Uterine cancer usually means endometrial cancer, which starts in the lining of the womb. It is the most common gynaecological cancer in many countries and mainly affects women after the menopause. Uterine sarcomas, which arise from the muscle wall, are much rarer and behave differently.
Because it causes abnormal bleeding early on, most endometrial cancer is diagnosed while still confined to the womb, where a hysterectomy is often the only treatment required. Tumour grade and molecular type determine whether radiotherapy or chemotherapy is added.
Symptome
- Any vaginal bleeding after the menopause, including spotting or a pink or brown discharge
- Bleeding between periods or unusually heavy periods after 40
- Watery or bloodstained discharge
- Pelvic pain or pressure, which is less common
- Pain during sex
- Weight loss, bloating or changes in bowel or bladder habit in advanced disease
Ursachen und Risikofaktoren
Most endometrial cancers are driven by oestrogen acting on the womb lining without the balancing effect of progesterone. Obesity is the leading risk factor, because fat tissue makes oestrogen. Others include diabetes, polycystic ovary syndrome, never having been pregnant, early periods and late menopause, oestrogen-only hormone replacement in a woman with a womb, and tamoxifen. Lynch syndrome carries a lifetime risk as high as 40 to 60 percent, and may be the first sign in a family. The combined pill, pregnancies and physical activity lower risk. Atypical endometrial hyperplasia is a precancerous state.
Wie es diagnostiziert wird
- Transvaginal ultrasound: Measures the thickness of the womb lining. A thin lining after the menopause makes cancer unlikely.
- Endometrial biopsy: A thin tube is passed through the cervix in the clinic to take a sample. It takes a few minutes and causes cramping.
- Hysteroscopy with directed biopsy: A small camera inspects the cavity, under local or general anaesthetic, when the clinic sample is inadequate or bleeding continues.
- Pelvic MRI and CT: MRI estimates how deeply the tumour invades the muscle wall and the cervix; CT looks for spread in higher-risk cases.
- Molecular classification: Testing for mismatch repair deficiency, p53 and POLE places the tumour in one of four groups that refine prognosis and treatment, and screens for Lynch syndrome.
Behandlungsmöglichkeiten
- Total hysterectomy with removal of tubes and ovaries: The standard operation, usually by keyhole or robotic surgery, which has quicker recovery than open surgery with equivalent cancer outcomes for this disease.
- Sentinel lymph node mapping: A dye identifies the first draining nodes for removal, reducing the need for full node dissection and the risk of leg swelling.
- Vaginal brachytherapy or external radiotherapy: Added after surgery according to risk group, to lower the chance of recurrence in the pelvis.
- Chemotherapy and immunotherapy: Carboplatin with paclitaxel for advanced or high-risk disease, with immunotherapy added particularly for mismatch repair deficient tumours.
- Hormonal treatment: High-dose progestogen tablets or a hormone-releasing coil for women who are unfit for surgery, or as carefully monitored fertility-sparing treatment for early low-grade cancer.
- Follow-up: Clinical review for about 5 years, with attention to weight, diabetes and cardiovascular health.
Wenn es dringend ist
Go to a local emergency department for very heavy vaginal bleeding that soaks through pads hourly, or bleeding with dizziness or fainting, and for severe pelvic pain with fever. After hysterectomy, heavy bleeding, offensive discharge with fever, a painful swollen leg or sudden breathlessness need urgent attention. Postmenopausal bleeding itself is not an emergency but should be assessed within 2 weeks.
Reisen nach Türkiye zur Behandlung
Postmenopausal bleeding should be investigated near home first, since ultrasound and biopsy are quick and widely available. A trip can suit a second opinion with molecular classification of the tumour, or a planned robotic or laparoscopic hysterectomy with sentinel node mapping, allowing about 10 to 14 days. Vaginal brachytherapy is a short defined course that can sometimes be included. External radiotherapy over 5 weeks, chemotherapy and 5 years of follow-up are better arranged where you live.
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Häufig gestellte Fragen
Does bleeding after the menopause mean cancer?
In about nine out of ten women it does not; thinning of the lining and polyps are more common causes. It must still always be checked.
Do my ovaries have to be removed?
Usually yes, because they can harbour spread and produce oestrogen. In selected younger women with early low-grade cancer, keeping them may be discussed.
I want children. Are there options?
For early, low-grade cancer confined to the lining, hormone treatment with repeated biopsies can postpone surgery in carefully selected women. Hysterectomy is advised once childbearing is complete.
Should I be tested for Lynch syndrome?
Tumour testing for mismatch repair proteins is now recommended for all endometrial cancers. An abnormal result leads to genetic counselling, which matters for bowel cancer screening in you and your relatives.