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There are two types of uterine cancer – endometrial cancer, which begins in the lining of the uterus (endometrium) and uterine sarcomas, which develop in the muscle tissue of the uterus (myometrium). Find out what increases your risk and read about prevention, diagnosis and treatment.

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Endometrial cancer

Endometrial cancer is a type of uterine cancer that occurs in the lining of the uterus (womb). The uterus is where a baby grows during pregnancy. It’s located between the bladder and the rectum and is part of the female reproductive system.

Endometrial cancer is the most diagnosed gynaecological cancer with over 3200 cases diagnosed each year, mostly in women aged over 50. It’s the most common type of uterine cancer and accounts for 95% of cases.

Like many cancers, early diagnosis and detection lead to the best treatment outcomes. The most common symptom is unusual bleeding, especially bleeding after menopause. As there is no known way to prevent or screen for endometrial cancer, it’s important to see your doctor if you notice any symptoms.

What increases your risk of endometrial cancer?

The exact causes of uterine cancer are unknown. However, some factors increase the risk of developing it, including:

Age
  • being over 60 years old
  • being postmenopausal
  • reaching menopause late (after age 55)
Hereditary factors
  • family history of ovarian, uterine, or bowel cancer (usually associated with Lynch syndrome)
  • having a genetic condition such as Lynch syndrome or Cowden syndrome
Hormonal factors
  • starting periods early (before age 12)
  • using oestrogen-only menopausal hormone therapy (or MHT, formerly called hormone replacement therapy, or HRT) or fertility treatment
  • taking tamoxifen to treat breast cancer (the benefits of treating breast cancer usually outweigh the risk of uterine cancer, so talk to your doctor if you are concerned)
Other factors
  • having a thickened uterine wall lining, endometrial hyperplasia is one of the causes
  • never having children
  • having high blood pressure (hypertension) or diabetes
  • being overweight or obese
  • having previous ovarian tumours, or polycystic ovary syndrome (PCOS). These factors present very low risk except in the case of obesity and/or endometrial hyperplasia with PCOS
  • having previous radiation therapy to the pelvis

Just because you have risk factors, doesn’t mean you will get endometrial cancer. However, some women who develop cancer of the endometrium don’t have any risk factors at all. If you’re concerned about your risk, speak to your doctor.

What are the signs and symptoms of endometrial cancer?

The most common symptom of endometrial cancer is unusual bleeding, particularly bleeding after menopause. If you have any bleeding, spotting or staining of blood after menopause, it's important to see your doctor.

Other common symptoms may include:

  • periods that are heavier than usual, or a change to your periods
  • bleeding in between periods
  • periods that continue without a break.

There are other, less common symptoms which include:

  • watery, smelly discharge
  • unexplained weight loss
  • discomfort or pain in your abdomen (belly)
  • pain during sex
  • difficulty passing urine.

These symptoms may be due to other conditions and not endometrial cancer. However, if you notice any of them, visit your doctor.

How is endometrial cancer diagnosed?

Your doctor will initially ask you questions about your symptoms, health history and family health history. A physical examination will then be conducted, including a pelvic examination to check your vulva, vagina and cervix, and a manual vaginal examination to check your uterus and pelvis. You may also have blood and urine tests.

Other tests used to diagnose endometrial cancer include:

  • a transvaginal ultrasound examination (internal ultrasound via the vagina) to look at your ovaries, uterus and endometrium
  • an endometrial biopsy where a sample of cells is taken from your endometrium and tested in a laboratory
  • hysteroscopy and biopsy (via the vagina) which allows the doctor to see inside your uterus and take a small sample of tissue from the endometrial lining
  • other imaging tests such as computerised tomography (CT) and magnetic resonance imaging (MRI) scans can be used to check if cancer has spread outside the uterus. These tests are more likely to be requested by the gynaecological oncologist.

Referral to a gynaecological oncologist

If your assessment and investigations suggest endometrial cancer is a possibility, ask your doctor for an immediate referral to a gynaecological oncologist. Gynaecological oncologists are specialist gynaecologists who treat cancers such as uterine cancer.

Treatment for endometrial cancer

Treatment for endometrial cancer depends on the extent of the cancer. It may include any of, or a combination of, the following:

  • surgery
  • radiotherapy
  • hormone therapy more likely in advanced stages
  • chemotherapy.

Prevention of endometrial cancer

There are no proven ways to prevent endometrial cancer, and there are no screening tests specifically for endometrial cancer. In most cases, early detection and diagnosis lead to good outcomes, which is why it’s important to see your doctor if you feel something isn’t quite right.

Uterine sarcoma

Uterine sarcoma is a rare uterine cancer that forms in either the muscle of the uterus or the supporting cells of the lining of the uterus. It occurs in about 2-5% of all uterine tumours and less than 1% of all gynaecological cancers. It is more likely to occur after menopause.

Most cases of uterine sarcoma are not associated with risk factors. However, about 10-20% of cases are linked to previous radiotherapy or tamoxifen use.

The symptoms are similar to those of endometrial cancer, as is the diagnosis.

Treatment is through surgery. However, this depends if it is confined to the uterus or has spread out of it.

When to see your doctor

It’s important to see your doctor if you notice any of the symptoms listed above, especially abnormal vaginal bleeding, or anything else that is unusual.

Further information about endometrial cancer can be found at:

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at July 2021.

Last updated: 14 October 2021 | Last reviewed: 16 July 2021

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