Womb-awareness (with some help from Wellbeing for Women)
The past 20 years have seen an increase of nearly 50 per cent in the number of women diagnosed with womb cancer (also called uterine or endometrial cancer). Some 8,000 cases are diagnosed annually in the UK, making it the fourth most common cancer in women (after breast, lung and colon). It mainly affects women after the menopause, with about 20 per cent occurring in premenopausal women. The level of awareness about womb cancer is very low, according to Dr. Emma Crosbie of the University of Manchester, who specialises in gynaecological oncology. Most GPs rarely see a case, which may mean a delay in diagnosis and treatment and affect a woman’s chance of survival. In 2012 there were 2,025 deaths from womb cancer in the UK. So I asked Dr. Crosbie and a panel of experts supporting the charity Wellbeing of Women to explain the relevant facts.
WHY HAS WOMB CANCER GOT MORE COMMON?
The biggest reason for the increase is obesity. This can lead to a toxic excess of the hormones oestrogen and insulin, which causes the lining of the womb to grow.
In women who menstruate, oestrogen is normally ‘opposed’ or balanced by progesterone but postmenopausal women stop producing progesterone. They do, however, still produce a small amount of oestrogen. Oestrogen is produced in fat cells, so the more body fat, the more oestrogen you produce.
Other pathways are involved, including insulin resistance and high levels of insulin-like growth factor (IGF) that lead to inflammation, which is also linked to cancerous growth.
Additional contributory factors are a known side effect of taking tamoxifen for breast cancer (mostly in postmenopausal women), fewer women having hysterectomies, and the rare genetic condition Lynch syndrome, which usually occurs in younger women and is linked to types of cancer.
WHAT ARE THE SYMPTOMS?
Bleeding is the cardinal symptom in postmenopausal women, which should prompt you to see your GP immediately. Also irregular bleeding – i.e., not during a period – in premenopausal women, or heavy bleeding in a woman of 45-plus. In 90 per cent of cases bleeding will not be due to a cancer but should always be investigated. Abdominal pain or cramping between periods, bloating, discharge or change of bowel habit should also be discussed.
WHAT SHOULD HAPPEN THEN?
A woman with postmenopausal bleeding should be referred for tests by the rapid access system. A pelvic ultrasound scan will assess the womb lining (endometrium) for abnormal thickness or polyps, which may call for a biopsy (sample of the lining).
Patients on HRT may be asked to stop by their GP to see if the bleeding stops too. The GP may investigate premenopausal women further before referral.
WHAT IS THE CURRENT TREATMENT?
Most patients are now treated by multidisciplinary teams at, or linked to, specialist gynaecological cancer centres. The standard surgical treatment is a hysterectomy (removal of the womb) with removal of the ovaries and fallopian tubes. Increasingly this is done by keyhole (laparoscopic) surgery or robotically so recovery time is shorter and the complication rate reduced; this is likely to become the gold standard surgical procedure. If it has spread outside the womb, radiotherapy or chemotherapy, or both, may be considered, as it may be after surgery, too.
HOW EFFECTIVE IS THE CURRENT TREATMENT
Overall, the survival rate has increased. But in a significant minority, the cancer will recur even after surgery and chemotherapy. The average survival time for this group is ten months. Groups led by Dr Sarah Martin at Barts Cancer Institute in London and Dr Crosbie at the University of Manchester are being funded by Wellbeing of Women to research new treatments for womb cancer.
HOW TO REDUCE THE RISK
• Keep to a reasonable weight and exercise regularly.
• Eat a rainbow of vegetables every day.
• Drink green tea, which may decrease the risk, also coffee.
• Don’t eat too much red meat as this has been linked to womb cancer among other types.
• Go to the doctor immediately if you experience bleeding.
WE CAN ALL HELP
Sanctuary Spa is working with Wellbeing of Women to fund Dr. Martin’s research. Until the end of February, the full price – £11.50 – of every 650 g Sanctuary Spa Ultimate Salt Scrub, ordered via www.sanctuary.com, will be donated to the charity. Or of course you can donate directly via www.wellbeingofwomen.org.uk.