Uterine cancer is a type of cancer that originates from any of the two layers of the uterus. These two layers are the endometrium (uterine lining) and the muscle layer. The endometrium is highly vascular, meaning it contains many blood vessels. As preparation for pregnancy, the endometrium lining increases in thickness. If pregnancy does not occur, the lining sheds and this is known as menstruation.
Cancer that develops in the endometrium is called Endometrial Carcinoma, which is the most common type of uterine cancer at approximately 95 percent. Cancer that arises from the uterus’ muscle layer is Uterine Sarcoma, which is rare.
According to the 2015 Singapore Cancer Registry Annual Registry Report, uterine cancer is fourth in the 10 most frequent cancers in females, with higher incidences in Indian and Malay women, respectively.
The cause of uterine cancer is unknown. Although there are certain factors that will increase a woman’s risk, 40 percent of cases have risk factors that are unidentifiable. However, what is certain is that the incidence of uterine cancer is highly dependent on age.
The common risk factors of uterine cancer include:
- Age – Although women can develop uterine cancer at any age, 70 percent of cases are reported at age 50 and above.
- Women who are postmenopausal – 75 percent of uterine cancers occur in women in this stage
- Women with irregular ovulation and missed periods
- Women with a personal history of ovarian, breast or colon cancer
- Women with a mother or daughter with uterine/endometrial cancer
- Unopposed oestrogen levels after menopause – This occurs in 75 percent of women. Continuous production of oestrogen after menopause increases the risk of uterine cancer because of the absence of progesterone, which keeps oestrogen levels and effects in check.
- Overweight or obese (more than 50 pounds overweight) – Fatty tissue in overweight or obese women produces higher levels of oestrogen, increasing the risk of uterine cancer.
- Lengthy period of menstruation – Woman started having menses at an early age (before age 12) or experienced menopause at an older age (after age 52)
- Women who never had pregnancy – Higher progesterone levels during pregnancy accord a protective effect on the endometrium.
- Women who are undergoing hormone and/or targeted treatment (particularly tamoxifen) for breast cancer – These women are advised to check with their doctors if they develop abnormal vaginal bleeding while taking tamoxifen.
- Hyperinsulinaemia – High insulin levels increase the risk of developing tumours
- History of Polycystic Ovarian Syndrome (PCOS)
- History of Endometrial Hyperplasia – Abnormal thickening of the uterine lining
- Liver disease
- History of pelvic radiation
- High fat diet
- Diabetes mellitus
When it comes to understanding a disease including uterine cancer, a medical term that is often encountered is “Pathophysiology”. This medical discipline describes the various changes and conditions that are typically observed as the disease state progresses.
In uterine cancer, the following pathophysiological changes are observed in the progression of the disease:
- Endometrial cancer originates in a polyp in a diffuse multifocal pattern
- The pattern of spread is partially dependent upon the degree of cellular differentiation of the tumour
- Early tumour growth is characterised by friable and spontaneous bleeding
- Later tumour growth is characterised by growth or invasion toward the cervix
Signs and Symptoms
Women who suspect that they might have uterine cancer should watch out for abnormal vaginal bleeding. This would include:
- Continuous menstrual periods or vaginal bleeding more than once a month or spotting or continuous bleeding throughout the month
- No menstrual bleeding for 12 months or more and then suddenly develops spotting or bleeding
- Menorrhagia or very heavy vaginal bleeding
Other signs and symptoms:
- Pain during sexual intercourse
- Painful or difficult urination
- Pelvic pain
- Abnormal vaginal discharge that is watery or blood-tinged
How is Uterine Cancer Diagnosed?
When a woman schedules an appointment with her doctor due to abnormal vaginal bleeding, the doctor will conduct a complete physical examination followed by a pelvic examination, which includes inspection and palpation of the uterus. Pap smear may also be ordered to check for the presence of abnormal glandular cells, which are characteristic of uterine cancer.
In the early stages of the disease, the results of the pelvic examination are frequently normal. It is only in the advanced stages that changes in the size, shape, or consistency of the uterus or its surrounding support structures may be found. For Pap smears, only 30 to 50 percent of patients with cancer will produce abnormal results.
If there are abnormal findings, the doctor may perform endometrial sampling/biopsy, wherein a thin device is inserted into the uterine cavity and a uterine lining sample is aspirated for analysis.
Another procedure that may be performed is dilation and curettage (D&C). D&C is done in cases of patient intolerance to examination, cervical stenosis, and recurrent bleeding after a negative biopsy. A day surgical procedure requiring hospital admission and the use of general anaesthesia, D&C involves dilating the cervix to allow for the insertion of a curette which will be used to scrape the uterine lining for tissue samples.
Other examinations that a doctor may order include transvaginal ultrasound, CT scan, or MRI.
Early Detection and Prevention
There are important tips that a woman should keep in mind to lower her risk of uterine cancer as well as enable early detection of disease. Keep the following tips in mind:
- Always have a yearly pelvic examination with your doctor.
- Any abnormal vaginal bleeding should be reported promptly to your doctor.
- Eat a healthy diet and maintain healthy weight.
- Increase intake of foods that are high in fibre, like vegetables and fruits, and decrease intake of high fat and high cholesterol foods.
- Observe a regular exercise regimen.
- Consult your doctor regarding the use of oral contraceptive pills, progestin hormone therapy, or Mirena (Medicated Intrauterine Contraceptive Device) as preventive measures for uterine cancer.
- Get pregnant and have children
Uterine cancer is a treatable disease as long as it is detected early. Sincere Healthcare Group offers comprehensive screening programmes utilising the latest medical equipment. If you are experiencing symptoms which may be indicative of uterine cancer, schedule an appointment with one of our specialists today.