Womb cancer, also called uterine cancer, is the fourth most common cancer in women in the UK, with around 10,200 new cases diagnosed every year. Treatments for womb cancer are very effective when the cancer is caught early. With treatment, around 7 in 10 women survive for at least 10 years after diagnosis.
Here, we’ll explore the symptoms and risk factors of womb cancer, as well as how it’s diagnosed and treated, including robot-assisted surgery.
What is womb (uterine) cancer?
Womb cancer refers to cancer that starts in any of the cells that make up the womb (uterus).
In most cases, womb cancer starts in the lining of the womb, which is called the endometrium. This type of womb cancer is called endometrial cancer. The most common type of womb cancer specifically starts in the gland cells of the endometrium — this is called endometrial adenocarcinoma.
A minority of womb cancer cases — around 1 in 20 — start in the muscle layer of the womb. These are called uterine sarcomas.
Cervical cancer vs womb cancer
Cervical cancer is not a type of womb cancer despite the fact that it starts in the neck of the womb (cervix) ie the narrow opening of the womb that connects to the vagina. Cervical cancer starts in different cells than womb cancer and the vast majority of cases are caused by infection with certain types of human papillomavirus (HPV). HPV does not cause womb cancer.
Uterine cancer symptoms
Womb cancer often gives early warning signs. This is one of the reasons why it can be detected early, which makes it very treatable.
In postmenopausal women, the most common symptom is vaginal bleeding. In women who have not gone through menopause, the most common symptom is irregular vaginal bleeding, such as in between periods or unusually heavy or prolonged periods.
Any abnormal vaginal bleeding — even a single episode of unexpected spotting — is worth getting checked.
Other signs of womb cancer include:
- A change in your bowel habits or urination
- A noticeable lump or swelling in your lower tummy
- Pelvic pain or a feeling of pressure
- Unusual or persistent vaginal discharge
If you notice any of these symptoms, see your GP as soon as possible.
Although these symptoms are often caused by other conditions, such as endometriosis, endometrial hyperplasia and uterine fibroids, it’s still important to have your symptoms investigated.
This is because early detection of womb cancer can make a big difference to the success of treatment. Over 9 in 10 women who are diagnosed with womb cancer during the earliest stage survive for at least 5 years.
Risk factors for womb cancer
Age is the single biggest risk factor for womb cancer, with most women diagnosed after the menopause. Other factors that can increase your risk of womb cancer include:
- Being overweight or obese — this may be why more younger women are developing womb cancer
- Going through the menopause late — this means going through menopause at age 55 or later
- Having a metabolic condition — this includes polyendocrine metabolic ovary syndrome (PMOS), formerly called PCOS
- Having certain inherited conditions — this includes Lynch syndrome, Cowden syndrome and Li-Fraumeni syndrome
- Not having any children
- Taking certain drugs eg tamoxifen, which is used to treat breast cancer
Getting a diagnosis
If you have any of the symptoms above, the first step is to see your GP. They will ask you about your symptoms and medical history. They may also perform a physical examination by gently pressing against (palpating) your lower abdomen to feel for any abnormalities.
Your GP may then recommend a detailed pelvic ultrasound scan. Ultrasound doesn’t use any radiation or powerful magnets but instead uses high-frequency sound waves.
There are 2 types of pelvic ultrasound scan: transabdominal and transvaginal. To investigate pelvic pain in women, a transvaginal ultrasound scan is often recommended as it can capture clearer images of the womb.
A transvaginal ultrasound scan involves gently inserting a thin, wand-like ultrasound probe into your vagina. This allows your doctor to capture images of the inside of your womb. It specifically allows your doctor to measure the thickness of your womb lining.
If your womb lining looks thicker than expected, it will need further investigation with a minimally invasive procedure called a hysteroscopy. This involves passing a thin, flexible, tube with a light and camera on the end (hysteroscope) into your vagina and through the neck of your womb. This allows your doctor to see live video images of the inside of your womb.
If any abnormal tissue is found, a tissue sample (biopsy) can be collected through the hysteroscope during the procedure. The tissue sample can then be examined under a microscope in a lab. This can identify whether the tissue is cancerous or not.
It’s important to note that there are many causes other than cancer that can make the womb lining appear thicker on an ultrasound scan. This includes endometrial hyperplasia, uterine fibroids and hormonal imbalances.
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Treating womb cancer
As womb cancer is usually diagnosed at an early stage in the UK, treatment is often successful.
The main treatment for womb cancer is surgery to remove the womb, fallopian tubes and both ovaries — this is called a total hysterectomy and bilateral salpingo-oophorectomy. This type of surgery is increasingly performed as a robotic-assisted keyhole surgery due to the benefits it provides over traditional open surgery.
At Spire Healthcare, we use the advanced da Vinci® robotic-assisted surgery system.
Benefits of robotic-assisted hysterectomy
Robotic-assisted hysterectomy uses smaller cuts of less than a centimetre, which allows for a faster recovery. In some cases, women can go home on the same day as their surgery or, if not, within 1–2 days. In contrast, traditional open surgery needs a hospital stay of 2–5 days.
Robotic-assisted hysterectomy also enables high-resolution 3D imaging and fluorescence imaging during the surgery. This allows for more accurate assessment of the nearby lymph glands to check whether the cancer has spread into them. This is called a sentinel lymph node assessment.
During a sentinel lymph node assessment, the first lymph node that a cancer would spread to is identified and assessed in great detail. This improved precision compared with the traditional removal of all the pelvic lymph nodes reduces the risk of long-term leg swelling caused by lymph gland removal (lymphoedema).
This means that robotic assisted surgery provides a more detailed assessment of your prognosis too ie the development and outcomes of the cancer and your treatment. This helps tailor any further treatment or follow-up, while keeping the risk of lasting complications as low as possible.
Additional non-surgical treatment
While most women only need surgery, some women may need additional treatment with chemotherapy and/or radiotherapy. This depends on whether, after surgery, more advanced cancer is detected than anticipated.
Your treatment options will be carefully explained, alongside counselling to help you clearly understand the risks and benefits. Your care team will support you throughout your treatment and with your decision-making process so that you can make an informed decision that best meets your needs.
