Most cases of endometrial cancer develop in postmenopausal women. Find out the signs and symptoms, and lower your risk.

 

BY: Dr Shamini Nair

 

Endometrial cancer is now the fourth most common cancer among women in Singapore, compared to its eighth spot, which it had some 10 years ago. According to the latest report from the National Registry of Diseases Office, endometrial cancer has risen by almost 60 percent from 1998 to 2008. In the period from 1998 to 2002, there were 904 cases of endometrial cancer. That number rose to 1,434 in the period of 2004 to 2008.

One postulated reason for this increase is that obesity is associated with an increased risk of endometrial cancer and obesity is a growing problem in Singapore. In addition, pregnancy is protective against endometrial cancer and our birth rate has been declining over the years. The more common type of endometrial cancer begins in the endometrium, the womb lining. It frequently presents with abnormal vaginal bleeding. A different type of cancer of the uterus is uterine sarcoma, which develops in the uterine muscle layer or myometrium.

 

Signs & symptoms

When endometrial cancer is in an advanced stage, it can spread to neighbouring organs such as the bowel, bladder and lymph nodes, with painful symptoms. Most cases of endometrial cancer develop in postmenopausal women, whose periods have stopped. However, it can also affect women younger than 40.

The signs and symptoms of endometrial cancer may include:

• Prolonged periods or bleeding in between the periods.
• Any bleeding after the time of menopause, or what is called postmenopausal bleeding.
• Abnormal pink or bloody discharge from the vagina.
• Pelvic pain. This can occur especially when the diagnosis is made in advanced endometrial cancer.
• Weight loss.

If there are any of the above signs or symptoms, a doctor should be consulted. The doctor will usually do a pelvic examination and a pelvic ultrasound. If a Pap Smear has not been done recently, the doctor may decide to do one.

In order to diagnose endometrial cancer, additional tests will need to be done. Firstly, the endometrial lining will need to be biopsied. This is to obtain a sample of cells from inside the womb for laboratory analysis. In some instances, this can be done in the clinic by using a device such as the Pipelle device. The latter is a disposable polypropylene sheath with an inner plunger. It does not require general anaesthetic.

However, some patients will need a hysteroscopy with dilation and curettage (D & C). This is a procedure in which a camera is inserted into the womb to look for abnormal areas in the womb. Thereafter, tissue is scraped from the lining of the womb and sent to the laboratory to be examined for cancer cells. This procedure is usually done under sedation or anaesthesia.

 

Treatment options

Surgery is the most common treatment for endometrial cancer. This could be either a surgical removal of the uterus alone (hysterectomy) or, more likely, the surgical removal of the uterus, fallopian tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy). For some patients the pelvic lymph nodes will be removed as well. After surgery, additional treatment may be required which could include radiotherapy, chemotherapy or hormone therapy. The need for additional treatment after surgery is determined by the stage of the disease and type of endometrial cancer that is found after laboratory analysis.

Radiotherapy involves the use of high-dose X-rays to kill cancer cells while chemotherapy is the use of drugs to kill cancer cells. Hormone therapy in the form of high-dose progestins may stop the growth of the tumour or prevent a recurrence.

 

Risk factors

In about 40 percent of patients, there are no identifiable risk factors.

It has been found that factors that increase the levels of oestrogen in the body can predispose to endometrial cancer. These are the following:

• Women who start to have their periods at a young age and women who have a late menopause (cessation of periods). The average age of menopause is 51 years old.
• Irregular ovulation or failure to ovulate can increase one’s lifetime exposure to oestrogen. Ovulation irregularities are common in women with a condition known as polycystic ovary syndrome (PCOS).
• Obesity. Fat tissue can change some hormones into oestrogen and being obese can increase levels of oestrogen in the body as well as the risk of endometrial cancer.
• Diabetes.
• Oestrogen-only replacement therapy (ERT) stimulates the lining of the womb and increases the risk of endometrial cancer.
• Ovarian tumours producing oestrogen.
• Personal history of breast cancer or ovarian cancer. 
• Tamoxifen treatment for breast cancer.
• Hereditary non-polyposis colorectal cancer (HNPCC). Women with HNPCC also have a significantly higher risk of endometrial cancer as well as colon and other cancers.

 

Prevention

So how can one lower their risk of endometrial cancer? Here are some ways:

• Maintaining a healthy weight. Obesity is one of the highest risk factors for the development of endometrial cancer in women.
• Good control of diabetes can also reduce the risk of endometrial cancer.
• Taking hormone therapy (HT) with progestin if the uterus is intact. Synthetic progestin, a form of the hormone progesterone, with oestrogen lowers the risk of developing endometrial cancer.
• Using birth control pills. Use of oral contraceptives has shown to reduce endometrial cancer.

It is equally important to consult a doctor early if you have any of the signs and symptoms of endometrial cancer stated above.

 

Dr Shamini Nair is a specialist in Obstetric & Gynaecology at Raffles Hospital.

(** PHOTO CREDITS: Weight scale by asifthebes, stock.xchng; woman doctor, ZoofyTheJi, stock.xchng)

 

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