Uterine cancer is cancer of the uterus (or womb). Cancer can arise from the lining of the uterus (called the endometrium), causing endometrial cancer. Cancers may also arise from the muscular wall of the uterus, the myometrium. These are called sarcomas.
Some cancers have both an endometrial and sarcoma component (carcinosarcomas). The exact type of cancer may affect the most suitable treatment for it.
What Are the Causes of Uterine Cancer?
Uterine cancer is caused when normal cells in the uterus change into abnormal cells. These cells grow at an uncontrolled rate. Studies have shown that there are ‘risk factors’ that increase the chance of developing uterine cancer.
Risk factors for endometrial cancer are: increasing age, being postmenopausal, long-term exposure to oestrogen, being overweight or obese, diabetes, abnormal overgrowth of the endometrium, not having had children, early onset of periods, late onset of menopause, a family history of breast cancer.
Treatment of breast cancer with hormone treatments such as Tamoxifen, and previous pelvic radiation therapy (for another cancer) have been associated with getting uterine cancer, but the risk is very low in these situations
What Are the Symptoms of Uterine Cancer?
Most women present with abnormal vaginal bleeding, often after menopause. Not all women who have abnormal vaginal bleeding will have uterine cancer. However if this happens, you should go to your GP and tell them, so they can decide if more tests are needed.
A biopsy (taking a small sample of the uterus) is done to diagnose uterine cancer.
What Are the Treatments for Uterine Cancer?
Once uterine cancer is diagnosed, a number of tests may be done to decide on the best treatment.
These may include a physical examination, blood tests and scans (Xrays). The treatment of uterine cancer usually involves surgery to remove the uterus (hysterectomy), tubes and ovaries. At the time of the operation, the surgeon will assess the extent of the tumour. They may also remove lymph nodes, the omentum (fatty tissue in the abdomen) and take a sample of fluid in the abdominal cavity for testing.
After the operation, the pathologist will examine the cancer. A team of doctors including gynae-oncologists (surgeons), radiation oncologists, medical oncologists, pathologists and radiologists will be involved in discussing the best treatment(s) for each patient.
Most patients will not need any further treatment following the hysterectomy, and a follow-up program will be recommended. If the cancer has features that increase the risk of the cancer coming back, the team may make a recommendation for additional treatment to reduce this risk.
The most common form of treatment recommended after surgery is brachytherapy to the vagina. Brachytherapy is treatment using a very small source of targeted radiation therapy. The aim of brachytherapy in this situation is to reduce the risk of cancer coming back, usually at the top of the vagina (vaginal vault).
Some patients may require external beam radiation therapy (treatment delivered from outside the body). External beam radiation therapy treats a larger area in the pelvis that includes where the tumour was growing, and the surrounding lymph nodes. It involves daily attendance at the treatment centre, five days per week, usually for 5 weeks. Treatment takes around 10-15 minutes. The treatment team will see the patient regularly.
Chemotherapy is sometimes given during radiation therapy; this is a “lighter” dose than usual and helps the radiation work better. Sometimes a few cycles of full dose chemotherapy are given following completion of radiation therapy. The treatment team will discuss what is best for the individual woman based on the patient and her cancer.
Where surgery is not able to be performed (for example, if the patient is not fit enough to have an anaesthetic), radiation therapy may be given to treat the uterine cancer. This is called ‘primary’ radiation therapy for uterine cancer and usually involves both external beam radiation therapy and brachytherapy.
Sometimes, cancer can come back after surgery. If the cancer is still localised, radiation therapy is an effective treatment that may be curative. Treatment usually involves external beam radiation therapy and brachytherapy. Chemotherapy may be used as well.
In cases where the cancer is advanced and not operable, radiation therapy alone can be used to deliver a high dose of radiation to the tumour to stop bleeding. Most centres in Australia use high dose rate brachytherapy, which delivers treatment in a very short period of time (minutes).
How effective is Radiation Therapy for Uterine Cancer?
Brachytherapy is effective in reducing the risk of recurrence with very few side-effects. Studies show that the risk of the cancer coming back at the top of the vagina is reduced from about 15 % (15 in 100 women) without brachytherapy to 1-2 % (1-2 out of 100 women) with brachytherapy.
External beam radiation therapy (with or without brachytherapy) is effective in reducing the chances of the cancer coming back in the pelvis area following surgery.
In primary radiation therapy for uterine cancer (where the patient is unable to have a hysterectomy for various reasons), the use of brachytherapy in addition to external beam radiation therapy enables the delivery of a higher dose of radiation therapy to the targeted area.
This is necessary to increase the chance of controlling the cancer without increasing side-effects
What Are the Side Effects of Radiation Therapy?
Generally, radiation therapy for cancer for the uterus is well tolerated. During vaginal vault brachytherapy (treatment to the top of the vagina), patients stay well. Occasionally, women may experience some fatigue (tiredness), bladder irritation and rectal (lower bowel) irritation over a few days or weeks.
During and shortly after external beam radiation therapy, some patients experience fatigue, diarrhoea, rectal and bladder irritation. Reddening of the skin or sometimes peeling of the skin in the treatment area can occur – it is like having sunburn over the pelvic area. The team of doctors and nurses will monitor the woman regularly to advise on management during and after treatment. Nearly all these short-term side effects completely go away.
Late side-effects of radiation therapy include a small risk of having injury to bowel and bladder. Lymphoedema (swelling due to fluid retention) of the lower part of the body may develop. If this occurs, the patient will need referral to a physiotherapist or lymphoedema specialist. Other possible late side-effects are pelvic fractures and narrowing of the vagina and/or dryness which may affect sexual function.
The treatment team will discuss these potential effects of therapy, and techniques to reduce the risks of these developing and treatment if they do develop.
If a woman develops menopausal symptoms after treatment, such as hot flushes, these can be discussed with the doctor and treating team. Women undergoing radiation therapy to the pelvis for uterine cancer will not be able to have children after the treatment. The doctor and treating team will also provide advice on fertility if this is a problem.
Many women, not surprisingly, feel very emotional during treatment of uterine cancer. All centres have psychological services available to support women going through the diagnosis and treatment of cancer of the uterus.
The best person to discuss radiation therapy for bladder cancer is a radiation oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you.
Find your closest radiation oncology Treatment Centre