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General Information on Endometrial Cancer (Uterine Cancer)


What is Endometrial Cancer (Uterine Cancer)


Endometrial cancer or sometimes also known as uterine cancer is the most common gynecological cancer in Singapore women with rising incidence. Endometrial cancer (uterine cancer) is a type of cancer that begins in the uterus.  The uterus is the hollow, pear-shaped pelvic organ in women where fetal development occurs. Endometrial cancer (uterine cancer) begins in the layer of cells that form the lining (endometrium) of the uterus.


Endometrial (uterine) and ovarian cancers are common in women who work and live in an urban environment where they are likely to have fewer pregnancies, breastfeed less and are more likely to have conditions such as obesity and diabetes. These factors alone do not explain why women get endometrial cancer, but they are factors that are more commonly found in women who have endometrial cancer.

 

The endometrium is the lining of the womb or uterus. It is into this lining that the very early foetus or embryo implants and continues to grow, making the uterus its home for the nine months of pregnancy till birth. This important tissue layer changes over entirely every single month, growing in anticipation of a pregnancy then shedding when no pregnancy occurs.

 

Cancerous changes in the lining of the womb typically take place in a woman’s late 40s and cancer of the endometrium is most commonly diagnosed in women in their 50s and 60s.

 

The one very bright star in the dark night of an endometrial cancer (uterine cancer) diagnosis is that >70% of cancers are diagnosed in the very first stage of development, also known as FIGO Stage I. Unlike ovarian cancer, most women with endometrial cancer (uterine cancer) are found to have their disease before it has a chance to spread outside of the uterus. This is because even early or pre-cancerous changes in the endometrial lining will result bleeding that most women will know to be “abnormal”.  Because there are troublesome signs that appear early, most women will see a doctor, make the diagnosis and get timely treatment. This is why endometrial cancer (uterine cancer) is unlikely to be deadly although it is a very common gynecological cancer.  

You can beat endometrial cancer (uterine cancer), most women do. All it takes is the courage to get tested if you have troubling symptoms, get treated and move on with your life and endometrial cancer (uterine cancer) need not trouble you again for the rest of your days.


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Who is at risk?


  • Obesity
  • High blood pressure
  • More years of menstruation (early menstruation or late menopause)
  • Never having been pregnant
  • Older age
  • Undergoing hormone therapy for breast cancer

*People who think they may be at risk should discuss this with their doctor. 
 

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What are the signs and symptoms?

 

  • A woman who is still having menstrual periods and experiences vaginal bleeding more than once a month or continuous bleeding or spoting throughout the month
  • A woman who has not had any menstrual bleeding for 12 months or more and then experiences spotting or bleeding
  • Difficult or painful urination
  • Pain during sexual intercourse
  • Pain in the pelvic area
  • An abnormal, watery or blood-tinged discharge from the vagina
 
*People who think they may be at risk should discuss this with their doctor. 
 

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What can you do to prevent Endometrial Cancer (Uterine Cancer)?


  • Maintaining a healthy weight
  • Regular exercise
  • Consulting your doctor about the risks of hormone therapy after menopause
  • Consulting your doctor on the option of birth control pills
 


How is Endometrial Cancer (Uterine Cancer) diagnosed?


Endometrial cancer (uterine cancer) can only be diagnosed after a tissue sample has been removed from the uterine lining and examined in the lab. This uterine tissue sample is most commonly obtained via an office procedure known as an endometrial sampling or a minor procedure performed in the operating theatre known as dilation and curettage or D&C.

 

Endometrial sampling is carried out almost the same way as a Pap smear, in the office and without the need for anesthesia. The entire procedure typically takes around 5-10 minutes. A fine straw-like device is passed into the uterine cavity and a small sample of the uterine lining is sucked out and sent to the lab for analysis and testing. Women who undergo this simple office procedure can expect some menstrual-like cramping during the procedure and in the few hours following the procedure. There may also be some light spotting for a day or two after the procedure. The main advantage of this procedure is that there is no need to undergo general anesthesia which makes the procedure most likely to be recommended by your doctor.

 

Dilation and curettage or D&C is a day surgical procedure. Women who undergo this procedure will need to be admitted to the hospital and can expect to stay a few hours without the need for an overnight stay. This procedure typically takes around 15-30 minutes and is performed under general anesthesia where the patient is completely asleep during the procedure. Women will typically experience some mild cramping and light bleeding after the dilation and curettage procedure for up to three days. The dilation portion of the procedure refers to the process where the cervix or neck of the womb is gently widened to allow the curette to pass into the uterine cavity. The curettage portion of the procedure is where the curette is used to gently scrape or curette the uterine lining for samples that can be tested. The process of dilation and curettage can be uncomfortable which is why it is typically performed under general anesthesia with the patient completely asleep.

 
 
 
 

What are the treatment options?

  
Depending on the stage of endometrial cancer (uterine cancer), there are various treatment options available.
 
Stage 1

Cancer is confined to the uterus only.

Stage II

Cancer is present in both the uterus and the cervix.

Stage III

Cancer has spread beyond the uterus, but hasn't reached the rectum and bladder. The pelvic area lymph nodes may be involved. 

Stage IV

Cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of the body.

 

Most women with endometrial cancer (uterine cancer) are productive members of society. Women living with endometrial cancer (uterine cancer) are mothers, grandmothers, bus drivers, entrepreneurs, policewomen and CEOs, they could be your colleague or the confident woman in a business suit standing next to you on the morning commute.  Women living with endometrial cancer (uterine cancer) are unaffected by their disease. This is because even very early changes in the endometrium can result in unusual vaginal bleeding patterns as described above. This usually prompts women who have vaginal bleeding that is unexpected to see their gynecologist or primary care doctor who helps make the diagnosis of endometrial cancer (uterine cancer).

 

Endometrial cancer (uterine cancer) is treated with surgery. In  most women, surgery to remove the uterus, ovaries and Fallopian tubes is sufficient to treat endometrial cancer (uterine cancer) completely. Depending the size of the tumour and other characteristics of the endometrial cancer (uterine cancer), additional tissues surrounding the uterus such as lymph nodes and the omentum may need to be removed during surgery as well.  Only women who are then found to have cancer outside of the uterus or who are at risk for cancer cells remaining in the body are given the recommendation to have further treatment in the form of radiation therapy, most commonly, or a combination or chemotherapy and radiation, rarely. About 90% of women with endometrial cancer (uterine cancer) will require no treatment beyond surgery.

 

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