Uterine cancer: symptoms and diagnosis
The most common symptom is unusual bleeding or a watery, bloody discharge from the vagina. Sometimes, this discharge can be smelly.
Other symptoms can include discomfort or pain in the abdomen, difficult or painful urination and pain during sex.
Unusual bleeding or discharge can happen before and after menopause. It is usually not due to cancer of the uterus. However all women with unusual bleeding or discharge should see their doctor for a check-up.
Doctors and other health professionals you may see
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist who will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see the following list). Ideally, all your tests and treatment should be available at your hospital. This may not be possible in some non-metropolitan areas.
Specialists and other health professionals who care for people with cancer of the uterus include:
- gynaecological oncologists, who are surgeons who specialise in cancers of the female reproductive system
- radiation oncologists, who specialise in radiotherapy
- medical oncologists, who specialise in chemotherapy
- endocrinologists, who specialise in hormone treatment
- nurses, who specialise in caring for patients who have cancer
- dietitians, counsellors, psychologists, social workers, physiotherapists and occupational therapists, who will advise you on support services and help you to get back to normal activities.
How cancer of the uterus is diagnosed
Your doctor will feel your abdomen to check for swelling.
Your doctor may also look at your vagina and cervix using a speculum (a bit like having a Pap test).
In this test, sound waves are used to create a picture of internal organs.
A small device called a ‘transducer' is put into your vagina. It makes sound waves and receives echoes. A computer makes a picture of the echoes produced when the sound waves meet something dense, like an organ or a tumour.
Using the ultrasound, the doctor can look at the size of your ovaries and uterus and the thickness of the endometrium. If there is anything unusual, your doctor will suggest that you have a biopsy.
You will have a biopsy if your doctor thinks that cancer could be present. Biopsy means removing some tissue so it can be looked at under a microscope.
Your doctor will look inside your uterus by stretching the cervix opening and inserting a device like a telescope (a hysteroscope).
There are different ways of taking tissue samples from the inside of the uterus:
- Tissue can be snipped out, or a spray of fluid may be used to dislodge cells.
- Tissue can be removed using a suction device. This method is called endometrial aspiration.
- Sometimes most of the uterus lining is scraped out. This is called a D&C (dilatation and curettage).
These procedures don't take very long; they are usually done in a few hours in hospital or at a day procedure centre. You will probably have a light general anaesthetic. There are some small risks involved with having an anaesthetic. Talk to your doctor for more information.
After, you may have period-like cramps and light bleeding that can last for a few days. Because you may have to wait a few days for test results, you may feel anxious as well.
You may have chest x-rays. Sometimes special x-rays using dye or barium are taken to test how well your kidneys, bladder or bowel are working.
These scans give pictures of the organs and other structures (including any tumours) in your body. They are usually done at a hospital or a radiology clinic.
Computed tomography (CT) scan: you will be asked not to eat or drink anything before the scan, except for a liquid dye. The dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly. You will be asked to lie on a table while the scanner, which is large and round like a doughnut, moves around you.
Magnetic resonance imaging (MRI: you will lie on a table inside a large metal tube which is open at both ends. The tube makes some people feel claustrophobic (afraid of being in a small space). If you think you are likely to feel claustrophobic, please tell the treatment centre in advance: you may be able to take someone into the room with you for support. The machinery can be quite noisy. You will need to remove all metal jewellery and cannot have an MRI if you have a heart pacemaker, brain aneurysm clip, cochlear metal implant or metal in your eyes.
Positron emission tomography (PET): you will be asked to not eat or drink anything before the scan. A small amount of radioactive material will be injected into a vein in your arm one hour before the scan. You will then be asked to lie or sit in a darkened room until the scan. For the scan, you will lie on a table and be moved through a large ring-shaped scanner. The tube may make some people feel claustrophobic. If you think you are likely to be affected in this way, please tell the treatment centre before your scan.
These scans take less than an hour although you may have to wait for the scan. Most people are able to go home as soon as their scan is over.
You may also have blood tests to assess your general health and to help with making decisions about your treatment.
'Staging’ the disease
The tests described on the previous pages show whether you have cancer. They can also show if the cancer has spread to other parts of your body. This helps your doctors ‘stage' the disease so they can work out the best treatment for you.
The ‘staging system' used for cancer of the uterus is the ‘FIGO system', developed by the International Federation of Gynaecology and Obstetrics.
Stage 1: the cancer is confined to the uterus.
Stage 2: the cancer has spread to the cervix.
Stage 3: the cancer has spread beyond the uterus/cervix to the ovaries, Fallopian tubes, vagina or nearby lymph nodes.
Stage 4: the cancer has spread further, to the inside of the bladder or rectum, throughout the abdomen or to other body parts.