Gynaecological Cancers & Conditions
Uterine Cancer (Endometrial Cancer)
Cancer of the uterus (womb) – also known as endometrial cancer – is the most common gynaecological cancer in Australia, affecting approximately 1 in 69 women before the age of 75. Fortunately, the disease tends to be detected early, with irregular or heavy periods, or post-menopausal bleeding, and can be completely cured in about 80% of cases.
Certain factors do increase your risk of getting uterine cancer, including obesity, having a late menopause and not having any children. In addition, certain inherited conditions such as LYNCH syndrome (also known as HNPCC) can also predispose you to developing uterine cancer, by up to 50%. In such cases, it may be advisable to undergo a prophylactic hysterectomy once you have completed your family.
What are the symptoms?
Patients with uterine cancer usually present with abnormal vaginal bleeding, such as heavy or irregular periods, or more commonly, post-menopausal bleeding. However, having post-menopausal bleeding does not necessarily mean that you have uterine cancer. While it is the most common symptom of the cancer, only 10 ~20% of those with post-menopausal bleeding will actually have uterine cancer; there may be many other reasons for the bleeding.
How it is diagnosed?
Diagnosis of uterine cancer is usually confirmed by an endometrial biopsy: sample of the tissue lining the womb/uterus. This is a small procedure which can normally be done in Dr Tan’s rooms using a specialised uterine lining sampling device.
In some cases, additional investigation might be necessary – either a hysteroscopy, where a tiny camera is inserted through the cervix to look inside the uterus and/or a curette, for testing by a pathologist. These will be done as day surgery cases under a short, general anaesthetic.
The results of these investigations will be discussed at a Multi-Disciplinary Tumour Board Meeting between Dr. Tan and a panel of expert Gynaecological Pathologists and Medical Oncologists.
Depending on the results, a further Chest X-Ray, CT scan of the abdomen and pelvis may be organised, as well as blood tests, in order to obtain the most information on if the cancer has spread and how far the cancer has spread away from the uterus.
How is it treated? What happens during surgery?
The usual treatment for uterine cancer is a form of surgery called ‘Modified Radical Hysterectomy’ where the entire uterus is removed. Both ovaries and any other visible signs of tumour in the surrounding tissues will be removed.
Hysterectomies can be performed in 3 ways:
One of the first places that uterine cancers spread to is the pelvic lymph nodes. However, removing these lymph nodes can also lead to increased complications. On the other hand, removing them and analysing them helps to determine the spread of the cancer and helps in deciding whether it is necessary to have supporting treatment, such as chemotherapy or radiation therapy after the surgery. Therefore the decision whether or not to remove them will only be made after evaluation of all factors including findings during the surgery.
Will I need chemotherapy or radiation therapy?
In some cases, radiotherapy is a vital part of treatment in the fight against uterine cancer.
Radiation therapy is usually used to treat uterine cancers in more advanced or high risk cases. The treatment is delivered into the vagina using special applicators, to be least invasive, and it has fewer side-effects. Occasionally for higher risk cases, external beam radiation may be required.
Chemotherapy is usually recommended only for certain types of uterine cancer or if the cancer has spread to the pelvic lymph nodes.
The need for chemotherapy and radiation therapy will be discussed individually for each patient and a decision made following discussion between Dr Tan and a panel of expert Gynaecological Pathologists, Radiation Oncologists and Medical Oncologists at a Multi-Disciplinary Tumour Board Meeting.
* Note: there are important ongoing research trials comparing the effectiveness of different supporting treatments in the fight against gynaecological cancers. Patient enrolment in these trials is very valuable and plays a huge role in improving our understanding of cancer treatments. Should you have any objection to being included in these trials, please mention this to Dr Tan – otherwise your participation will be assumed, with gratitude.
What happens after my surgery and treatment?
Dr Tan will discuss the best follow-up regime, tailored to suit each individual patient. For patients living outside the Perth Metropolitan Area, Dr Tan can make arrangements for ongoing follow-up with your local GP or gynaecologist.
Uterine cancer is completely cured in the majority of cases – however, it is normal for patients to have regular follow-ups for 5 years after treatment. Dr Tan feels it is particularly important to be alert to any new symptoms, rather than just relying on follow-up visits. If uterine cancer recurs, it almost always presents with vaginal bleeding or other symptoms, so detection is usually early and treatment possible quickly.
What about using HRT after uterine cancer?
Patients may be worried about the use of HRT after uterine cancer, as the endometrial cells in the uterus normally grow in response to oestrogen and similar hormones. However, there has been no evidence from research to show that Hormone Replacement Therapy (HRT) increases the chance of uterine cancer recurring. Dr Tan firmly believes that if HRT is indicated because of intolerable post-menopausal side-effects (eg. “hot flushes”), then HRT can be safely used without concern. (The only exception being patients who are high risk for developing breast cancer or who have a history of breast cancer). There are also certain type of rare uterine cancers like endometrial stromal sarcomas which should not be prescribed HRT. Dr Tan will discuss these with you, and if further counselling is required, a referral to the Menopause Service After Cancer at King Edward Hospital will be organised for you.
Certain factors do increase your risk of getting uterine cancer, including obesity, having a late menopause and not having any children. In addition, certain inherited conditions such as LYNCH syndrome (also known as HNPCC) can also predispose you to developing uterine cancer, by up to 50%. In such cases, it may be advisable to undergo a prophylactic hysterectomy once you have completed your family.
What are the symptoms?
Patients with uterine cancer usually present with abnormal vaginal bleeding, such as heavy or irregular periods, or more commonly, post-menopausal bleeding. However, having post-menopausal bleeding does not necessarily mean that you have uterine cancer. While it is the most common symptom of the cancer, only 10 ~20% of those with post-menopausal bleeding will actually have uterine cancer; there may be many other reasons for the bleeding.
How it is diagnosed?
Diagnosis of uterine cancer is usually confirmed by an endometrial biopsy: sample of the tissue lining the womb/uterus. This is a small procedure which can normally be done in Dr Tan’s rooms using a specialised uterine lining sampling device.
In some cases, additional investigation might be necessary – either a hysteroscopy, where a tiny camera is inserted through the cervix to look inside the uterus and/or a curette, for testing by a pathologist. These will be done as day surgery cases under a short, general anaesthetic.
The results of these investigations will be discussed at a Multi-Disciplinary Tumour Board Meeting between Dr. Tan and a panel of expert Gynaecological Pathologists and Medical Oncologists.
Depending on the results, a further Chest X-Ray, CT scan of the abdomen and pelvis may be organised, as well as blood tests, in order to obtain the most information on if the cancer has spread and how far the cancer has spread away from the uterus.
How is it treated? What happens during surgery?
The usual treatment for uterine cancer is a form of surgery called ‘Modified Radical Hysterectomy’ where the entire uterus is removed. Both ovaries and any other visible signs of tumour in the surrounding tissues will be removed.
Hysterectomies can be performed in 3 ways:
- Laparoscopic (‘keyhole’) surgery – with his Fellowship in Gynae-Endoscopic Surgery, Dr Tan is particularly adept at this form of surgery and it is his preferred method for treating uterine cancers and benign gynaecological conditions. The benefits include less pain, a shorter hospital stay and improved quality of life after surgery.
- Abdominal surgery – this is usually chosen if there are specific reasons that laparoscopic surgery cannot be performed, such as previous surgeries or infections which may have left a lot of scar tissue in the abdomen, or if the cancer has spread too much to allow removal through a keyhole approach.
- Vaginal approach – this method is rarely used as it does not allow good viewing or access of the abdominal cavity. However, it may sometimes be used on very unwell patients with multiple medical problems who cannot undergo either a laparoscopic or abdominal approach.
One of the first places that uterine cancers spread to is the pelvic lymph nodes. However, removing these lymph nodes can also lead to increased complications. On the other hand, removing them and analysing them helps to determine the spread of the cancer and helps in deciding whether it is necessary to have supporting treatment, such as chemotherapy or radiation therapy after the surgery. Therefore the decision whether or not to remove them will only be made after evaluation of all factors including findings during the surgery.
Will I need chemotherapy or radiation therapy?
In some cases, radiotherapy is a vital part of treatment in the fight against uterine cancer.
Radiation therapy is usually used to treat uterine cancers in more advanced or high risk cases. The treatment is delivered into the vagina using special applicators, to be least invasive, and it has fewer side-effects. Occasionally for higher risk cases, external beam radiation may be required.
Chemotherapy is usually recommended only for certain types of uterine cancer or if the cancer has spread to the pelvic lymph nodes.
The need for chemotherapy and radiation therapy will be discussed individually for each patient and a decision made following discussion between Dr Tan and a panel of expert Gynaecological Pathologists, Radiation Oncologists and Medical Oncologists at a Multi-Disciplinary Tumour Board Meeting.
* Note: there are important ongoing research trials comparing the effectiveness of different supporting treatments in the fight against gynaecological cancers. Patient enrolment in these trials is very valuable and plays a huge role in improving our understanding of cancer treatments. Should you have any objection to being included in these trials, please mention this to Dr Tan – otherwise your participation will be assumed, with gratitude.
What happens after my surgery and treatment?
Dr Tan will discuss the best follow-up regime, tailored to suit each individual patient. For patients living outside the Perth Metropolitan Area, Dr Tan can make arrangements for ongoing follow-up with your local GP or gynaecologist.
Uterine cancer is completely cured in the majority of cases – however, it is normal for patients to have regular follow-ups for 5 years after treatment. Dr Tan feels it is particularly important to be alert to any new symptoms, rather than just relying on follow-up visits. If uterine cancer recurs, it almost always presents with vaginal bleeding or other symptoms, so detection is usually early and treatment possible quickly.
What about using HRT after uterine cancer?
Patients may be worried about the use of HRT after uterine cancer, as the endometrial cells in the uterus normally grow in response to oestrogen and similar hormones. However, there has been no evidence from research to show that Hormone Replacement Therapy (HRT) increases the chance of uterine cancer recurring. Dr Tan firmly believes that if HRT is indicated because of intolerable post-menopausal side-effects (eg. “hot flushes”), then HRT can be safely used without concern. (The only exception being patients who are high risk for developing breast cancer or who have a history of breast cancer). There are also certain type of rare uterine cancers like endometrial stromal sarcomas which should not be prescribed HRT. Dr Tan will discuss these with you, and if further counselling is required, a referral to the Menopause Service After Cancer at King Edward Hospital will be organised for you.