Overview
Over 5% of all female cancers in Europe are cancers of the endometrium, making it the fifth most common cancer in European women. It occurs most commonly in postmenopausal women over 50 years old (50% are over 60 years old) and is more common in women who have never been pregnant.
Most uterine cancers are diagnosed early on in the disease. Postmenopausal bleeding is a worrying symptom and most women seek medical help as soon as they notice it. For women who present early on in their illness the prognosis is usually good.
Back to top
Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7million |
| Number of new uterine cases (2006) |
149,300 |
|
84,900 (EEA) |
|
82,500 (EU25) |
| Number of uterine cancer deaths (2006) |
46,600 |
|
24,200 (EEA) |
|
23,600 (EU25) |
Back to top
Cancer types
There are a number of different cancer types that can develop in the endometrium:
- Endometrial adenocarcinoma - the most common form of uterine cancer accounting for more than 75% of cases.
- Papillary serous carcinoma, which is rare.
- Clear cell adenocarcinoma - another rare form of uterine cancer.
- Carcinosarcomas that develop in the endometrium. They are very rare.
- Leiomyosarcomas, which develop from the smooth muscle found in the wall of the uterus. They are also very rare.
Back to top
Causes of Uterine Cancer
The risk factors for uterine cancer are:
Back to top
Prevention of Uterine Cancer
Obese women are advised to lower their weight to reduce their chance of developing uterine cancer.
Women who are still menstruating and who take the contraceptive pill have a lower risk of cancer of the uterus.
Preventative removal of the uterus and ovaries is radical, but may be considered for women with Lynch syndrome (Hereditary Non-Polyposis Colorectal Cancer [HNPCC]) which carries a 40 to 60% lifetime chance of developing uterine cancer.
Common Symptoms
The most common symptom of uterine cancer in postmenopausal women is vaginal bleeding.
Other symptoms in all women are:
- bleeding between menstrual periods
- heavier menstrual periods
- an abnormal vaginal discharge
Diagnostic Tests
The main way to diagnose uterine cancer is through the examination of biopsies of the endometrium to identify malignant cells and the precise type of cancer.
Back to top
Treatment
The main options for uterine cancer are surgery and radiotherapy.
Surgery
Surgery is the first line treatment for cancer of the endometrium. The surgical options are:
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy (usually including a lymph node dissection)
- Radical hysterectomy involving the removal of the cervix, uterus, fallopian tubes, ovaries and a vaginal cuff (and usually a local lymph node dissection)
Side effects and complications of surgery and their management
Incontinence is a potential problem after a hysterectomy, and rarely faecal incontinence can occur.
Lymphoedema can occur in one or both legs following lymph node removal.
Early menopause - for patients treated with bilateral oophorectomy there will be an immediate menopause which is treated in the majority of patients with hormone replacement therapy (HRT).
Back to top
Radiotherapy
Radiotherapy may be used after surgery in combination with chemotherapy.
Treatment planning is an essential part of radiotherapy. CT, MRI or PET scans are used to define the area to be treated.
External beam radiotherapy is given on an outpatient basis as a series of daily treatments (but not usually including the weekend).
Complications and side effects of radiotherapy
Radiotherapy affects normal cells as well as cancer cells. The effects on normal cells will be reduced as much as possible but nevertheless nearby tissues will be affected and as a result patients experience a range of symptoms.
Vaginal bleeding and discharge immediately after radiotherapy treatment are common and are usually resolved quickly.
Diarrhoea due to rectal inflammation is also common and usually goes away after a couple of weeks. A low fibre diet and anti-diarrhoeal medication will help.
Cystitis that causes a burning sensation on passing urine can last for about two weeks after treatment. Drinking plenty of fluids is helpful as are some medicines.
Nausea and sickness are also common during treatment. Anti-emetic medication can help but it is important to maintain a nutritious diet with sufficient calories during treatment (if necessary using high calorie drinks instead of food).
Sore skin in the treated area is common and can be treated with soothing creams. However, it is best to avoid perfumed soaps, creams or deodorants which may irritate the skin further.
Pelvic radiotherapy affects the ovaries and usually precipitates the menopause which starts about three months after treatment. The menopause can include hot flushes, dry skin, a dry vagina and possibly loss of concentration. Most of these symptoms are effectively treated with hormone replacement therapy.
Tiredness affects many patients treated with radiotherapy. It may be relieved by a balance of rest and exercise.
Sometimes the bowel may be permanently affected by the radiotherapy, causing increased bowel motions and diarrhoea.
If the bladder is scarred by radiotherapy, bladder frequency may become a problem.
Sexual intercourse can be painful if the vagina has been scarred by treatment. Vaginal dilators and hormone creams can be helpful for these patients.
Lymphoedema can occur in one or both legs as a result of surgery or radiotherapy but is more common in patients who have had both surgery and radiotherapy.
Back to top
Chemotherapy
Chemotherapy may be given after surgery, even if there is no sign of the cancer spreading. It is given in case cancer cells remain.
The drugs most commonly used are cisplatin, cyclophosphamide, doxorubicin, and paclitaxel.
These drugs are often used in combination with or instead of radiotherapy.
Chemotherapy side effects
Chemotherapy does have side effects which vary according to the drugs used and the individual patient’s response to them. These may include:
- myelosuppression, leading to anaemia
- susceptibility to infection and bruising
- nausea and vomiting
- hair loss
- diarrhoea
- mouth ulcers
External radiotherapy is normally given as a series of short regular treatments in a radiotherapy department (each treatment may be referred to as a fraction).
Back to top
Prognosis
Many factors affect prognosis including the stage of the cancer, its histological appearance, the patient’s age, general health and their individual response to treatment (which will vary). For this reason, statistics can only be considered as a general guide as they are produced by grouping together patients in whom these factors are similar but not identical. These figures are historical, often covering a 10 or 20 year period, and so do not reflect improvements in survival through more modern treatment.
Survival rates indicate the percentage of people who survive the disease for a specific period of time after their diagnosis – usually 5 or 10 years. They will also include patients who are free of the disease, or still undergoing treatment.
5-year survival rates for uterine cancer are:
- If endometrial cancer is detected early, results of treatment are very good with nearly 90% of women surviving at least 5 years, and most are cured.
- But for patients whose disease has spread into the pelvis fewer than 20% of women will survive 5 years.
Back to top
Key Trends
Obesity is increasing and becoming a significant risk factor for uterine cancer as well as many other conditions.
Early presentation results in more effective treatment and better outcomes for the patient.
Radiotherapy after surgery reduces recurrence rates.
Improving the delivery of lower doses to reduce side effects whilst providing the same level of protection against recurrence of the cancer is a key objective of current research.
Assessment of Image-Modulated RadioTherapy (IMRT) to reduce adverse effects on the bowel is another key research area.
The use of combined chemotherapy and radiotherapy as a treatment for more advanced disease, which has been shown to work well in other cancers (for example, lung cancer) is an issue that requires further investigation.
Back to top