Womb (uterus) cancer

The womb (uterus) is a pear-shaped organ where a baby grows during pregnancy. It sits low in the pelvis (the area between the hips) and the pelvic floor muscles hold it in place.

Most womb cancers begin in glandular cells in the lining of the womb, which is called the endometrium. Because of this, they're known as endometrial cancers.

There are different types of endometrial cancer. It is usually found early and treated successfully.

What follows is about endometrial cancer.

The first sign of womb cancer is usually unusual vaginal bleeding. This can show up in a few ways:

• bleeding after the menopause (this is the most common symptom)
• bleeding between periods
• heavier periods than usual (if you have not been through the menopause)
• a bloody or pink and watery vaginal discharge

Less common symptoms are pain or discomfort in the pelvic area, or pain during sex.

If you notice any unusual vaginal bleeding, always see your doctor about it. Other conditions that affect the womb, like fibroids, can also cause unusual vaginal bleeding, so the bleeding doesn't always mean cancer, but it does need to be checked.

Some things can raise your risk of developing womb cancer. Doctors call these risk factors.

Having a risk factor doesn't mean you will get cancer. And if you have none, that doesn't mean you won't get it either.

If you have symptoms of womb cancer, you'll usually start by seeing your doctor. They may do a pelvic examination (an internal examination) to feel for anything unusual in the pelvis.

They may also arrange:

• a blood test
• a urine sample
• a trans-vaginal ultrasound

Your doctor may refer you directly to a gynaecologist. This is a doctor who treats problems with the female reproductive system.

You'll be referred urgently (within 2 weeks) if you have:

• vaginal bleeding after the menopause
• a lump in your pelvis that your doctor can feel
• ongoing vaginal bleeding between your periods

The gynaecologist will explain any other tests you need to have. This may include:

• a cervical screening test, if you haven't had one recently
• a biopsy

They'll also ask whether you have any close relatives with womb or bowel cancer.

If you're diagnosed with womb cancer, you may have further tests. These show where the cancer is and whether it has spread from where it started. This is called staging.

The results help you and your doctor make decisions about your treatment. Your doctor may arrange:

• an MRI scan
• a CT scan
• a chest X-ray

Waiting for test results can be a difficult time, and getting information and support can help.

The stage of womb cancer tells you two things:

• how far the cancer has grown
• if it has spread from where it started

Grading is different. It looks at how the cancer cells appear under the microscope compared with normal cells.

Staging and grading help you and your doctor make decisions about your treatment.

A team of specialists will meet to talk about the best treatment for you. This is called a multidisciplinary team, or MDT.

When the MDT plans your treatment options for womb cancer, they'll look at several things. These include:

• your general health
• the type and size of the tumour
• whether the cancer has begun to spread

The main treatment is an operation to remove the womb, cervix, fallopian tubes and ovaries. Sometimes this operation is the only treatment you need to cure the cancer.

Depending on the stage and grade of the cancer, you may also be offered treatments after surgery. These can help reduce the risk of the cancer coming back.

Your doctor will explain the different treatments and their side effects. They'll also talk with you about what you should think over before you decide on treatment.

You may also be invited to take part in a clinical trial.

The treatment you have will depend on your situation, and there are several options.

If you want to have children in the future, talk to your doctor about your fertility before you start treatment. With womb cancer that is early-stage and low-grade, it may sometimes be possible to have fertility-sparing treatment.

For womb cancer, the main treatment is usually surgery to remove the womb, which doctors call a hysterectomy. Surgery is sometimes used as well when the womb cancer has spread.

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.

In womb cancer, it may be given after surgery to reduce the risk of the cancer coming back. It may also be the main treatment for womb cancer, or it may be used to help manage the symptoms of advanced womb cancer.

Chemotherapy for womb (uterus) cancer means using anti-cancer (cytotoxic) drugs to destroy cancer cells. Doctors sometimes use it after surgery or radiotherapy, to lower the risk of the cancer coming back. It may also be used to help control the cancer and ease symptoms.

Two hormones, oestrogen and progesterone, can change how the cells in the lining of the womb grow. So your doctor may offer you hormonal therapy for womb cancer. It's used to try to shrink and control the cancer, and to ease the symptoms it causes.

Doctors may use newer treatments called targeted therapy and immunotherapy when womb cancer has spread. They can help to control the cancer and slow its growth.

During a biopsy or surgery, a sample of the cancer cells is taken, and your doctor will send it off to be tested. The result helps to show which type of treatment may work best for you.

Your doctor or nurse will tell you whether these treatments are suitable for you.

After treatment for womb cancer, you'll probably want to get back to doing the things you did before your diagnosis. But you may still be coping with the side effects of treatment and with some difficult emotions.

Recovery takes time, so try not to be hard on yourself. It's not unusual to feel anxious and lonely at this time.

You'll have regular check-ups after your treatment, and they'll include an internal examination. These will be every few months at first. Eventually, you may only be seen once a year.

If you have any problems or new symptoms in between appointments, contact your cancer doctor or specialist nurse as soon as possible.

Some people don't have routine appointments. Instead, they're asked to contact their cancer doctor or nurse if they have new symptoms, or if they're worried about anything.

Important symptoms to be aware of are:

• bleeding from the vagina or back passage
• pain in the pelvic area
• any lumps or swellings

If womb cancer comes back in the same area, it can often be treated successfully.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan womb cancer forum, where you can talk to others affected by womb cancer, ask questions and share your experience

Even if you already live a healthy life, you may still choose to make a few positive changes after your treatment for womb (uterus) cancer. Small things like eating well and keeping active can improve your health and wellbeing, and they help your body recover.

Don't include personal information, for example your name, your location or any personal health conditions.