It came as a double shock, firstly when a close friend of mine told me she had been diagnosed with cancer, and secondly that I had never heard of this particular cancer type even though I have been working in cancer research for well over a decade. She told me she had womb cancer, and that she had initially gone to her doctor because she had started bleeding again. She knew this was abnormal for a woman who had been through menopause but on the other hand, had never imagined this could be a symptom of cancer.
Since my friend’s diagnosis, I have wanted to find out more about womb cancer and how it had escaped my attention for so long. It turns out that cancer of the womb also called uterine and endometrial cancer, tops the list as the most common gynaecological cancer affecting women in the UK. Around 9,400 women are diagnosed with womb cancer each year making it the fourth most common cancer affecting British women (behind breast, lung, and bowel). Despite this, there is little public awareness about the disease which remains poorly researched and understood.
Perhaps because womb cancer tends to affect older women, most cases are diagnosed in women aged 40–74, or because it presents early and is surgically curable could be some of the reasons why it has been overlooked. However, with the incidence of womb cancer rising and with more women dying of the disease, it highlights the need to raise public awareness and to encourage women with symptoms to go and see their doctor.
What is womb cancer?
Womb cancer is often called endometrial cancer because most womb cancers develop from cells in the lining of the womb (called the endometrium). It is not clear exactly what causes womb cancer, but a hormone imbalance is known to be one of the main risk factors, specifically, high levels of the hormone oestrogen. Long-term treatment of menopausal symptoms with hormone replacement therapy (HRT) can cause this hormone imbalance along with other risk factors such as obesity and diabetes. Approximately 3% of womb cancers are linked to an inherited cancer predisposition condition called Lynch syndrome.
Womb cancer is more common in women post-menopause, although 1 in 4 women diagnosed is pre-menopausal. The most common symptom is abnormal bleeding from the vagina and as post‑menopausal women do not expect to bleed, womb cancer is usually picked up early and often cured. Indeed, around 90% of womb cancer diagnoses are reported due to post-menopausal or irregular vaginal bleeding. However, in pre-menopausal women, the symptoms can be harder to identify or sometimes women will ignore their symptoms because they have recently had a clear cervical screening test. Womb cancer cannot be picked up by a cervical screening appointment, so it is important to still get any abnormal symptoms checked out. For women who have not been through menopause, irregular bleeding could be spotting between periods, unusually heavy periods, or a blood-stained discharge. To avoid unnecessary worry, most women with abnormal bleeding will not have gynaecological cancer, but it is important to get checked out, just in case it is, because when womb cancer is diagnosed early is it often curable.
Treatments for womb cancer
The most common treatment for womb cancer is a hysterectomy which involves the surgical removal of the womb but is also likely to include the removal of the ovaries and fallopian tubes. Some patients may also undergo a course of radiotherapy or chemotherapy. Although having a hysterectomy is often curative, especially when the cancer is caught in the early stages, the after‑effects of the surgery can have a major impact on life, particularly on a woman’s sex life, as it may be more physically difficult to have sex and sex drive may be reduced. For pre-menopausal women, a hysterectomy will mean they will no longer be able to get pregnant. This can pose a huge dilemma for women who are yet to go through menopause and would still like to have children. In these instances, a type of hormone therapy may be used, or women can opt for chemotherapy and radiotherapy only, but the chances of curing cancer without surgery are lower. A late diagnosis, or having a rare aggressive subtype, often proves lethal. Fewer than half the women in whom cancer has spread outside the womb into nearby tissues in the pelvis or the lymph nodes will live beyond 5 years. When cancer has spread to the soft tissues of the abdomen or into other organs such as the lungs and liver, fewer than 1 in 5 women will live longer than 5 years.
Womb cancer incidence
Despite improved overall survival rates over the past 20 years, womb cancer is an increasingly problematic gynaecological cancer. According to the GLOBOCAN cancer statistics, in 2018 there were an estimated 382,069 new cases and 89,929 deaths attributed to womb cancer making it the second most common and the fourth leading cause of death due to gynaecological cancer among women worldwide. Furthermore, according to the International Agency for Research on Cancer, the incidence of womb cancer is rising rapidly compared to 2018, and by 2040 is estimated to increase by more than 50% globally. The incidence rate of womb cancer is higher in developed countries with the highest incidence rates in North America, Northern and Western Europe. The increase in the incidence of womb cancer is thought to be caused by two main factors: an increase in obesity and an ageing female population.
Current progress in womb cancer awareness and research
Now, more than ever, action needs to be taken to help raise public awareness and to invest in high‑quality research to advance our understanding of womb cancer that will lead to improvements in the clinical care of patients, and ultimately save lives. Recent initiatives have been set up to prioritize womb cancer research. In 2015, the James Lind Womb Cancer Alliance Priority Setting Partnership, led by Emma Crosbie, Professor of Gynaecological Oncology at the University of Manchester, conducted a nationwide survey to establish the top 10 most important unanswered research questions in womb cancer – according to patients, carers, and healthcare professionals – and to seek the funds to start tackling these questions whilst simultaneously raising public awareness of the disease.
Encouragingly, progress is starting to be made, particularly in the early detection of womb cancer. Professor Emma Crosbie has made it her mission to champion womb cancer awareness and is leading pioneering research into the prevention and early detection of womb cancer; recently her team of researchers developed a non-invasive diagnostic test that can detect cancer cells from urine or vaginal sample, potentially speeding up diagnosis and subsequent treatment. In 2020, Professor Emma Crosbie and colleagues at St. Mary’s Hospital, Manchester, UK, established the Peaches Womb Cancer Trust, which is a charity dedicated to improving the lives of women with or at risk of womb cancer.
My friend is currently recovering from a hysterectomy. She will be undergoing further tests to see if she requires additional treatment. It is a troubling time for her, as well as for her family and friends, but I hope that because she reacted quickly and went to her doctor about the abnormal bleeding that the prognosis is good.
Finally, if you only take one message home from this blog, let it be this: if you are experiencing abnormal vaginal bleeding, it probably is not cancer, but it is best to get it checked out anyway, just in case.
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