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Uterus and Endometrium Cancer |
Article Sections
Causes
Symptoms
Diagnosis
Treatment
FAQs |
Introduction
The lining of the uterus or womb is known as the endometrium. The endometrium comprises many blood vessels that go through phases of increasing thickness before being shed as the monthly menses or periods. Hormones produced by the body control each phase of increasing thickness of the endometrium.
How common is Uterus and Endometrium Cancer?
Endometrial cancer is the commonest female genital tract cancer in the United States of America. In Singapore, it is the 10th commonest cancer in females, after ovarian and cervix cancers. Endometrial cancer affects mainly women who have reached menopause. Seventy five percent of the time, endometrial cancer occurs after age 50.
Risks and Causes
Women at high risk of developing endometrial cancer tend to be obese and have a large body frame. Women who are 22kg overweight have a 9-fold risk of developing the cancer.
Constant oestrogen stimulation without progesterone modification, which can be found in certain oral contraceptive pills, is also a risk factor. Absence of ovulation, from whatever cause, causes a lack of progesterone. Patients with absence of ovulation have infertility and menstrual disturbances.
Although endometrial cancer is known to be dependent on hormones for its further growth, about 40% of patients have no risk factors.
Symptoms
The only significant clinical sign is abnormal bleeding from the vagina, such as bleeding occurring after the menopause. Pain occurs when there is very advanced disease.
Diagnosis
Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of endometrial cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with endometrial cancer is good.
Aspiration of endometrial contents can be performed as an outpatient procedure when endometrial cancer is suspected. A small tube called a pipette is inserted through the cervix into the uterus and endometrial contents aspirated by suction. The aspirated material is then sent for histology, i.e. examination under a microscope.
Once the diagnosis is confirmed computerised scans (CT) of the uterus and surrounding region and chest x-rays to look at the lungs are performed.
Treatment
A woman's age and reproductive needs determine the choice of treatment.
The mainstay of treatment for endometrial cancer is hysterectomy, or surgical removal of the uterus.
In certain cases, radiotherapy is required after surgery to prevent recurrence of the cancer. Occasionally, radiotherapy alone without surgery is used to cure a patient with endometrial cancer who is not fit for surgery because of other medical conditions. Radiotherapy is associated with skin redness and bladder and rectal irritation, causing pain on passing urine or on defaecation.
Hormonal treatment is used in patients with advanced incurable endometrial cancer. Up to one-third of patients with endometrial cancer that has spread to the lungs have shrinkage of the cancers.
Chemotherapy appears to be effective in patients with advanced incurable endometrial cancers that are aggressive and not responsive to hormones. Side effects of therapy include temporary complete hair loss, nausea and vomiting, darkening of the skin, mouth ulcers and loss of appetite.
Frequently Asked Questions
I bleed from the vagina after sexual intercourse. I am worried. Is this cancer?
Although there may be other reasons that can cause vaginal bleeding, such as cervix infection, early medical attention should be sought. Many cancers of the uterus and cervix can be cured if detected early.
I am on hormone replacement therapy. Is there any risk?
Hormone replacement therapy has many benefits and some disadvantages. Before starting, you should ask your doctor, who knows your personal medical history, for the risks and benefits. Hormone replacement therapy is beneficial in many patients.