Uterine cancer

Physical examination

The doctor may check your abdomen for swelling. To check your uterus, the doctor will place two fingers inside your vagina while pressing on your abdomen, or they may use an instrument (a speculum) that separates the walls of the vagina (similar to a cervical screening test).

Pelvic ultrasound

A pelvic ultrasound will use soundwaves to make a picture of your uterus and ovaries. The soundwaves echo when they meet something dense such as a tumour or organ. A computer then makes a picture from these echoes. A pelvic ultrasound can be done in two ways and you often have both types at the same appointment. A pelvic ultrasound usually takes between 15 and 30 minutes. If anything appears unusual, the doctor may suggest a biopsy.

Abdominal ultrasound

In order to get good pictures of the ovaries and uterus in an abdominal ultrasound you will need to have a full bladder so you will be asked to drink water before your appointment. A technician called a sonographer will move a small device called a transducer over your abdomen.

Transvaginal ultrasound

For a transvaginal ultrasound you do not need a full bladder. The sonographer will insert a transducer wand into your vagina. You may find the ultrasound uncomfortable, but it should not be painful.

If you feel uncomfortable or embarrassed about having the ultrasound, talk to the technician beforehand. You can ask to have a female sonographer or have someone else in the room with you.

Endometrial biopsy

An endometrial biopsy is done in the specialist’s office. A long, thin tube (pipelle) is inserted into your vagina to gently suck cells from the uterine lining. The cells are sent to a pathologist who examines them under a microscope. There may be some discomfort similar to period cramps so your doctor may suggest taking non-steroidal anti-inflammatory drugs such as ibuprofen, before the procedure.

Hysteroscopy and biopsy

A hysteroscope is a telescope-like device which is inserted through your vagina into your uterus and allows a gynaecologist or gynaecological oncologist to see inside your uterus. During this procedure, tissue can also be removed (biopsy) and sent for further testing in a laboratory.

Blood and urine tests

Blood and urine tests may be used to assess your general health and inform treatment decisions.

Other tests

If cancer is detected in your uterus, you may have other scans to see if the cancer has spread to other parts of your body, such as an x-ray, CT scan or MRI scan. For particular types of uterine cancer, such as sarcoma, a PET scan may be used.

Surgery (hysterectomy and bilateral salpingo-oophorectomy)

The most common form of treatment for cancer of the uterus is surgically removing the uterus and cervix. This procedure is called a total hysterectomy. If the fallopian tubes and both ovaries are also removed, it is called a bilateral salpingo-oophorectomy.

Ovaries are often removed to reduce the risk of the cancer coming back, as ovaries produce oestrogen, a hormone that may cause the cancer to grow.

The surgery can be performed through a cut in the abdomen (laparotomy) or using keyhole surgery (laparoscopic surgery). You will be given a general anaesthetic. During the procedure, the surgeon may remove additional tissue if the cancer has spread, or to remove lymph nodes in your pelvis.

For women who were not menopausal before treatment who then have a bilateral salpingo-oophorectomy, they will experience menopause with the removal of their ovaries. Therefore, if you are concerned about how surgery will affect your fertility, it is important to talk to your specialist before treatment begins.

The treatment team will advise you of how to take care of yourself following surgery, including avoiding lifting, driving and sexual intercourse for a short period of time during your recovery.

Radiation therapy (radiotherapy)

Radiation therapy, the use of x-rays to kill or injure cancer cells, is commonly used as an additional treatment to reduce the chance of the cancer coming back. It may be recommended as the main treatment if you are not well enough for surgery.

Radiation therapy is given either externally, where a machine directs radiation at the cancer and surrounding tissue; or from inside the body (brachytherapy), where radioactive material is put in thin tubes and placed near the cancer internally.

Radiation therapy to the pelvic region may cause menopause, therefore, if you are concerned about how treatment will affect your fertility, it is important to raise your concerns with your treatment team before treatment commences.

Hormone therapy

Hormone therapy is usually given if the cancer has spread or if the cancer has come back (recurred). It is also sometimes used if surgery is not an option. Progesterone is the main hormone treatment for women with uterine cancer, and it is available in tablet form or by injection by a GP or nurse. It helps shrink some cancers and to control symptoms.

Chemotherapy

Chemotherapy is used to treat certain types of uterine cancer, or when cancer comes back after surgery or radiotherapy, or if the cancer is not responding to hormone treatment. It can be used to control the cancer and to relieve symptoms. It is usually given as a drug that is injected into a vein (intravenously). The doctor will explain the chemotherapy treatment course and how long it will last.

Immunotherapy

Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. An immunotherapy drug called pembrolizumab (used in combination with the targeted therapy drug lenvatinib, see below) may be an option for some people with endometrial cancer that has spread or is no longer responding to treatment with chemotherapy.

Targeted therapy

Targeted therapy is a drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. A targeted therapy drug called lenvatinib may be used to treat endometrial cancer that has spread or come back, or to boost the effectiveness of immunotherapy.

Palliative care

In some cases of uterine cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of uterine cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.