What is uterine cancer?

Uterine cancer is cancer that affects the uterus (womb).

The uterus is part of the female reproductive system. It is located low in the abdomen between the bladder and the rectum.

Cancer of the uterus can affect the lining of the uterus (endometrial cancer) or the connective tissue or muscle (known as uterine sarcoma). Endometrial cancer is the most common form of uterine cancer.

What are the symptoms of uterine cancer?

The most common symptom of uterine cancer is unusual vaginal bleeding. This may include:

• heavier bleeding during your period
• bleeding between periods
• persistent bleeding or spotting
• bleeding or spotting after menopause

Less common symptoms include:

• smelly, watery vaginal discharge
• abdominal pain
• unexplained weight loss
• difficulty urinating (weeing)
• changes in bowel movements (poo)

What causes uterine cancer?

The cause of uterine cancer is unknown, but factors that can increase your risk include:

• older age (especially being post-menopausal)
• obesity
• previous radiotherapy to the pelvis
• a family medical history of cancer of the uterus, ovary or bowel
• inherited conditions such as Lynch syndrome or Cowden syndrome
• endometrial hyperplasia — thickening of the lining of the uterus
• smoking

Hormonal factors also play a role. You are more likely to develop uterine cancer if you:

• have never been pregnant
• started periods relatively early (before the age of 12 years)
• experienced menopause relatively late (age 55 years or older)
• have taken certain types of hormone therapy in the past

When should I see my doctor?

If you have any symptoms of uterine cancer or endometrial cancer, you should visit your doctor. Your doctor will ask about your symptoms and your medical history. They will also give you a physical examination.

Your doctor will check to rule out other conditions that may cause abnormal vaginal bleeding.

These can include:

• polyps
• endometrial hyperplasia (thickening of the uterine lining)
• fibroids
• endometriosis

Your doctor will talk with you about tests to confirm a diagnosis. They may also refer you to a specialist for further tests.

How is uterine cancer diagnosed?

Your doctor will usually start with a pelvic examination and an ultrasound.

During a pelvic exam, your doctor will examine your abdomen and uterus for any swelling or lumps. They may also place two gloved fingers inside your vagina while pressing on your abdomen.

A pelvic ultrasound uses soundwaves to create images of your organs.

The pelvic ultrasound can be done in 2 ways.

• Abdominal ultrasound— a scan is performed with an ultrasound probe placed on your abdomen.
• Transvaginal ultrasound— with your consent, a scan is performed using an ultrasound probe placed gently inside your vagina.

Often, the sonographer will perform both types of scans, to get the clearest images of your uterus. If you are worried about having these scans, speak to your doctor or the sonographer when you make the appointment. It may help to choose a sonographer you are comfortable with. You may also choose to have someone you know in the room with you.

If these tests show a tumour, your doctor will refer you for a biopsy, where a specialist will take a sample of cells from your uterus to check in a lab. Some doctors will do the biopsy in their office.

In other cases, your doctor may recommend a biopsy during a hysteroscopy. This is a day procedure performed under general anaesthetic, where a thin tube with a camera and light is inserted through your cervix. This is done to examine the lining of your uterus for abnormalities.

Depending on your situation, your doctor may also recommend other tests, for example:

• magnetic resonance imaging (MRI) scan
• computed tomography (CT) scan
• positron emission tomography (PET) scan
• x-ray

How is uterine cancer treated?

Cancer of the uterus is usually treated with surgery to remove your uterus and cervix, along with both fallopian tubes and ovaries. This operation is called a total hysterectomy with bilateral salpingo-oophorectomy. In some cases, you may be able to keep your ovaries. Your doctor will talk you through the procedure and what is involved.

Uterine cancer is often diagnosed early and surgery is the only treatment needed.

If the cancer is more advanced, your doctor may recommend additional treatments such as:

• radiotherapy
• chemotherapy
• hormone therapy
• immunotherapy
• targeted therapy

Side effects

Removing your uterus will mean that you cannot become pregnant. If fertility is important to you, be sure to discuss your options with your doctor before you start treatment. You can also seek emotional support from your doctor, a cancer nurse or counsellor.

Treatments for uterine cancer can also cause other side effects. These include changes to your bladder, bowel and sexual function.

If you have your ovaries removed during surgery, you will go through menopause. Symptoms of menopause caused by cancer treatment can be more severe than those of people who experience menopause naturally, because your hormone levels will decrease more suddenly.

You can discuss ways to reduce or manage some of these side effects with your doctor.

Follow-up

After you finish treatment, you should see your doctor regularly for follow-up, which may include:

• pelvic examinations
• pelvic ultrasound or other imaging tests

Seeing your doctor for the recommended follow-up means that if the cancer comes back, it can be treated early. Early treatment lowers the risk of complications.

Living with uterine cancer

Living with uterine cancer can affect many areas of your life, including physical, emotional and social well-being. After treatment, you may feel tired, notice changes in your bladder or bowel habits, or have menopausal symptoms if your ovaries were removed.

It is common to have a wide range of emotions, such as anxiety, sadness or fear of the cancer returning.

Talk to a counsellor, social worker, or support group to help you manage these feelings.

Maintaining a healthy lifestyle including a balanced diet, regular physical activity and enough sleep can support your recovery and overall health.

It is important to attend all follow-up appointments and tell your doctor about any new symptoms. Regular monitoring can help detect any recurrence early and allow for timely treatment.

Remember, living with uterine cancer is not just about managing the disease. Take care of yourself, seek support and maintain your regular daily life as much as possible.

What are the complications of uterine cancer?

Uterine cancer and its treatment can lead to different complications, depending on the cancer type, stage and treatment.

Surgical complications: Surgery to remove the uterus, cervix, and sometimes ovaries and fallopian tubes can cause bleeding, infection, or damage to surrounding organs such as the bladder, bowel, or ureters.

Menopause and hormonal changes: If your ovaries are removed during surgery, you will go through menopause suddenly. This may lead to:

• hot flushes
• night sweats
• mood changes
• vaginal dryness
• a higher risk of osteoporosis

Fertility loss: Removal of the uterus means you cannot become pregnant. Talk to your doctor about fertility preservation options before starting treatment if this is important to you.

Bladder, bowel and sexual function: Surgery or radiation may affect your bladder or bowel habits and sexual function, causing discomfort, incontinence, or changes in libido.

Recurrence: In some cases, cancer can return either in the pelvis or in distant organs.

Regular follow-up appointments are important to detect any recurrence early.

Can uterine cancer be prevented?

The exact cause of uterine cancer is unclear, so there are no specific prevention strategies.

Managing your risk factors and maintaining a healthy lifestyle can help reduce your risk.

The use of certain oral contraceptive pills may also reduce the risk of having cancer of the uterus.

Resources and support

If you are living with cancer, there are services that can help. These include:

• support groups and programs
• home nursing
• Meals on Wheels — community meal providers

Visit the Cancer Australia website for fertility and sexuality support and advice for living with cancer.

Languages other than English

The Cancer Council has a guide to endometrial cancer care, available in several languages.

For general information about cancer in languages other than English:

• Visit Cancer Council's Multilingual resources page.
• Cancer Council's cancer guides can be downloaded as PDFs in other languages.
• Canteen has a guide for young cancer patients translated into languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

• Cancer Council has cancer information for Aboriginal and/or Torres Strait Islander peoples.
• Cancer Australia also has more information about cancer for Aboriginal and/or Torres Strait Islander peoples.