Womb (endometrial) cancer: bleeding symptoms, tests and treatment

The NHS describes womb cancer as cancer that affects the womb (uterus), the place where a baby grows during pregnancy. It says most womb cancer starts in the lining of the womb, the endometrium, and is known as endometrial cancer. Anyone with a womb can get it. Cancer Research UK adds that most endometrial cancers are adenocarcinomas, arising from the glandular tissue of the lining, and that trans men and non-binary people assigned female at birth can also develop womb cancer if they have not had their womb and cervix removed.

Cancer Research UK says most people who develop it are older women and that it is much less common in those under 40. The NHS notes that how serious womb cancer is depends on its size, whether it has spread and your general health. Cancer Research UK points out that cancer of the neck of the womb (cervical cancer) is covered separately.

The NHS lists the main symptoms as bleeding or spotting from the vagina after the menopause, heavy periods that are unusual for you, vaginal bleeding between periods and a change to vaginal discharge. Other symptoms can include a lump or swelling in the tummy or pelvis, pain in the lower back or between the hip bones, pain during sex and changes to how often you pee and poo. Cancer Research UK says the most common symptom is abnormal vaginal bleeding, especially in post-menopausal women.

The NHS stresses these symptoms are common and can be caused by many different conditions, so having them does not definitely mean you have womb cancer, but you should not wait to contact a GP: finding it early can mean it is easier to treat. It encourages people not to be embarrassed, since the doctor or nurse will be used to talking about these symptoms.

• Any vaginal bleeding after the menopause, even a single spot, should be checked.

• Tell the GP about any personal or family history of cancer or Lynch syndrome.

• Do not assume bleeding is due to HRT or a minor cause without checking.

Cancer Research UK says being overweight or obese is one of the biggest risks of womb cancer in the UK, and that other factors can also increase risk. The NHS flags Lynch syndrome, a genetic condition that increases cancer risk, as something to mention at your GP appointment and which may be discovered during tests; if found, you will be referred to a specialist who can explain what it means for you and your family.

Knowing about risk should lead to action rather than worry: the same advice, to report bleeding promptly, applies whether or not you have risk factors.

The NHS says you will be asked about your health, family history, medical conditions and symptoms, and may be examined: you can ask for a female doctor or nurse, you undress from the waist down behind a screen, and the GP may feel inside the vagina with two gloved fingers while pressing on the tummy, feel inside the bottom, and use a speculum as in cervical screening. They should explain each step before they start. If the GP thinks you have symptoms that could be cancer, you may get an urgent referral, which does not definitely mean you have cancer.

Tests depend on your symptoms. The NHS lists a transvaginal scan, where a finger-sized scanning device is inserted into the vagina, blood tests, hysteroscopy, in which a thin tube with a camera looks inside the womb, and a biopsy removing cells from the womb lining, done during hysteroscopy or separately. They should not be painful, though some may be uncomfortable, and after a biopsy you may have cramping or a little bleeding.

Results should arrive within a few weeks; a longer wait does not mean anything is wrong. If cancer is found, further tests such as CT, MRI or PET scans, a chest X-ray and genetic tests help establish the size and spread (the stage). Cancer Research UK explains that the stage tells you about size and spread, the type is the cell it started from and the grade is how abnormal the cells look.

The NHS says womb cancer is usually treatable when found early, and treatment depends on the size, location, spread and your general health. It will usually include surgery, chemotherapy or radiotherapy, and may include targeted medicines. Surgery is often the main treatment, especially if found early, and different operations involve removing the womb and cervix (hysterectomy); the womb, ovaries and fallopian tubes if cancer has spread there; lymph nodes around the womb or pelvis; the upper vagina; or the bladder or rectum if cancer has returned or spread there. Recovery can take a long time.

Radiotherapy may be the main treatment if you cannot have surgery, or be used if the cancer is large or has spread, or after surgery to help stop it coming back, sometimes with chemotherapy. Chemotherapy may be given alone or with radiotherapy, after surgery, or to slow the cancer and ease symptoms. Hormone therapy may be used to ease symptoms or control cancer that has spread outside the womb if you are not well enough for surgery or radiotherapy, and immunotherapy may suit advanced or recurrent womb cancer. The care team also talks about the impact of treatment on fertility and helps manage side effects including diet changes.

The NHS says a group of specialists looks after you and a clinical nurse specialist is your main point of contact. You will have regular check-ups during and after treatment, possibly with tests and scans, and should not wait for the next one if you have worrying symptoms. It suggests that bringing someone to appointments can help, and that Macmillan Cancer Support has a helpline open every day. Cancer Research UK says survival depends on many factors including the stage and grade, and that support is available from clinical nurse specialists, charities, community services and family and friends.

On the NHS, bleeding after the menopause leads to an urgent suspected-cancer pathway with a gynaecology team, usually a scan and hysteroscopy with biopsy, and treatment planned by a gynaecological cancer multidisciplinary team.

Private gynaecology can speed up scan, hysteroscopy and biopsy, and offer second opinions. If cancer is found, ask who coordinates the cancer team, whether your case will be discussed by a multidisciplinary team and how follow-up and any Lynch syndrome testing will be arranged.