The uterus or womb is a part of the female reproductive system. It is located in the female pelvis behind the bladder and in front of the rectum. Other parts of the female reproductive system are attached to it including the ovaries, fallopian tubes, cervix (neck of the uterus) and the vagina.
The uterus is made up of two layers
- Myometrium – the outside muscular wall
- Endometrium – the inner layer of the uterus which in women of child bearing age becomes thick each month under the influence of the hormone oestrogen getting ready for a potential pregnancy. This is the lining that is shed each month during a period.
Uterine cancer is cancer arising from the uterus. The cancer can arise from the inner lining or from the outer muscular wall. Cancers of the endometrium are called endometrial carcinoma and are much more common than those arising from the muscle which are called sarcomas.
Some cancers have both an endometrial and sarcoma component (carcinosarcomas). The treatment offered will depend on the type of cancer that is found.
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.
Common 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, or bleeding that is occurring after menopause. Other symptoms may include vaginal discharge, pelvic pain, or unexplained weight loss. Not all women who have abnormal vaginal bleeding will have uterine cancer. However any abnormal vaginal bleeding should be investigated through your GP.
To make a diagnosis your doctor may examine you, order tests including pelvic ultrasound and send you to a gynaecologist for further assessment. A biopsy (taking a small sample of the uterus) is necessary in order 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 including blood tests and CT scans to check if there is any spread of the cancer.
The treatment of uterine cancer usually involves surgery to remove the uterus (hysterectomy), fallopian 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.
Some patients will not need any further treatment following the hysterectomy, and a follow-up program will be recommended involving routine checks. 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 treatment involves using a very small radioactive source that is delivered to the top of the vagina. An applicator is inserted into the vagina by the oncologist and fixed in position. The machine that houses the source is connected to the applicator and delivers the radiation. This procedure is not painful but may be a little uncomfortable. The treatment can take anywhere from 5 to 20 minutes depending on the source. The total number of brachytherapy treatments can vary depending on the centre you attend. 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).
Most centres in Australia and NZ that perform brachytherapy use HDR (high dose rate) treatment which allows for treatment to be done in a short time. Some centres may use other sources and techniques requiring a longer treatment time. For more detailed information on brachytherapy please refer to the brachytherapy for uterine cancer section.
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 with the external radiation treatment which helps the radiation work better. Sometimes a few cycles of full dose chemotherapy may be given following completion of radiation therapy. The treatment team will discuss what is best for the individual woman based on the patient and the 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 treat the tumour to stop bleeding.
How effective is Radiation Therapy for Uterine Cancer?
Brachytherapy is effective in reducing the risk of recurrence at the top of the vagina with very few side-effects.
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 treatment can provide long term pelvic control depending on the pathology but would not be considered a cure.
What Are the Side Effects of Radiation Therapy?
Side effects of vaginal vault brachytherapy is discussed in detail in the Brachytherapy for uterine cancer section
Common early side effects during External Beam Radiation Therapy (EBRT)
- Urinary irritation – frequency, urgency, discomfort and possible blood in the urine
- Diarrhoea and large bowel irritation (discomfort with bowel movements and possible bleeding)
- Small bowel irritation – Nausea, vomiting and general abdominal discomfort
- Skin irritation and possible pubic hair loss
- Vaginal irritation
These side effects occur to some degree in most people and can be managed during treatment when you are seen by the treating team.
Late side effects following External Beam Radiation Therapy (EBRT)
Note that severe late complications are rare.
- Bowel changes – Ongoing changes in bowel habits experienced in the form of diarrhoea, certain food intolerances, pain with bowel movement, passage of mucous or blood, constipation
- Urinary irritation – most times the bladder effects improve however some people can have ongoing irritation with frequency, burning and urgency. Some people can also develop urinary incontinence, but this is not very common
- Vaginal changes – scarring with dry shortened vagina
- Small bowel obstruction –Some people can develop bowel obstruction and have abdominal pain, nausea and vomiting with changes in their bowel from constipation to watery diarrhoea or a complete blockage. This is rare but if it occurs requires immediate medical attention
- Lymphoedema – swelling of the legs, mild cases commonly but if you have had the lymph glands removed at surgery and have pelvic radiation your risk of this increases
- Pelvic fractures
- Second cancer – rare
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
Page last updated: 11/09/2020