Occurs in about 1 in 100 women.
Endometrial cancer is commonest in women in their mid to late fifties.
It is rare before the age of 40.
Womb cancer occurs in all countries. It is commonest in the USA and
western countries but has an increasing incidence in Asian.
A hormone called ‘oestrogen’ that is naturally produced in the ovaries
is thought to be associated with ‘endometrial cancer’. ‘Oestrogen’ is a
component of hormone replacement therapy drugs and without the opposite
drug (‘progesterone’) there is an increasing risk of womb cancer.
Womb cancer is also more common in women who are overweight, have no
children, and who suffered from a condition called polycystic ovaries in
the past. Women whose periods started at a young age and ended at an old
age are also more likely develop womb cancer.
Overweight women are more likely to develop womb cancer as fat tissue
produces ‘oestrogens’. Other conditions associated with being overweight
such as hypertension and diabetes are also associated with the
development of womb cancer.
A healthy diet which is low in fat and sugar helps prevent against womb
cancer as does regular exercise. There is no screening test for womb
cancer but early presentation to a doctor when abnormal vaginal bleeding
occurs normally results in it’s detection at an early stage.
Womb cancer usually presents as vaginal bleeding after a woman’s periods
have stopped. It may also present before the periods have stopped as
abnormal bleeding. ‘Uterine sarcomas’ often present as a lump that can
be felt on the abdomen or with non-specific symptoms of bloating and
change of bowel habit.
When a woman presents with abnormal bleeding the first investigation to
occur is normally an ultrasound scan. Low ultrasound measurements of the
thickness of the lining of the womb can exclude the possibility of
‘endometrial cancer’. Sometimes a small plastic device is used to take a
biopsy from the womb lining. If there is still doubt as to the possible
cause of any abnormal bleeding, a telescope is used to examine the
lining of the womb. This test is called ‘hystereoscopy’.
Treatment is initially by surgery with removal of the womb and ovaries.
Sometimes it is necessary to remove the glands in the pelvis also.
A proportion of women also require radiotherapy. There are two types of
radiotherapy commonly used. The first is vaginal radiotherapy where a
probe is placed into the vagina for a period. This often occurs two or
three times on separate occasions. The other type of radiotherapy is
pelvic treatment where irradiation is used from the outside. This is
used in more advanced forms of womb cancer and usually involves spending
a period on the treatment couch daily for five or six weeks.
Chemotherapy is used for womb cancer when it has spread.
‘Endometrial Hyperplasia’ is a condition of the womb that can lead on to
cancer. It is diagnosed by examining a sample of the womb under a
microscope and presents with similar symptoms to womb cancer. In it’s
earliest form it is treatable with a drug called ‘progesterone’. It it’s
more advanced form a hysterectomy is required.
Recurrent womb cancer has a poor prognosis. If a woman has a single site
of recurrence at the top of the vagina it may be possible to excise it
surgically or use radiotherapy if a woman has not had it already. Other
treatments for recurrent womb cancer include chemotherapy and hormone
treatment.
Most ‘endometrial cancers’ present early and are curable. If a woman has
other illnesses such as diabetes or high blood pressure or if the woman
is overweight, then surgery may be hazardous making the chances of a
cure reduced. Advanced ‘endometrial cancer’ and most ‘uterine sarcomas’
have a poor prognosis.
Studies are currently underway assessing the relative value of surgery
and radiotherapy to the pelvic glands in the treatment of womb cancer.
It is hoped that this type of treatment may be tailored more precisely
in the future. The role of keyhole surgery is also being evaluated and
early studies have suggested a role for this.
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