Treating cancer of the endometrium Information for patients Gynaecology
We have written this leaflet to provide you with information following your diagnosis of cancer of the endometrium. We understand that this can be a very difficult and stressful time in your life. To be told that you have cancer can be a real shock and most women will have many questions and fears. This leaflet will provide you with written information about the different ways of treating cancer of the endometrium. Your doctor and nurse specialist (key worker) are available for you to talk to about any aspect of your disease and to explain the treatments you may be offered. What is cancer of the endometrium? The endometrium is the lining of the uterus (womb). A cancer can occur when the cells of the endometrium grow abnormally. If left untreated the cancer may grow and spread through the wall of the uterus and to other parts of the body. Ovary Fallopian tube Uterus Vagina page 2 of 8
What treatment can I have? Cancer of the endometrium can be treated in several ways. Your doctor will discuss these with you and advise which treatment would be recommended for you. Hysterectomy This is the most common treatment for cancer of the endometrium and for many women this is the only treatment they will need. A hysterectomy is the name given to the operation to remove a woman's uterus (womb) and cervix (neck of the womb). Both ovaries and tubes are removed as part of your operation (surgery). They are removed to help reduce the risk of the cancer spreading and help to stage the disease (tell how much cancer is there). For some people the operation can be done using laparoscopic (keyhole) surgery. Your doctor will discuss the exact procedure with you. You will be given a booklet that contains more information about having a hysterectomy. Radiotherapy This is sometimes given in addition to, or instead of having a hysterectomy. Radiotherapy is the use of high energy X-rays to destroy abnormal cells. These cells are more sensitive to radiotherapy than normal cells and will be destroyed. Normal cells in the area being treated are also affected by the radiotherapy but recover after treatment. Radiotherapy can be given externally (similar to having an X-ray) or internally, where the radioactive source is placed near the cancer using a vaginal applicator. Your doctor will discuss the exact treatment with you and explain how it is to be carried out. You will also be given written information about the type of radiotherapy you are going to have. page 3 of 8
Clinical trials We are constantly investigating ways of improving the treatment of endometrial cancer. In order to do this, clinical trials are organised to compare current methods of treatment and to introduce and study the effectiveness of new treatments. If you are eligible (meet the requirements) your doctor may ask if you would consider taking part in a clinical trial and give you information about this. You do not have to take part in any trials and you do not have to give a reason if you do not wish to take part, your care will not be affected in any way. If you would prefer not to take part in a trial you will be offered the standard treatments that are available. Drug treatments These include chemotherapy and hormonal therapy which may also be used in some cases. What is chemotherapy? Chemotherapy is a form of drug treatment used to destroy abnormal cells. Cancer cells are more sensitive to chemotherapy than normal cells. Chemotherapy is given as an infusion (drip) through a tube/cannula into a vein in your arm or neck, or in tablet form. The side effects of chemotherapy vary depending on the specific treatment you are having. Your doctor will explain this to you and you will be given information leaflets about the chemotherapy you are going to have. What is hormone therapy? Hormone therapy is another form of drug treatment. This is often used in patients who choose not to or, for medical reasons, are not able to have other forms of treatment. Hormone therapy can be given in tablet form. Alternatively, an inter-uterine device ('coil') containing hormones page 4 of 8
(Mirena coil) can be inserted into your uterus to help control the cancer cells. Your doctor will discuss hormone therapies with you. Will I need any further investigations? Sometimes it is necessary to carry out further investigations before deciding which treatment is best for you. Your doctor will explain, discuss and plan your care and treatment with you. Where will I go to have my treatment? Surgery is carried out at the Royal Hallamshire Hospital. Radiotherapy and chemotherapy are given at Weston Park Hospital. Some forms of chemotherapy be may be given at Doncaster Royal Infirmary. How will my treatment affect me? Psychological effects Having treatment for any kind of cancer can be very stressful and upsetting. People will react in different ways; there are no right or wrong ways to feel. Your specialist nurse (key worker) is available if you would like to discuss how you are feeling about your diagnosis and treatment. Physical effects The physical effects of cancer treatments vary. Your nurse will give you verbal and written information about what you may expect from the specific treatment you are going to have. Loss of fertility Although not common, cancer of the endometrium can occur in younger women who have not had any children or who would have liked to have had more children. It is not possible to become pregnant following treatment for endometrial cancer. If you would like to speak page 5 of 8
to a specialist doctor about fertility issues before starting any treatment this can be arranged. Menopausal symptoms Many women with endometrial cancer have already gone through the menopause so removing your ovaries or having radiotherapy is unlikely to have any effect on your hormone production. If you are still having periods, removing your ovaries or having radiotherapy will cause early menopause. This may cause symptoms such as: Hot flushes Irritability Dryness of the vagina Loss of libido (reduced sexual desire) Dry skin Hair loss You may not experience all of these symptoms, but, if these symptoms occur they may occur more suddenly than during a natural menopause. You may be able to have hormone replacement therapy to help with these symptoms and your doctor will be happy to discuss this with you. Sexual intercourse Endometrial cancer cannot be passed to your partner during intercourse. Occasionally you may notice a change in your libido following diagnosis and treatment. This may be improved or reduced, but it is difficult to predict how it may affect you. Radiotherapy may also cause soreness and inflammation of the vagina. After radiotherapy the vagina may become shorter and narrower and less lubrication may be produced. The vaginal changes can be uncomfortable, especially during intercourse. The use of vaginal dilators following treatment is recommended. The radiographer or your specialist nurse will discuss this with you. page 6 of 8
Your specialist nurse is available if you would like to discuss any issues and will try to answer any questions you have. What happens when my treatment has finished? When your treatment is completed we will arrange to see you at a follow up clinic for 3 years (every 3 months for the first year, then 4 monthly and 6 monthly intervals). This may be at either the Gynaecology Outpatient Clinic which is held in the Jessop Wing, or at Weston Park Hospital depending on the treatment you have had. If you were referred to Sheffield Gynaecological Cancer Centre from one of the district hospitals, it may be possible for you to have follow-up appointments in your local hospital. You will need to discuss this with the consultant who is looking after your care. Where can I find more information? You will be given contact details for your specialist nurse key worker. Your key worker is an experienced specialist nurse in gynaecology cancer. Her role is to provide support and information for you and for your family throughout your treatment. Your key worker can also provide you with information about other agencies that may be able to offer support, counselling, benefits advice and information. Please feel free to contact your key worker if you have any concerns or questions about your planned treatment or if you simply wish to talk to someone about how you are feeling. You can contact the nurse specialist gynaecology-oncology key workers on: 0114 226 8423 page 7 of 8
You can also telephone the main switchboard on: 0114 271 1900 and ask for the Clinical Nurse Specialist for Gynaecology to be contacted. Or for general information please contact: Ward G2 0114 226 8367 0114 226 1094 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD5369-PIL141 v5 Issue Date: September 2018. Review Date: September 2021