Read about the latest UK research looking at womb cancer.
All cancer treatments have to be fully researched before they can be used for everyone. This is so we can be sure that:
- they work
- they work better than the treatments already available
- they are known to be safe
The latest research into causes, prevention and treatment for womb cancer is outlined below.
Lynch syndrome or hereditary non polyposis colon cancer (HNPCC) is an inherited faulty gene that increases the risk of certain cancers in some families. It's associated with a number of cancers, including bowel cancer and womb cancer.
Doctors are looking at how many womb cancers are due to Lynch syndrome. Out of these women, the researchers want to find out how many would consider yearly bowel screening to remove any small growths (polyps) that might become cancer.
Researchers are also looking at the genetic causes of a number of different cancers. Some genes greatly increase the risk of developing cancer, and some genes cause a smaller increase in risk. The aim of this research 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.
There are 2 main types of hormone replacement therapy (HRT). One contains oestrogen only. The other contains oestrogen and progesterone, and is called combined HRT.
Research shows 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. 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.
Researchers are also looking at whether having progesterone reduces the risk of developing womb cancer in obese women.
Womb cancer usually affects older women and is uncommon in young women. The usual treatment is removal of the womb (hysterectomy) and ovaries. Doctors are looking into using hormone therapy to treat very early stage womb cancer in some young women.
Most low grade endometrial cancers will respond well to hormone treatment (with progesterone).
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 and 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 often use an MRI scan to see if womb cancer has spread and, if so, how far it has spread. The MAPPING trial looked at whether a PET-CT scan or a different type of MRI scan works better than the usual MRI scan. We are awaiting the results of this trial.
Surgery for early womb cancer often cures the cancer. But there is a risk that the cancer might come back. Removing the nearby lymph glands reduces that risk but has side effects and increases the risk of developing swelling of the legs (lymphoedema).
Researchers are looking at a new 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 surgeon injects a dye into the cancer. This dye shines brightly under infrared light, showing the sentinel nodes.
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.
There is not a standard way of dealing with the lymph glands. Some doctors remove them at the time of surgery. They decide about whether women need further treatment such as chemotherapy based on whether there are any cancer cells in the glands. Other doctors don’t remove them and give chemotherapy with or without radiotherapy. Researchers are looking into whether one is better than the other.
Metformin is a drug to treat diabetes. Early research in the laboratory has shown that metformin can slow down the growth of some cancers, including womb cancer.
A study looked at metformin before surgery for womb cancer or a condition affecting the lining of the womb called endometrial hyperplasia. This condition increases the risk of womb cancer. The researchers wanted to find out if taking metformin before surgery helps slow down the growth of womb cancer or endometrial hyperplasia.
Researchers are looking at how metformin combined with exercise might affect cells in the womb.
The aim of treatment after surgery is to lower the risk of the cancer coming back in the future. Your doctor may call it adjuvant therapy. It is unclear who needs to have it and which treatment is best for womb cancer. Researchers are looking into the following treatments after surgery:
- chemotherapy and radiotherapy together (chemoradiotherapy)
After radiotherapy to the pelvic area, some people can have long term bowel problems such as:
- needing the toilet more often
- bleeding from the back passage
This happens if the radiotherapy causes a thickening of the tissue making it less stretchy (radiation fibrosis). Doctors are trying to find ways to relieve these problems.
Researchers have looked at whether using a high pressure oxygen treatment called hyberbaric oxygen (HBO) therapy could help relieve the long term side effects of radiotherapy to the pelvis. They found no evidence that HBO helped people with bowel side effects from radiotherapy. These results disagree with other reports that say HBO is helpful. We need more research to know for sure.
Researchers are looking into the use of a palm oil supplement and a drug called pentoxifylline to relieve symptoms caused by pelvic radiotherapy. Doctors think these may work well together to reduce radiation fibrosis.
Everyone has bacteria in their gut and each type of bacteria has an individual smell. Radiotherapy can change the number of different types of bacteria. Researchers want to find out if an electronic nose can predict long term changes in bowel function after pelvic radiotherapy by picking up the changes in smell. Looking at the way bacteria changes may help researchers to understand and predict who will and won't experience bowel problems long term.
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. Researchers are looking into:
- comparing ixabepilone with doxorubicin or paclitaxel
- doxorubin (Adriamycin) and cisplatin with or without paclitaxel (Taxol)
- a new drug called AEZS 108 which combines doxorubicin with a hormone
Biological therapies are treatments that act on processes in cells or change the way that cells signal to each other.They can stimulate the body to attack or control the growth of cancer cells. Biological therapies that researchers are looking into for womb cancer include:
- deforolimus (also called AP23573 or MK-8669)
Doctors often use a hormone therapy called megestrol acetate (megace) to treat womb cancer that has spread or come back after treatment. Researchers are looking at 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.
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. It is for post menopausal women whose cancer has hormone receptors.
Biomarkers are substances that doctors can measure in the body to help them tell how a disease is developing or how a treatment is working. Levels of biomarkers change before, during and after chemotherapy. Researhers are looking into whether measuring these biomarkers can help them work out which treatments will work for an individual and 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.
Following treatment for womb cancer, some women may experience some long term physical, social and emotional difficulties. There is research looking to see if planned rehabilitation sessions can help women to return to as normal a life as possible.