Uterine Cancer or Endometrium Cancer (Uterus Cancer)
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Overview
 What is Uterine Cancer or Endometrium Cancer?
Uterine cancer arises from the uterus or womb. The uterus comprises of 2 layers - the uterine lining and the muscle layer. The uterine lining is also known as the endometrium. It comprises of many blood vessels and go through phases of increasing thickness before being shed as monthly menses.
The most common type of uterine cancer are those arising from the endometrium known as carcinoma whereas those arising from the muscle are known as sarcoma (rare).
How common is Endometrium Cancer?
There are about 297 cases diagnosed annually according to the Cancer Registry 2005-2009. It is the 4th most common women’s cancer in Singapore.
Age of Onset
Endometrial cancer can affect women of any age, although 70% of the time, endometrial cancer occurs after the age of 50 years.
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Causes and Risks
In about 40% of patients, no risk factors are identified.
Factors associated with endometrium cancer include obesity, diabetes mellitus, hypertension . Unopposed estrogen stimulation e.g. estrogen only pills is a strong risk factor. Patients with the condition called polycystic ovarian syndrome are also at risk.
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Symptoms
Symptoms and Signs of Endometrium Cancer
The main clinical sign is abnormal vaginal bleeding (e.g. post menopausal bleeding, irregular menstrual bleeding, menorrhagia) or vaginal discharge and occasionally pelvic pain.
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Diagnosis
Diagnostic Tests
Ultrasound of the pelvis is useful to demonstrate whether there is any abnormality of the endometrium (e.g. thickening). However, to diagnose endometrial cancer, an endometrial biopsy is necessary. This can be achieved via outpatient aspiration of endometrial contents (e.g. pipelle or explora endometrial sampling devices) or as a minor day surgical procedure called hysteroscopy, dilatation and curettage. Specimens from the dilatation and curettage/outpatient aspiration are sent for analysis in the pathology laboratory.
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Treatment Options
Treatment of Endometrium Cancer
The mainstay of treatment for uterine cancer is surgical removal of the uterus with fallopian tubes and ovaries as well as the draining lymphatics. It will also allow the doctors to assess the extent of spread of the cancer (stage of the cancer). Following the surgery, additional or adjuvant treatment such as radiotherapy, hormonal treatment or chemotherapy may or may not be required depending on the stage, grade and type of cancer.
Prognosis of Endometrium Cancer
The overall prognosis of endometrial cancer is good if diagnosed in the early stage.
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Frequently Asked Questions
Although there may be other reasons that can cause vaginal bleeding, such as cervix infection or trauma, you should seek early medical attention. Many cancers of the uterus and cervix do present with bleeding. If detected and treated early, there is a higher chance of cure.
I am on hormone replacement therapy. Is there any risk of getting cancer?
Studies show that combined hormone replacement therapy, known as HRT in short (progestin and estrogen) may help menopause symptoms in women who still have a uterus without increasing their risk of endometrial cancer. Before starting, you should ask your doctor, who knows your personal medical history, for the risks and benefits of the therapy.
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