Uterine Cancer: Are You at Risk?

Uterine cancer is the fourth most common cancer in Singapore, with around 2,968 cases reported between 2016 and 2020. It is commonly also referred to as endometrial cancer, although uterine cancer also includes uterine sarcoma.

What is Uterine Cancer

The uterus is a pear-shaped organ that plays a role in menstruation and pregnancy. It sits between your rectum and bladder in your pelvis, and it is where a fertilized egg would be implanted during pregnancy. It is made up of the perimetrium (outermost layer), myometrium (muscular middle layer), and the endometrium (the inner layer that is shed during your menstrual cycle). The top part of your uterus is called the corpus, while the end of your uterus is the cervix and connects your uterus to the vagina.

Endometrial cancer begins in the endometrium, while uterine sarcoma develops in the myometrium and is much rarer than endometrial cancer.

The majority of uterine cancer cases in Singapore are diagnosed after 40 years of age, typically between 50 and 70 years old. If it is detected early, the rates of recovery are higher than if the disease is advanced.

There are several stages of uterine cancer:
Stage I: The cancer is confined to the uterus only.
Stage II: The cancer is present in both the uterus and the cervix.
Stage III: The cancer has spread beyond the uterus, perhaps to the lymph nodes in the pelvic area, but hasn’t spread to the rectum or bladder.
Stage IV: The cancer has spread beyond the pelvic area and can affect the bladder, rectum, and more distant parts of your body.

Symptoms

Signs of uterine cancer may resemble those of other conditions such as endometriosis, fibroids, or polyps. If you notice unusual pain in your body or abnormal vaginal bleeding, you are advised to consult your healthcare provider to get a proper diagnosis.

Symptoms of uterine cancer include:

• Vaginal bleeding in between period cycles
• Vaginal bleeding or spotting after menopause, even if it’s a slight amount
• Lower abdominal pain or cramps in your pelvis
• Thin white or clear vaginal discharge after menopause
• Extremely prolonged, heavy, or frequent vaginal bleeding after menopause

Risk Factors

Although there is no known exact cause of uterine cancer, there are certain risk factors that may increase your risk of developing the cancer. Most of these risk factors are related to the balance between the hormones estrogen and progesterone.

Risk factors for uterine cancer include:

• Age: Your likelihood of developing uterine cancer increases with age.
• High-fat diet: Fatty food leads to obesity and also increases your risk of cancers, including uterine cancer.
• Family history: If your mother or sister has a history of uterine cancer, your chances of developing it are higher. People with certain conditions, such as Lynch syndrome or polycystic ovarian syndrome (PCOS) are also at a higher risk of uterine cancer.
• Obesity: Adipose tissue can synthesize estrogen, raising your risk of uterine cancer.
• Early menstruation: If your period started before the age of 12, your risk of uterine cancer may increase as your uterus would have been exposed to estrogen for longer.
• Late menopause: Similarly, if your menopause occurs after age 50, your risk increases as your uterus would have been exposed to estrogen longer.
• Prior radiation therapy to the pelvis: Radiation therapy to the pelvis to treat other cancer can cause damage to your cell’s DNA. This damage may increase your risk of uterine cancer.
• Estrogen replacement therapy: Estrogen replacement therapy is used to relieve symptoms of menopause. However, getting it without progesterone increases your risk of uterine cancer.

According to radiation oncologist Dr. Lee Khai Mun, the top three risk factors he looks out for are “obesity, a strong family history of breast, uterine, ovarian and colon cancers, as well as irregular or heavy periods”. If you have these risk factors and are worried, it is best to speak to a healthcare provider.

Diagnosis & Treatment

Unfortunately, there is currently no standard screening test for uterine cancer. According to Dr. Lee, uterine cancer may be incidentally diagnosed along with cervical cancer after a Pap smear test.
If you notice possible signs of uterine cancer, do talk to your healthcare provider for a proper diagnosis. Some tests that may be conducted include:

• CT scans, where detailed pictures of the inside of your body are taken.
• MRI scans use radio waves and a powerful magnet to create images.
• Transvaginal ultrasound involves inserting a probe into your vagina to get pictures of your uterus.
• Endometrial biopsy has a thin, flexible tube inserted through your cervix and into your uterus to remove a small amount of your endometrium.

After diagnosis, your exact treatment plan will be determined after further assessment from your doctor.

“As with all confirmed cancers,” Dr. Lee shares. “Treatment options for patients are decided after full assessment of the subtypes and stage of uterine cancer. This includes dilution and curettage (D&C) where a sample of the tissue from the uterus will be taken for assessment, biopsies, radiological imaging such as MRI and PETCT, and surgical staging.”

Most women with uterine cancer might need surgery such as a hysterectomy, or the removal of the uterus. Which is then followed by either radiation therapy, vault brachytherapy as well as chemotherapy, based on the risk assessment of your tumor subtype and histology grade.

“Some common side effects of these treatment methods include surgical risk of bleeding and infection,” says Dr. Lee. “Radiation risks of bladder and bowel dysfunction, lymphedema (swelling due to the buildup of lymph fluids), and chemotherapy risks of nausea, vomiting, hair loss, and immune suppression.”

According to Dr. Lee, the treatment methods mentioned above will have an effect on your fertility, so do speak to your doctor prior to your treatment commencing if you have any concerns. Uterine cancer is not the end of the road and with early detection and prompt treatment, you’ll have a higher chance of beating the cancer.