Endometrial Cancer

Sometimes when women find out they have endometrial cancer, they may not have had any symptoms and never knew they had a problem.

There are a number of symptoms or changes to look out for, including:

• bleeding from the vagina after menopause
• bleeding from the vagina between periods
• an unusual discharge (ooze) from your vagina, especially if you have been through the menopause. This discharge might be watery, or it might have blood in it or have a bad smell.
• pain in the belly
• pain when you’re having sex
• finding it hard or painful to pee
• losing of weight without trying.

Having these symptoms may not mean you have cancer, but it is important to check. It’s not unusual for some of these changes to happen around the menopause, and it’s usually not due to endometrial cancer.

All women who have vaginal bleeding after they have had the menopause should be referred by their doctor to a gynaecologist, who is a doctor that specialises in women’s health. Ask your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker about this. You can request females doctors, nurses and health workers to follow Women’s Business protocols.

If you have any of these problems, or are worried about something else, yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

You won’t know if you have endometrial cancer until your doctor has yarned with you, done a physical examination and completed some tests. 

 The tests might include:

• an ultrasound, like you might have had when pregnant, except that the doctor puts a probe inside your vagina to do it
• blood tests
• a hysteroscopy, where a doctor uses a type of telescope to look up your vagina and into your womb.
• a D&C (dilation and curettage), which can be done at the same time as the hysteroscopy, where a doctor scrapes the lining of your uterus to get a sample which they look at with a microscope 
• a biopsy (sometimes called a Pipelle), where a tiny bit of your uterus lining is taken out through a plastic tube, and they look at it with a microscope.

A hysteroscope, D&C and biopsy will most likely be done in surgery.  You will be given medicine to make sure you do not feel any discomfort during these procedures.

Most women who have these tests find out they don’t have endometrial cancer, but it’s important to check. 

Most endometrial cancers begin in the cells that make and release mucus and other fluids. These are called adenocarcinomas, and the most common type is called endometrioid tumour.

There are other types of endometrial cancer, but these are less common.

If you are diagnosed with endometrial cancer, your doctor will explain which type you have.

If you have endometrial cancer, you might be told it’s at a certain stage. This describes whether or not the cancer has spread to other parts of your body, and how far. Knowing the stage of the cancer helps you and your doctors to decide on the best treatment for you.

• Stage 1: the cancer is only in the womb, or uterus
• Stage 2: the cancer has spread to the cervix, which is between your womb and your vagina
• Stage 3: the cancer has spread to the lymph nodes and close organs
• Stage 4: the cancer has spread to other parts of the body such as the bladder or further – this is also known as metastatic cancer.

With all stages of endometrial cancer, there is plenty of treatment and support that can help you, including traditional medicine and practices like ceremony and being on Country. 

There are a number of different ways to treat endometrial cancer.

Your doctors will yarn with you about what treatments they recommend and what your options are best for you.

Most women have surgery. Some have radiotherapy, chemotherapy or hormone therapy as well. You might need one of these, or a combination of them.

Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker about which treatment you might have. You can also yarn about if you want to include any traditional healing, bush medicine or cultural practices in your treatment plan.

Surgery

Surgery is a procedure done in hospital to remove the cancer and help to stop it from spreading to other parts of your body. This involves staying in hospital, having an anaesthetic (so that you are asleep during the operation) and an operation.

Some women may have their womb removed, and some have their cervix, fallopian tubes and ovaries removed too. Some women have their lymph nodes taken out as well.

Sometimes the surgery is done through a cut in your belly. Sometimes it can be done as keyhole surgery.

Surgery for endometrial cancer may affect your fertility (having children). Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker if you have questions about this and the assistance available to patients and their family for travel and accommodation if you need to travel away from home for surgery.

Read more about surgery. and fertility-sparing options.

Radiotherapy

Radiotherapy (or radiation therapy) uses X-rays to destroy cancer cells in one part of your body.

External therapy:

You might have radiation therapy to your pelvic area to treat endometrial cancer. Most women who have radiotherapy have it 5 days a week for 4-6 weeks, and each session takes an hour or so. But it might be different for you.

Internal therapy, also called brachytherapy:

You might also receive radiotherapy by putting the radiation directly into your body. This is called brachytherapy. This involves giving radiation via a needle or another device into the vagina. The device stays in place from a few minutes to a few days. Depending on the treatment and the dose of radiation you receive, you might need to stay in hospital or make a daily visit for treatment.

You can only have radiotherapy in cities and some big towns – see this list. If your doctor thinks you need radiotherapy and you don’t live near a radiotherapy site, assistance is available for travel and accommodation for you and your family.

Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

Read more about radiotherapy.

Chemotherapy

Chemotherapy or “chemo” involves you taking strong drugs to kill the cancer cells.

Many people have chemo in cycles – such as one day every three weeks, or once a week. You may also be recommended to have chemo at the same time as radiotherapy, and this will be given once every 3 weeks. Some people have chemotherapy tablets at home, but most need to go to a hospital or clinic to get the treatment. But you usually don’t need to stay in hospital for chemo.

Most chemo comes as injections into your arm or hand that drip in over a few hours and some need you to take home a small bottle home for two days then come back to take it off again. If you’re having chemo, your doctor will tell you exactly how it will work for you.

Chemo can make people feel sick for a while, but there are things they can do to help. Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker. Mob who had have chemo say that being on Country, doing Women’s Business and Men’s Business as well as ceremony and bush medicines are a good help during treatment.

Read more about chemotherapy and side effects.

Hormone therapy

Some types of cancer of the womb depend on the hormones in your body. If you have this type of cancer, then your doctor might suggest drugs to affect your body’s hormones. It can slow, and maybe stop, the growth of the cancer.

Hormone therapy usually means that you take tablets every day for months or years. Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

Read more about hormone therapy.

Effect on fertility

If you haven’t had menopause, some of these treatments might affect your ability to have kids. It might be possible for you to have a type of treatment that still makes it possible for you to have kids. Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker about this.

Read more about the effects of cancer treatment on fertility and fertility-sparing options.

It is important for you to understand why you are getting the treatment your doctor chooses and how it is supposed to help you. Different treatments try to do different things. It depends on what cancer you have, and whether it has spread to other parts of your body, and what you want. Ask your doctor or specialist if the treatment they suggest:

• is meant to cure you, by getting rid of the cancer and stopping it spreading, or
• won’t cure you, but is meant to prolong your life, or make your feel better.

Your doctors will yarn with you and explain this. You can yarn with them and tell them what you think, and what you want. Some people will want to try everything possible to stay alive. Others want simpler treatments, or may not want to leave Country for treatment, or don’t want any treatment at all. It’s your choice. You can talk about traditional healing, bush medicines and cultural practices to include in your treatment plan and also talk to another doctor to help you decide.

It can take time to decide about treatment. There are usually some options to hear about and choices to make. 

It can be helpful to write things down, and have someone else come to appointments to help remember information. Mob who have had a cancer diagnosis also recommend yarning with trusted family, friends and Elders.

Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

Always ask about the cost of treatment. Many treatments are free through public hospitals, but some may not be. Ask your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

Learn more about financial support.

It all depends on the type of treatment you’re having. People will have treatment for different durations of time. After treatment is over, your doctor might keep in touch with you to check how you’re going and monitor your health.

During your cancer journey you will have the opportunity to build trust and safe relationships with your doctors, nurses and Aboriginal and/or Torres Strait Islander health workers that may last beyond your treatment.

It is not possible to say what causes endometrial cancer in a single person. We do know there are some features that are more common in people who develop breast cancer. These features are called “risk factors”.

But it is usually hard to be sure whether a risk factor contributed to the development of the cancer. And having one or more risk factors does not mean that someone will develop this cancer. In fact, many people with endometrial cancer have no obvious risk factors.

Some factors can even lower your risk of developing endometrial cancer.

Risk factors for endometrial cancer that you can change:

• being overweight 
• having high blood pressure or diabetes.

Risk factors for endometrial cancer that you can’t change:

• being post-menopausal (having gone through the menopause, or 'change of life')
• never having children
• family history of ovarian, endometrial or bowel cancer
• having a thickened lining of the womb (endometrial hyperplasia)
• having taken female hormones, such as the oral contraceptive pill (OCP or “the pill), or hormone replacement therapy (HRT)
• taking tamoxifen, a drug used to treat breast cancer
• previous tumours on the ovaries or polycystic ovary syndrome
• having a genetic condition such as Lynch syndrome.

Clinical trials might be an option for you. Talk to your doctor to help you decide if taking part is a good option. Read more about clinical trials.

Read more detail on endometrial cancer here.