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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 into womb cancer including looking into the genetics of womb cancer, hormone replacement therapy (HRT), surgery, treatment after surgery 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.

Here is a video on what it's like to take part in a clinical trial:

View a transcript of the video showing what happens when you take part in a clinical trial. (Opens in a new window)

 

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 2 main types of hormone replacement therapy (HRT). One type contains oestrogen only. The other contains oestrogen and progesterone – the main 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 post menopausal 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 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

Womb cancer usually affects older women and is uncommon in young women. The usual treatment is removal of the womb (hysterectomy) and ovaries, which can be very distressing if young women want to have children. So doctors are looking into using hormone therapy to treat very early stage womb cancer in some young women.

Doctors are only likely to consider fertility sparing treatment for young women with low grade endometrial cancer. Most of these cancers will respond well to hormone treatment (with progesterone). The 2 most common hormone treatments doctors use to treat womb cancer are

  • Medroxyprogesterone acetate (MPA)
  • Megestrol acetate (MA).

Doctors may also use an intrauterine device (IUD or coil) containing a hormone called levonorgestrel. Early trials are also looking at surgery to remove the cancer itself (leaving behind the womb) followed by hormone treatment for about 6 months.

As long as there is a good response to hormone treatment, you can eventually try to get pregnant. You are followed up very closely to check for signs of cancer coming back (recurrence). Once you have completed your family, you will have a hysterectomy.

This is not a standard way of treating early womb cancer, and doctors are still finding out the best drugs to use, the doses, how long to use them and what the best follow up is. Doctors make sure women are aware of this before deciding to have fertility sparing treatment.  Researchers continue to look into this type of treatment to make sure it is safe and effective for young women with early 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 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 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 nodes is called lymphadenectomy.

The results showed that systematically removing all the lymph nodes in the pelvis does not help to stop the cancer coming back. But may increase the risk of developing swelling of the legs (lymphoedema), which can cause a number of problems. Any swollen or suspicious looking lymph nodes should still be removed.

The PIONIR study is looking at a test to see if it can help surgeons see which lymph nodes are the first to take up fluids draining from the cancer. These lymph nodes are called sentinel nodes. During surgery, the study team injects a dye into the cancer. This dye shines brightly under infrared light, showing the sentinel nodes. If this works, in the future these nodes could then be tested for cancer during surgery, so the surgeon will know whether to remove the rest of the nodes or not. 

 

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 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 at the same time 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. Having these treatments together does cause more side effects, so it isn't suitable for everyone.

One UK trial is looking at giving chemotherapy at the same time as radiotherapy after surgery (the PORTEC 3 trial). This trial has closed and we are waiting for the results.

Chemotherapy

It is not completely clear yet what the role of chemotherapy is after surgery for early womb cancer. Doctors are more likely to use it if there is a high risk of the cancer coming back, for example for high grade cancers or clear cell or serous types of endometrial cancer. 

A few studies found that chemotherapy reduced the risk of cancer coming back outside the pelvis, but did not increase the average length of time women lived (overall survival). But the researchers found that in a subgroup of women with higher stage or higher grade cancer, or women over the age of 70, chemotherapy did seem to improve survival. Doctors are waiting for the results of further trials to show whether or not chemotherapy is helpful for women with early stage cancer. These trials include the PORTEC 3 trial and the GOG 249 trial in America. This American trial is comparing external radiotherapy to the pelvis with internal radiotherapy (brachytherapy) followed by carboplatin and paclitaxel chemotherapy. Other trials are looking at the best combination of chemotherapy drugs to use for womb cancer. 

 

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. IMRT is used routinely for some types of cancer such as head and neck cancer.

Doctors are now starting to use IMRT, or a newer technique called volumetric modulated arc radiotherapy (VMAT), in some centres for womb cancer.

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. This trial has closed and we are waiting for the results.

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.  This trial has closed and we are waiting for the results.

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. Both these trials have closed and we are waiting for the results.

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. Similar drugs researchers are looking into for womb cancer include everolimus and temsirolimus. They are all types of mTOR inhibitors.

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. This trial has closed and we are waiting for the results.

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. A UK study is looking 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. 

These trials have closed and we are waiting for the results.

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Updated: 7 October 2014