St. James’s Hospital (SJH) Gynaecological Cancer Care Centre is the largest provider in the Republic of Ireland of treatment for malignancy of the reproductive organs: cancer of the womb (uterus), cervix, ovary, vagina and vulva. Our centre provides a regional and national service and is accredited by the NCCP (the HSE’s National Cancer Control Programme) for complex radical gynaecological surgeries. International standards of treatment apply, and the service is supported by research and teaching activities through Trinity College Dublin and the Cancer Trials Research Office at SJH.
Over 300 women with gynaecological cancer are referred to the centre annually. Cancer of the endometrium (lining of the womb) is the most common cancer, followed by cancer of the ovary/fallopian tube, then cervical cancer. Cancers of the vulva and vagina are less common. Women are referred by their general practitioners or by gynaecologists at their local hospital. A Multi-Disciplinary Team of doctors plans and provides the cancer care, and surgery is performed at SJH. Some of the treatments such as chemotherapy can be given in other local regional hospitals. Radiotherapy treatment is given at St Luke’s Hospital (SJH and in Rathgar, Dublin). When treatment is completed, long-term follow-up care is often provided at the patient’s local hospital. Follow-up visits may go on for five years or longer.
Endometrial Cancer (Cancer of the Womb)
The womb, or uterus, is a pear-shaped organ located between the bladder and the rectum. The inside of the uterus has two layers: The thin inner layer is called the endometrium and the thick outer layer, which is composed of muscle, is called the myometrium. In women who menstruate, the endometrium thickens every month in preparation for pregnancy and the endometrial lining is shed during the menstrual period. After menopause, when menstrual periods stop, the endometrial lining normally stops growing and shedding. In women who have endometrial cancer, the uterine lining develops abnormal cells.
Most womb cancers are slow growing, but there are cases of aggressive womb cancer. The cancer may spread to other parts of the body, particularly the lymph nodes. Cancer of the womb is often suspected when a woman has abnormal vaginal bleeding, particularly bleeding after menopause. An ultrasound scan of your abdomen (tummy) or internally (trans-vaginal) will help the doctor to decide whether you need a biopsy (a sampling of cells from the lining of the womb). The most common tests include:
- Endometrial Biopsy: An internal test done in the outpatient clinic.
- Hysteroscopy: A test that is done as a day surgery, with a short anaesthetic with dilation and curettage (D&C).
Both tests take a sample of tissue from the lining of the uterus, called the endometrial lining. A laboratory doctor will examine the tissue with a microscope to see whether there are signs of cancer.