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Womb cancer research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know they are safe. First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to use are they tested in people, in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

There is research looking into the genetics of womb cancer, hormone replacement therapy (HRT), surgery, treatment after surgery, radiotherapy, and support for women with womb cancer. Researchers are also looking at treatments for advanced womb cancer, including chemotherapy, biological therapy and hormone therapy.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating womb cancer section.

 

 

Why we need research

Doctors and researchers must fully investigate all potential new treatments before they can be used as standard treatment for everyone. This is so that

  • We are sure they work
  • We are sure they work better than treatments available at the moment
  • We know they are safe
 

The research process

First, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients.  If we say a treatment is at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer.

Tests in patients are called clinical trials. Cancer Research UK supports many UK and international clinical trials.

Our trials and research section has information about what trials are including information about the 4 phases of clinical trials.  If you are interested in taking part in a clinical trial, visit our clinical trials database. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.

All the new approaches covered here are the subject of ongoing research. Until studies are complete and new effective treatments found, these treatments can't be used as standard therapy for cancer of the womb.

 

Genetics

Gene damage can cause a cell in the body to multiply out of control, and eventually form a tumour. Sometimes people are born with faulty genes that put them at a higher risk of cancer. People who inherit gene faults are likely to develop cancer at a relatively young age. And there is probably a history of cancer in their family. Research into these faulty genes helps scientists to understand the causes of womb cancer and could lead to prevention or new treatments.

Finding genes associated with a higher risk of womb cancer can help to identify women most at risk. In future, these women may be able to have regular screening to pick up womb cancer early on. First we’d have to carry out research into suitable and reliable screening tests. Looking at the womb with trans vaginal ultrasound and taking a tissue sample of the womb lining have been shown to be reliable screening tests for women who are past their menopause. But they haven't been tested in younger women so we can't be sure how reliable they are in premenopausal women.

We already know of one rare inherited gene fault called HNPCC that increases the risk of bowel cancer, womb cancer, ovarian cancer and stomach cancer. This is also called Lynch syndrome. Researchers in America have estimated that almost 2 out of every 100 women (almost 2%) diagnosed with womb cancer has this inherited gene fault. Amongst those under 50, about 8 out of every 100 women with womb cancer (8%) will have Lynch syndrome. Do remember that womb cancer is very rare in younger women.

The NSECG study have identified some gene changes that may increase the risk of cancer of the womb lining (endometrial cancer). There is another study looking at the genetic causes of cancer (the SEARCH study). This study is being done to find out more about possible genetic causes of a number of cancers. Some genes greatly increase the risk of developing cancer. But some genes do not increase the risk so greatly – these genes are hard to find. The aim of the study is to find out more about the genes that greatly or slightly increase cancer risk. It also aims to find any other factors that work with our genes to increase cancer risk.

 

HRT to prevent womb cancer

There are two main types of hormone replacement therapy (HRT). One type contains oestrogen only. The other contains oestrogen and progesterone – both the female sex hormones – and is usually called combined HRT.

We know that oestrogen only HRT increases the risk of womb cancer. For this reason, doctors don’t usually give this type of HRT to women who have not had their womb removed. Oestrogen only HRT seems to increase womb cancer risk even more in very overweight (obese) women.

According to some early research, one type of combined HRT may lower the risk of womb cancer in postmenopausal women. This is continuous combined HRT, where you take progesterone and oestrogen daily. Continuous combined HRT seems to protect most strongly against womb cancer in very overweight (obese) women.

The more commonly used type of combined HRT is called cyclical combined HRT. You take oestrogen every day and progesterone for 10 to 14 days out of every 28 days. Cyclical HRT doesn't seem to affect womb cancer risk very much either way.

We will need larger clinical trials before we know whether continuous combined HRT really can help to prevent womb cancer. In any case, we need to balance this against the recent finding that combined HRT increases the risk of breast cancer and any other possible negative effects of taking daily hormones.

 

Early womb cancer in young women

In September 2010 a very small pilot study reported on the use of intrauterine devices (IUDs) to treat very early womb cancer in women aged 40 or younger. Intrauterine means inside the womb and IUDs are usually used to prevent pregnancy. Womb cancer usually affects older women and is uncommon in young women. But the usual treatment is removal of the womb (hysterectomy) and ovaries, which can be very distressing if young women want to have children. 

A team of researchers in Italy carried out an early trial. They wanted to see whether they could get rid of early womb cancer using an IUD containing a hormone levonorgestrel for a year combined with a monthly injection of gonadotropin releasing hormone (GnRH) for 6 months. The aim was to allow young women to have children before having a hysterectomy. Intrauterine levonorgestrel stops growth of the inner lining of the womb, while GnRH stops oestrogen production. Oestrogen is the hormone that can promote the development of womb cancer.

After a year the IUD was removed and the women had surgery to remove the cancer. 9 women went on to have children. Doctors followed up the women every 6 months to check that cancer had not come back. Once the women had completed their families they had a hysterectomy to make sure that the cancer did not come back in the future. Some women who were very young when diagnosed with cancer were able to become pregnant several years after their IUD treatment.

This is very early research and we need larger trials to make sure that this is a safe and effective treatment for young women with womb cancer.

 

Improving diagnosis

Doctors often use an MRI scan to see if womb cancer has spread  and, if so, how far it has spread. The MAPPING trial  in the UK is looking at whether a PET-CT scan or a different type of MRI scan works better than the usual MRI scan

 

Surgery

If caught early, womb cancer is curable with surgery to remove the womb (hysterectomy). But there can be a risk that the cancer will come back. One major UK trial, called ASTEC (SURGERY), published the results in January 2009. The trial looked into removing the glands (lymph nodes) around the womb, as well as the womb itself, in early stage womb cancer (stage 1 womb cancer). The operation to remove lymph glands is called lymphadenectomy.

The results show that systematically removing all the pelvic lymph glands does not help to stop the cancer coming back. And completely removing the pelvic lymph glands may increase the risk of developing swelling of the legs (lymphoedema), which can cause a number of problems. But any swollen or suspicious looking lymph glands should still be removed. 

 

Treatment after surgery

You may have treatment after surgery to remove your cancer. This is to try to lower the risk of the cancer coming back in the future. Your doctor may call it adjuvant therapy. There is a lot of debate about the best adjuvant therapy for womb cancer. There is also discussion about who needs to have it. Researchers are looking into the following treatments.

Radiotherapy

A UK trial called ASTEC (RADIOTHERAPY) looked into giving radiotherapy after surgery to try to lower the risk of the cancer coming back. The trial was for stage 1 and 2 womb cancer at intermediate or high risk of the cancer coming back after surgery. The results from this trial were published in January 2009. The researchers found that external radiotherapy did not help women to live longer than those who didn't have it. They suggest that internal radiotherapy may be a better way of reducing the cancer coming back in the area. So we need more research to find that out. 

Chemoradiation

A recent trial looked at giving chemotherapy as well as radiotherapy. It found that chemotherapy and radiotherapy can reduce the chance of the cancer coming back after surgery more than radiotherapy on its own. Research in the USA and Europe has looked at using both chemotherapy and radiotherapy after surgery for women at a high risk of the cancer coming back. Giving these treatments together is called chemoradiation. This combined treatment has been useful in other gynaecological cancers. 

One UK trial is looking at giving chemotherapy at the same time as radiotherapy after surgery (the PORTEC 3 trial). We will need to wait for the results of these trials before doctors will know whether this type of treatment should become routine and who should have it.

Chemotherapy

Research is looking into using chemotherapy instead of radiotherapy, but there is not enough proof that it works for it to be used routinely. One issue with chemotherapy is that there are likely to be more side effects, which may put women off. So some women may be less likely to complete their full course of treatment. So far the research results haven't been clear. One large trial reported that chemotherapy with a single drug called doxorubicin given after surgery didn't help. A Japanese trial has reported that a combination of 3 chemotherapy drugs called CAP after surgery. CAP is cyclophosphamide, doxorubicin (also called Adriamycin) and cisplatin. It could be as helpful as radiotherapy for some women with womb cancer.

There is information about trials for womb cancer on our clinical trials database.

 

Side effects of radiotherapy

Intensity modulated radiotherapy (IMRT) is a new way of giving radiotherapy. In this type of treatment, the radiation beam is shaped so that it fits the cancer more exactly. This may help treat the cancer by giving a higher dose directly to the tumour. But it may also help reduce side effects by keeping delicate areas out of the radiotherapy field. 

Studies in the USA are looking into IMRT to reduce side effects for womb cancer. The specialist has to shape the beam so that it avoids the bladder, bowel, and the bone marrow in the pelvic bones. This treatment is still experimental and is not standard treatment for womb cancer in the UK. It is important to test in this way because it is possible that cutting some areas out of the treatment field could increase the risk of the cancer coming back.

The HOT II trial is looking at whether using a high pressure oxygen treatment called hyberbaric oxygen (HBO) therapy can help to relieve the long term side effects of having radiotherapy to the pelvic area. 

The PRECIOUS trial is looking into how doctors and nurses collect information about the side effects of radiotherapy for womb cancer. Researchers have developed a questionnaire which people answer on a computer. They want to test the questionnaire to find out how good it is at helping doctors understand and treat the side effects.  

There is more information about these trials on our clinical trials database.

 

Treating advanced womb cancer

Doctors and researchers are looking at the following treatments for advanced womb cancer.

Chemotherapy

Doctors are looking at chemotherapy treatments for women with womb cancer that has come back or has spread to another part of the body after previous chemotherapy. The CA163196 trial aims to find out whether the chemotherapy drug ixabepilone works better than doxorubicin or paclitaxel. It will also find out more about the side effects of these treatments. 

The EORTC 55984 trial is looking at doxorubin (Adriamycin) and cisplatin with or without paclitaxel (Taxol) for women with advanced womb cancer.  Doctors know that doxorubin and cisplatin work well together and this trial is trying to find out if adding another drug, paclitaxel, will mean that the cancer is less likely to come back. 

A trial is looking at a new drug called AEZS 108 for advanced womb cancer. AEZS 108 has 2 parts. One part is the chemotherapy drug doxorubicin. The other part is a type of hormone. The hormone helps doxorubicin attach to cancer cells using certain hormone receptors. The main aim of the trial is to compare AEZS 108 with doxorubicin to find out which helps women with advanced womb cancer live longer.

Biological therapy

Doctors sometimes treat advanced endometrial cancer with chemotherapy or progesterone therapy. But the cancer can sometimes come back very soon after these 2 treatments. Researchers are hoping that a new biological therapy called deforolimus (also called AP23573 or MK-8669) may work better. One trial is looking at using deforolimus as a treatment for advanced womb cancer. It is comparing deforolimus with progesterone therapy for women with advanced womb cancer who have had chemotherapy. 

Hormone therapy

Doctors often use a hormone therapy called megestrol acetate (megace) to treat womb cancer that has spread or come back after treatment. A trial is using a new drug called BN83495 with megace to see how well this combination works at controlling the cancer. Doctors hope that it may control the cancer for longer than megace on its own. It may also improve women's quality of life. BN83495 works by blocking sex hormones. The trial is for women with womb cancer that has hormone receptors.

Anastrozole is a type of hormone therapy that doctors use to treat some types of breast cancer. Researchers are now looking to see if it helps women with other types of hormone sensitive cancers. The Paragon trial is looking at anastrozole for womb or ovarian cancer that has come back after chemotherapy. It is for post menopausal women whose cancer has hormone receptors.

Biomarkers

As patients respond differently to treatments doctors are investigating ways to find out which women will respond to which drug. They also want to find out how long the benefits last. There is a study looking at using biomarkers to help doctors choose suitable treatment for women who have ovarian or womb cancer. Researchers are looking for chemical and proteins blood and urine samples of women who have these cancers. These chemicals are called biomarkers. Levels of biomarkers change before, during and after chemotherapy. This study may help find out what the baseline levels of these biomarkers are. The study information may also be able to tell doctors how well a chemotherapy treatment is working.

A different study is looking at circulating blood vessel cells and cancer cells to find useful biomarkers to plan the treatment of womb and other women's cancers.

You can find out about womb cancer trials on our clinical trials database. Pick 'womb' from the dropdown menu of cancer types.

 

Follow up care

Following treatment for womb cancer, some women may experience some long term physical,social and emotional difficulties. There is a UK study to see if planned rehabilitation sessions can help women to return to as normal a life as possible.

The ENDCAT study is comparing follow up telephone calls from a clinical nurse specialist with hospital appointments. Another UK study is looking at how health professionals assess possible sexual difficulties in women who have had radiotherapy for womb cancer or cervical cancer.

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Updated: 21 February 2013