Cancer of the Uterus - Fact Sheet

	The Uterus
	What is Cancer of the Uterus?
	What Causes Endometrial Cancer
	Symptoms
	Diagnosis
	Treatment

The Uterus

The uterus (womb) is the pear shaped organ in the pelvis, at the top of the vagina, in which a baby grows. The lower part of the uterus is called the cervix. A layer of tissue called the endometrium lines the womb, and is designed to accept the implantation of a fertilized egg for the purposes of pregnancy. it is the endometrium which is shed every month in the form of a menstrual period, whenever a pregnancy does not occur. It is then replaced ready for another potential opportunity for pregnancy.

What Is Cancer of the Uterus?

The most common cancer of the uterus is endometrial cancer. Cancer of the endometrium occurs when cells originating in the endometrium (womb lining) become cancerous. This cancer is fairly common, with some 250 cases occurring in Queensland each year. It occurs mostly in post-menopausal women and is most common in women between 60 and 69 years of age. However, cases are seen in women as young as 30.

What Causes Endometrial Cancer?

Like many other female cancers, the main factors that appear to influence the development of endometrial cancer are related to hormones, in particular oestrogen. Other factors which have been seen to increase the risk of developing endometrial cancer are family history, medical conditions, infertility, body weight, and hormone replacement therapy. Oral contraceptives that use a combined oestrogen and progestogen formulation may lower a woman's chance of developing endometrial cancer.

Symptoms

The most common symptom of endometrial cancer is post-menopausal bleeding. As such, any bleeding from the vagina after menopause should be investigated to ensure that cancer is not the cause. Other symptoms include:

	Bleeding or discharge not related to menstruation (periods);
	Difficult or painful urination;
	Pain during intercourse; and
	Pain in the pelvis area, hips, thighs or buttocks.

If you do have any of the above symptoms you must have them checked by your doctor, but remember, they are common to many other conditions and most women with these symptoms do not have cancer.

Endometrial cancer has been found in women taking a drug called Tamoxifen as part of their treatment for breast cancer. As such, these women must also be wary of any vaginal bleeding not related to normal periods, and should report it to their doctor as soon as possible.

Diagnosis

Because cancer of the endometrium grows inside the uterus, it does not usually show up on a Pap Smear. For this reason, if you have symptoms, your doctor may do other tests, such as a Pipelle Sampling, hysteroscopy and/or dilation and curettage (D&C) to check the inside of the uterus. While a Pipelle sampling can often be performed in a doctor's surgery, such procedures as a hysteroscopy or D&C generally require admission to a hospital and anaesthesia. The purpose of these tests if for a sample of the lining of the uterus to be taken and sent to a pathologist for examination to check for the presence of any cancer cells.

A Pipelle sampling is sampling of the endometrium using a Pipelle sampler. A Pipelle sampler is a thin plastic tube that has a plunger down the centre. It is passed through the cervix into the uterus. When the plunger is pulled back, holes in the sides of the tip allow endometrial cells to be sucked into the tube. The sampler is rotated on withdrawal to ensure a good sample of cells is taken. These cells are then placed in formalin and sent to a pathologist for examination.

A Hysteroscopy is an examination using a small telescope to have a look inside the uterus. The procedure is often performed in hospital under a short general anaesthetic, but with modern small flexible cystoscopes, it can be done as an outpatient procedure or in a doctor's surgery under a local anaesthetic.

Dilation and Curettage refers to dilation of the cervix and curettage of the uterus. It involves putting (generally) metal tubes of progressively increasing size in the cervix to stretch (dilate) it until it is large enough to fit a curette. The curette is then put into the cavity of the uterus and scrapes out whatever is lining the inside of the uterus. This sample is then sent for examination by a pathologist.

The outcomes for treatment of endometrial cancer depend on the stage of the cancer at the time of diagnosis and treatment. As such, it is imperative that you contact your doctor should you have any of the previously mentioned symptoms.

Treatment

All stages of endometrial cancer can be treated, however all are not curable. Treatment depends on the stage of your disease, the type of disease and your age and overall medical condition. The types of treatment used are surgery and radiation therapy.

While endometrial cancer is in its early stages, and is limited to the uterus and cervix, treatment is usually by surgery. The operation involves the removal of the uterus, fallopian tubes and ovaries. Lymph nodes may also need to be removed. Radiation therapy may also be used at this early stage, depending on the depth of the cancer, the type of tumour and whether or not the cancer has affected the lymph nodes.

As the cancer progresses and begins to affect cells outside the uterus (but not outside the pelvis), the bladder or rectum, radiation therapy generally becomes the primary method of treatment. Treatment for advanced endometrial cancer needs to be individualised.

If you have any questions about your own treatment, don't be afraid to ask your doctor. It often helps to make a list of questions you wish to ask your doctor and to take a close friend or relative with you. Some women find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel this will be helpful.