Endometrial cancer (cancer of the lining of the womb, or uterus) usually presents with abnormal vaginal bleeding. Often this occurs after the menopause, but 25% of endometrial cancers occur in the premenopausal age group and 5% occur before the age of 40. It may present simply as heavy periods. Although most cancers of the uterus present with post-menopausal bleeding (90%), only around 10% of patients presenting with post-menopausal bleeding in fact have endometrial or uterine cancer.
Signs and symptoms of endometrial cancer may include
- Vaginal bleeding after menopause.
- Bleeding between periods before menopause
- An abnormal, watery or blood-tinged discharge from your vagina.
- Pelvic pain.
Risk factors for developing endometrial cancer are obesity, late menopause, nulliparity (no children), and polycystic ovarian syndrome with irregular or infrequent periods. Some inherited conditions such as Lynch syndrome (also known as HNPCC) may result in up to 40-50% chance of developing endometrial cancer. If you do have this hereditary condition you are advised to undergo prophylactic laparoscopic hysterectomy and bilateral salpingo-oophorectomy after childbearing is complete to prevent cancer.
Endometrial hyperplasia is a spectrum of changes in the uterine lining that is recognized as being increasingly likely to progress to endometrial cancer if left untreated.
Diagnosis of endometrial cancer requires a biopsy of the endometrium (lining of the womb), which can sometimes be done in the rooms at your initial visit with Dr Farrell via a pipelle (specialised uterine lining sampling device). A day surgery curette (cleaning of the uterine lining for pathology assessment) and hysteroscopy (look inside the uterus with a tiny camera through the cervix) may be necessary. This is performed under a short general anaesthetic.
All pathology results are reviewed weekly by expert gynaecological pathologists and Dr Farrell in a multidisciplinary team (MDT) meeting to ensure the highest possible standards of care are maintained.
If a cancer is confirmed, usually a CT scan of the chest, abdomen and pelvis is arranged along with a CA125 (tumour marker) to maximise our knowledge of any possible spread of the cancer away from the uterus to allow the best possible treatment to occur.
The standard management of patients with endometrial cancer is removal of the uterus, tubes and ovaries. Sometimes removal of lymph nodes in the pelvis and abdomen is required for staging and treatment planning. Dr Farrell offers a new approach called sentinel lymph node removal where appropriate. This is a procedure where special dye is injected into the cervix, and 1-2 lymph nodes from each side of the pelvis are identified by using a special camera, and removed. These lymph nodes are the first lymph nodes to drain the cancer, and if they are negative for cancer cells there is a very high possibility that other lymph nodes will not have cancer cells in them and they will not be removed. By removing a smaller number of representative lymph nodes in this way, the risk of lymphoedema (permanent swelling in the legs) is reduced significantly. Dr Farrell will discuss the option of this treatment with you if this is appropriate. It can almost always be performed with a laparoscopic approach. Dr Farrell completed a Masters of Surgery at Sydney University on this very topic of lymphadenectomy for endometrial cancer (see published papers on this website).
Most patients do not require extra (adjuvant) treatment, but those that have high risk features on review of all pathology in our multidisciplinary tumour board or with spread away from the uterus noted at the time of surgery will generally be advised to have additional treatment which may consist of chemotherapy and or radiotherapy and or hormonal therapy.
The majority of patients treated for uterine cancer are cured of their disease.
Dr Farrell will coordinate follow up after treatment is completed, with 3 monthly reviews for 2 years, then 6 monthly reviews for a total of 5 years at minimum.
For more information follow the link to the Cancer Council Booklet for uterine cancer information on this website.