Reported in The Star (2/5/07) pertaining to Uterine Cancer:

·          It usually affects the lining of the uterus (endometrium).

·          It is the fourth most common cancer in women in Peninsular Malaysia.

 ·          Benign growths of the uterus – such as polyps and fibroids – are common. They are not cancerous. After removal, such growths do not come back, in most instances.

 ·         Most types of uterine cancer are endometrial cancer. If uterine cancer spreads outside the uterus, it will be found in the adjacent lymph nodes and structures, or to distant organs, like the lungs, liver and bone.    

Difference between Cervical Cancer And Uterine Cancer:

Uterine cancer has to be distinguished from cervical cancer which involves the lowest part of the uterus that abuts on the upper end of the vagina. The cervical (commonly called Pap) smear detects early, pre-cancerous change in the cervix. It does not detect uterine cancer. 

Risk factors Of Uterine Cancer include: 

  • Age. Endometrial cancer occurs mostly after the menopause, the average age of which is 50 years. However, it may occur around the time the menopause begins. 
  • Obesity. Apart from the ovaries and adrenal glands, fat cells produce a certain amount of oestrogen. 
  • Diabetes 
  • High blood pressure 
  • Women who do not ovulate regularly and often have missed periods. 
  • Prolonged exposure to oestrogen (e.g. no or few children, early age when menstruation began, late menopause, i.e. past 50 years old). 
  • Polycystic ovarian syndrome. Many women with this condition are overweight.  
  • Endometrial hyperplasia. Abnormal thickening of the endometrium. Most women who have this condition do not develop cancer. 
  • Women who had cancer of the ovary, breast or colon. 
  • Women whose mother or daughter had endometrial cancer. 
  • Women with an intact uterus and who use estrogen without progestogens for hormone replacement therapy for menopausal symptoms.  
  • The medicine, tamoxifen, which is taken to prevent or treat breast cancer. (The benefits of tamoxifen in the treatment of breast cancer outweigh the risk of developing endometrial cancer.) 

·         Women who have used the combined oral contraceptive pill have a reduced risk of endometrial cancer. This protection persists for at least 10 years after stopping the pill. 

 ·         Most women who have the above risk factors do not get endometrial cancer. Many women with endometrial cancer have none of the risk factors. There is no explanation why this is so. 

Symptoms Of Uterine Cancer: 

There is no screening test for endometrial cancer in women without symptoms. The key to early detection is being alert to its symptoms.   The main symptom is abnormal bleeding, spotting or discharge. This may be steady or occur irregularly. The bleeding may start as a watery, blood streaked flow that gradually contains more blood.   It should not be assumed that abnormal vaginal bleeding occurs with the menopause. The bleeding may also occur between periods or after sexual intercourse.  A doctor should be consulted if any of the following symptoms occur: abnormal vaginal bleeding or discharge, painful sexual intercourse, pelvic pain and/or difficulty or pain on passing urine.  If the endometrial cancer has spread, there may also be symptoms referable to the organ(s) to which it has spread. Consult the doctor. 

Diagnosis and staging:

Most of the tests that diagnose endometrial cancer can be done in the doctor’s office. After taking a history, the doctor will do a physical examination, including a pelvic examination. A Pap smear may be taken to check for abnormal cervical cells, although it is not a dependable test for endometrial cancer.  A transvaginal ultrasound will show if the endometrium has thickened and, if it has, it needs to be examined.  An endometrial biopsy is indicated when the endometrium has thickened.   Sometimes, a hysteroscopy or dilatation and curettage may be done.   If endometrial cancer is diagnosed, the extent of the disease (stage) will need to be determined to plan treatment.

The various stages are: 

Stage 1 – the cancer is confined to the body of the uterus (corpus). 

Stage 2 – the cancer has spread from the corpus to the cervix. 

Stage 3 – the cancer has spread outside the uterus but not outside the pelvis and not to the bladder or rectum. 

 Stage 4 – the cancer has spread to the bladder or rectum, or beyond the pelvis to other parts of the body.   Blood and urine tests, chest x-rays, computerised tomography (CAT) scans, magnetic resonance imaging (MRI), sigmoidoscopy or colonoscopy may be done. 

Treatment Of Uterine Cancer:

There are different treatment options in endometrial cancer: surgery, radiotherapy, and hormone therapy. Some patients receive a combination of therapies.   You are advised to ask the doctor about the pros and cons of the treatment methods, the success and failure rates, the risks and complications as well as the objective of treatment.   In the vast majority of cases, the objective is to cure. Sometimes, when the cancer has spread and curing it is not possible, the objective is to control or slow down its spread.   Occasionally, when there is extensive spread, the objective is palliative, i.e. to alleviate pain and other distressing symptoms. 

Follow-up  Regular follow-up is essential. This would include a general physical examination, pelvic examination, x-rays and laboratory and/or imaging investigations. Any problems that arise should be attended to and treated as soon as possible. 

Most cases of endometrial cancer are diagnosed early because abnormal vaginal bleeding occurs at an early stage. When treated early, the cure rates from endometrial cancer are excellent. It must be stressed that this is only possible if medical attention is sought early.