Uterine cancer (womb cancer)

What is uterine cancer?

Cancer of the womb (uterine cancer) is most common in women between the ages of 60 and 70, and is the fifth most common cancer in the UK. It is often discovered early and treated successfully. Cancer is the uncontrolled growth of cells that create tumours. If the tumour is capable of spreading to other organs or tissue, then it is cancerous (or malignant). If it is not capable of spreading, then it is known as benign. The uterus is another name for the womb, an important part of the female reproductive system. The most common type of womb cancer is when cells start to grow out of control in the lining of the womb (endometrium). This is also known as endometrial cancer.   

Common uterine cancer symptoms:

The most common symptoms of womb cancer include the following:  

• Bleeding after the menopause
• Unusually heavy bleeding 
• Bleeding between periods 
• Vaginal discharge – pink, watery or white 
• Pelvic pain 
• Pain during intercourse 
• Weight loss

About 90% of womb cancer cases are diagnosed as a result of bleeding after the menopause. It is important to remember that abnormal bleeding may be a symptom of other, more common conditions including endometriosis or fibroids (see our individual fact sheets on these conditions for more information).   If you do experience any of these symptoms, it is important you see your doctor or a consultant gynaecologist straight away. It is unlikely to be cancer, but if it is, the sooner you have it treated, the better.

What causes this type of cancer?

The cause of womb cancer is currently unknown, but it is believed that the balance between the female sex hormones oestrogen and progesterone plays an important part in the development of the disease. There are a number of risk factors that may indicate an increased likelihood of developing womb cancer.  

Family history – there is a genetic link to womb cancer. If there have been cases of ovarian cancer in close family members, there may be an increased risk of developing the disease.  

Age – womb cancer most commonly develops after the menopause with 93% of cases in women between the ages of 50 and 70 in the UK.

Being overweight – overweight women are generally twice as likely to develop womb cancer than women of a normal weight, and obese women are three times as likely.  

Menstrual history – womb cancer is more likely to occur in women who began their periods relatively early, and reached menopause relatively late. Experience of infrequent or irregular periods can also be factors.

Fertility and pregnancy – womb cancer is more common in women who have not had children or who have had problems with fertility. Risk decreases the more children a woman has had.   

Contraception – taking the oral contraceptive pill seems to reduce the risk of developing womb cancer.

Polycystic Ovary Syndrome (PCOS) – if you have suffered from this condition you nmay have an increased risk of womb cancer (please see our separate fact sheet on PCOS for information on the condition).

Hormone replacement therapy (HRT) – taking HRT, especially the oestrogen only type, can increase the risk of womb cancer. Your doctor will discuss the risks and benefits if you are considering HRT.

Tamoxifen treatment – taking tamoxifen for the treatment of breast cancer increases the risk of womb cancer. The benefits of the drug outweigh the increased risk, but you should have regular pelvic check ups and report any unusual bleeding immediately.

Race – white women are more likely to develop womb cancer, but if black women do develop the disease it is likely to be a more aggressive cancer.

How is womb cancer diagnosed?

After discussing your symptoms with you, your consultant gynaecologist may need to carry out a pelvic examination. This may involve pressing on your lower abdomen. They may also feel inside the vagina while pressing on your abdomen to check if there is any abnormality in the pelvic area. Your consultant may also use a speculum (an instrument inserted into the vagina to allow the consultant to see the neck of the womb or cervix).

Other tests may include:

Endometrial biopsy – a sample of tissue is taken from inside your womb for testing in the laboratory.

Dilatation and curettage (D and C) – this procedure is performed under a general anaesthetic and involves scraping tissue from lining of your inner womb to be examined under a microscope. If cancer is found then you will need further tests to establish what stage the cancer has reached, and if it has spread (this process is called staging). These tests may include: 

Pelvic or transvaginal ultrasound scan – a probe is passed over the lower abdomen, or inserted into the vagina, and sound waves are used to produce pictures of the womb, ovaries and surrounding pelvic area.

MRI scan – this type of scan can help your consultant see the size and position of tumours. It is a computerised diagnostic technique that can provide very detailed two or three dimensional pictures of organs and structures within the body, without using x-rays or other forms of radiation. MRI scans are not suitable for all women.

CT or CAT scan – similar to an MRI scan but using a series of x-rays instead of magnetism to build up a picture of soft tissue.

Treatment

Treatment options and their success will depend on the stage of the cancer and how far it has spread. Most cases of womb cancer are discovered early and treated successfully. The objective of all treatment is to remove or destroy the abnormal cells.

Surgery

The most common treatment is the removal of the womb by surgery (hysterectomy). Often the fallopian tubes and ovaries are also removed (hysterectomy with bilateral salpingooophorectomy). Often no further treatment is required. See our separate fact sheet on hysterectomy for more information on this procedure.

Further treatment

If the cancer has spread or you have an aggressive form of cancer, further treatment may be required to destroy cancer cells that are still be present following surgery. If the cancer was caught early, these additional treatments may not be required.

Chemotherapy – involves a course of drugs that are designed to kill remaining cancer cells and disrupt the growth of new ones. The drugs can be administered in tablet form, more often by intravenous injection, and sometimes directly into the abdomen. 

Radiotherapy – less commonly used than chemotherapy. It uses high energy x-rays to destroy the remaining cancer cells. It is highly targeted and therefore minimises damage to other cells. 

Hormone Therapy  – the hormone progesterone may be used to stop the cancer growing in other areas of the body.    Cancer treatments can cause unpleasant side effects including nausea and vomiting, fatigue and hair loss. It is important to discuss these with your consultant before deciding to go ahead. Coping with cancer can be difficult emotionally as well as physically. Help and support from your family and friends will be invaluable.   There are a number of organisations that offer support, often putting you in contact with other women who have been affected. These are listed at the end of this fact sheet.  

Fertility

Womb cancer usually affects women after the menopause, but in rare cases women may require treatment while they are still of childbearing age.   If a hysterectomy is performed, you will not be able to become pregnant. If you want to have children, hormone therapy could be used to control growth of the cancer without a hysterectomy. However it is possible that the cancer may return. You should discuss your individual situation with your consultant.