One in four women are not aware of uterine cancer and three in five women can’t name any sign or symptom of these cancers which are currently the fifth most common cancer in women (after breast, lung, bowel and skin) in Ireland.
These findings are from a new survey carried out on behalf of the Irish Network for Gynaecological Oncology to raise awareness of the symptoms of uterine cancer so that women can be diagnosed and treated for it earlier.
“The chief symptoms of uterine cancers [cancer of the womb] is abnormal bleeding prior to or after the menopause and if these symptoms can be presented early, it’s treatable and curable,” explains Dr Catherine O’Gorman, gynaecological oncology Fellow at St James’s Hospital, Dublin.
Carrying excess weight is the strongest risk factor of developing uterine cancer. This is because fat tissue produces a certain amount of the oestrogen hormone which, if overproduced, can cause an over-thickening in the lining of the womb (the endometrium) putting it at risk of developing cancer cells. Women taking the breast cancer drug, tamoxifen, women taking oestrogen-only hormone replacement therapy and women who have had polycystic ovarian syndrome are also at an increased risk of developing uterine cancers.
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Donal Brennan, professor of gynaecological oncology at University College Dublin (UCD), predicts that obesity will be the strongest risk factor for many cancers in 10 years’ time but currently uterine cancer is the cancer most associated with obesity. “As levels of obesity rise, there will be an increase in uterine cancers [the majority of which are endometrial cancers] and women with a body mass index [BMI] of 40 are at seven times greater risk of developing endometrial cancer than women with a BMI of 25,” explains Brennan.
However, he is very keen to stress that these statistics must not stigmatise or shame women who are overweight but instead put the onus on the medical profession to build relationships with their patients to help them reach a “healthier weight” rather than blame people for not reaching societal norms around ideal weights.
“Women with obesity have been poorly treated by an oversimplified approach which focuses on weight loss and increasing exercise. But if individuals can set personalised targets, say to lose 10 per cent of their body weight, we will get a lot more durable results,” he explains.
The focus on obesity is important for many cancers but particularly for uterine cancers because over 50 per cent of those who develop this form of cancer will have cardiovascular disease, high blood pressure and/or diabetes as well. “It’s part of my job to improve the cardiovascular health of my patients. There is a problem sometimes when the whole focus goes on the cancer,” says Brennan who works in both the Mater Misericordiae and St Vincent’s University Hospitals in Dublin.
Women who are diagnosed with uterine cancers have a good prognosis if the cancer is found at an early stage in the disease process and there have been studies which found the cancer can go away in patients who lose 10 per cent or more of their body weight.
However, doctors are concerned that many women still don’t recognise that heavy bleeding – particularly after the menopause – is the strongest potential sign of uterine cancer. “Any post-menopausal woman who has bleeding should get it checked out and any woman under 50 who has heavy, persistent bleeding should have it checked out too. The vast majority of these women won’t have uterine cancer,” explains Brennan.
Diagnosis is done via ultrasound, hysteroscopy (camera into the womb) and biopsy.
The standard treatment for uterine cancer is surgery to remove the womb (hysterectomy) and some women who have a genetic risk of uterine or colon cancer will opt for a risk-reducing hysterectomy in their late 40s. “The majority of uterine cancers are diagnosed at an early stage and can be managed with surgery alone. If patients present early, the five-year survival rates are 85-90 cent,” says Brennan.
“Some women who want to preserve their fertility have [bariatric or metabolic] surgery to lose 20-25 per cent of their body weight to bring their cancer under control instead of having a hysterectomy. Their overall health improves and their high blood pressure and diabetes goes too,” explains Brennan.
Between 3 and 5 per cent of women diagnosed with uterine cancer will have a genetic abnormality which predisposes them to colon cancer as well. Once genetic tests identify this so-called Lynch Syndrome, the women and family members can be sent for screening for colorectal cancer.
“This allows us to identify more cancers at an earlier stage,” explains Brennan, who leads the team on the Living Well Cancer Programme for women impacted by breast or gynaecological cancers.
I had never heard of endometrial cancer and when I tell people now they don’t know what it is either
Catriona Doyle (52) thought she was going through the menopause when she experienced night sweats and heavy bleeding at her late 40s. “I didn’t know that heavy and erratic periods might be a symptom of endometrial cancer. I was carrying some extra weight on my stomach but I was fit,” says Doyle who was diagnosed with both ovarian and endometrial cancer at aged 46.
When she contacted a doctor on call with strong pain in her stomach, she was sent to Beaumont Hospital with suspected appendicitis. An ultrasound and CT scan ruled out appendicitis but revealed tumours in her uterus and on her ovaries. Three weeks later, Doyle, who has one daughter, had a radical hysterectomy. The subsequent histology report confirmed endometrial cancer as well as ovarian cancer. “Both of these cancers are usually found in older post-menopausal women so younger women aren’t expected to have it,” she says.
A regular runner, Doyle is now back training for the marathon and raising funds for the Mater hospital. “I had never heard of endometrial cancer and when I tell people now they don’t know what it is either so it’s important that women don’t put everything down to the menopause and get checked out if they have heavy periods with long gaps in between,” says Doyle.
“Maintaining a healthier weight and having an active lifestyle is the best way to prevent uterine cancer,” adds O’Gorman.
