Background Facts This is the 5th most common cancer in women in England, affecting approximately 3500 women per year. Uterine cancers most commonly arise from the Endometrium, the layer of cells lining the womb which are shed with menstruation. Cancers can arise from the muscle layer of the uterus (uterine sarcomas) but these are much more rare and treatment is similar. Endometrial cancer is most common among post-menopausal women and it typically presents with abnormal vaginal bleeding or blood-stained discharge. It is more common among women taking HRT and similar preparations such as Tibolone and Tamoxifen.. Approximately 20% of cases present in women of childbearing age and may be discovered when investigated for heavy or irregular periods. These women are more likely to have a history of cancer in the family, most commonly of bowel or endometrial cancer. Endometrial cancer is more common among women with diabetes and is also associated with polycystic ovaries in young women. Most endometrial cancers present at an early stage with the tumour confined to the uterus. As a result, treatment by hysterectomy is usually curative. Uterine sarcomas may cause no bleeding problems but may alternatively present with painful enlargement of the uterus. They are often difficult to distinguish clinically from benign fibroids but are very rare before the menopause. Pelvic MRI scanning may be helpful in determining the nature of a suspicious uterine mass. These are vascular tumours and have a greater tendency both to spread beyond the uterus and to recur locally after treatment than endometrial cancers, and as a result carry a worse prognosis. Investigations Thickening and irregularity of the lining of the uterus on a transvaginal ultrasound is suspicious of possible malignancy. The diagnosis is confirmed with a biopsy of the endometrium. This is usually performed through the cervix with a fine plastic straw-like device, and may be done in clinic. If a biopsy is difficult to obtain initially, a hysteroscopy examination of the uterine cavity may be required under either local or a general anaesthetic. An MRI scan may be arranged of the pelvis either to look at the nature of a uterine mass, or to look at the possible local spread or invasion of a tumour. Sometimes a transvaginal ultrasound scan (TVS) alone is used to image the pelvis pre-operatively. Treatment Hysterectomy and removal of both fallopian tubes and ovaries is the mainstay of treatment for uterine cancers. For some high grade or more advanced stage tumours additional treatment with either radiotherapy to the pelvis or chemotherapy may be used post-operatively. At the time of surgery, biopsies may be taken to assess possible spread of the disease (staging). These include saline washings from the pelvis, biopsy of the omentum (fatty tissue attached to the gut), and the pelvic lymph nodes. Analysis of the pelvic lymph nodes may prevent the need for radiotherapy for many women. Its potential therapeutic effect is controversial. Pelvic radiotherapy reduces the risk of recurrence within the pelvis and is recommended for some higher grade and larger tumours. Laparoscopic keyhole surgery using the harmonic scalpel drastically reduces the side-effects of surgery experienced by women. With this technique the uterus is removed through the vagina after laparoscopic dissection. Hence this technique is not suitable for very large uterine tumours. Recovery from Surgery The recovery and effects of the hysterectomy are essentially the same as for other women undergoing hysterectomy for benign disease, but often a larger incision is used. Effects of Pelvic Lymph Node Dissection The effects of this appear remarkably few. The commonest appears to be of altered sensation usually affecting the lateral part of the front thigh. Very rarely the vulval skin nerves may be affected. This altered sensation usually recovers at least in part with time. Lymphoedema or limb swelling affecting the lower limbs is quite rare occurring in approximately 2-5% of cases. It is much more common however if pelvic radiotherapy is subsequently given in addition. Rarely swelling may affect the vulva or even around the waist. In most cases such swelling is mild and reducible and is not of great concern to most patients. Lymphoedema may occur much later, sometimes following a skin infection or seemingly trivial injury. It is advisable to pay good attention to the skincare of the lower limbs following a pelvic lymph node dissection, keeping the skin well moisturized, and treating any bites and cuts promptly with antiseptic. Lymphatic massage or compression stockings or tights can help to reduce cases of lymphoedema once this has developed. Follow-up after Treatment Traditionally patients are followed up every three months initially with an abdominal and vaginal examination at each visit, with follow-up for five years overall. No smear tests are required. In cases where the prognosis is very good the length of follow-up may be reduced. It is important to contact your doctor or consultant if you develop further vaginal bleeding following a hysterectomy for uterine cancer.