated but if the cancer has spread this can be extended to include other areas
Hormone treatment
Some cancers of the uterus depend on hormones for growth. Women's ovaries are removed during surgery for two reasons:
- because the cancer may have spread to the ovaries
- because they produce oestrogen, which may help the cancer to grow.
Tissue removed during your operation will be tested to see if your cancer can be treated by hormones. Hormone treatment can work very well for advanced or recurrent cancer of the uterus. It can also be used to treat early stage cancer of the uterus if other medical problems prevent surgery or radiotherapy.
Chemotherapy
Chemotherapy is the treatment of cancer using anti-cancer drugs. Chemotherapy may be offered with radiation therapy and is usually given to women who have a very high risk of the cancer returning, to try to prevent recurrence. It may also be recommended for women whose cancer is quite advanced when they are first diagnosed, to try to shrink the cancer or to relieve symptoms caused by the cancer. If cancer returns after surgery or radiotherapy, chemotherapy may be used to control the growth of the cancer and to help relieve symptoms. It is also used if the cancer does not respond to hormone treatment.