What is endometrial cancer?
Endometrial cancer is also known as womb cancer or cancer of the lining of the uterus. The lifetime risk of a getting endometrial cancer is 1 in 100 (1%) and peak incidence is after menopause in 50s and 60s, hence it’s important for women in the menopause to be aware of the signs and symptoms. High BMI, diabetes and blood pressure also increase the risk.
Uterine walls are very muscular and it takes a long time for the cancerous cells to spread beyond the uterus. This cancer is commonly detected at an early stage and is often cured by a simple hysterectomy.
Can HRT cause endometrial cancer?
Combined HRT is actually protective against endometrial cancer. Risk of endometrial cancer is 30% less in women on HRT. Progesterone within the combined HRT opposes even the endogenous oestrogen in the body, which means less risk of endometrial cancer.
What are the symptoms?
Bleeding after menopause is the usual presenting symptom. However, bleeding after menopause is often caused by many other benign causes such as polyps or vaginal dryness. In fact, out of 100 women with bleeding after menopause, only 5-6 will have endometrial cancer. It is, however, the most important cause of this abnormal bleeding and hence needs to be taken seriously.
Occasionally, endometrial cancer can occur before menopause. If there is any bleeding between periods or if the periods are prolonged or heavier, that needs to be taken seriously and investigated.
What tests would I need?
A pelvic examination is necessary to look for causes such as cervical polyp or atrophic changes in the vagina. A pelvic ultrasound scan is often the first investigation to assess the lining of the uterus and also look for other abnormalities. The endometrial lining is thin after menopause and usually measures below 4mm. An endoscopic examination of the uterine cavity and biopsy of the uterine lining is the definitive gold standard test to rule out or sometimes confirm the diagnosis.
I have been diagnosed with endometrial cancer. Will I need an MRI scan?
MRI scan is needed to make sure that the cancer cells are limited to the uterine cavity. Invasion of cells into the uterine walls can be assessed on MRI as well as lymph node status.
How is endometrial cancer treated?
A simple hysterectomy which is often carried out as a key-hole procedure is often the only treatment needed. A key-hole hysterectomy is associated with tiny incisions, a short hospital stay and quick recovery.
After hysterectomy, the cancerous cells are further tested to see if there is spread beyond the inner half of the uterine wall. If this is a possibility, further treatment with radiotherapy may be offered to minimise chances of cancer cells coming back.
What is the prognosis?
As most of the cases of endometrial cancer are diagnosed at an early stage, the prognosis is usually excellent. It is therefore important to see a doctor quickly if you have any symptoms of abnormal bleeding.
What should I do to protect myself from endometrial cancer?
We recommend an “[email protected]” (well-woman check at 50years of age) which your GP can organise or we will be happy to arrange. Please visit contact London Gynaecology on 0207 10 11 700 or click here to send a message.