Uterine Cancer

The uterus is the hollow, pear-shaped organ located in the female pelvis. The main function of the uterus is to nourish the developing foetus before birth. The uterus has two layers: an outer muscular lining and an inner lining known as the endometrium, which thickens and sheds during a woman’s menstrual cycle.

Uterine cancer or endometrial cancer, affects the inner lining of the uterus. A less common type of uterine cancer, which affects the outer muscular lining is called uterine sarcoma.

Uterine cancer is the 4th most common women’s cancer and most common female genital tract cancer in Singapore. While uterine cancer can affect women of any age, the majority of cases (70%) occurs in women above the age of 50.

If uterine cancer is discovered early and confined to the uterus, removing the womb often eliminates the cancer. The cure rate can be over 90% when the disease is detected at an early stage.

Symptoms of uterine cancer may include:

• Abnormal vaginal bleeding
  • Post-menopausal bleeding
  • Irregular menstrual bleeding
  • Abnormally heavy bleeding (Menorrhagia)
  • Spotting or bleeding between periods
  • Blood-tinged, watery discharge from the vagina
• Pelvic pain

When to see a doctor

Make an appointment with your doctor if you experience any abnormal vaginal bleeding or if you have any signs or symptoms that worry you. Any bleeding or spotting after menopause is abnormal, consult a doctor if you experience this.

There are several ways to lower the risk of uterine cancer and improve early detection and diagnosis:

• Maintain a healthy lifestyle – have a nutritious diet, regular exercise and maintain a healthy weight
• Go for a yearly pelvic examination
• Consult a doctor early, if you notice any abnormal vaginal bleeding. Most bleeding is not caused by uterine cancer, but your doctor can investigate the cause of the abnormal bleed.

While the causes of uterine cancer are unknown, a high level of oestrogen has been found to play a role in its development. Other risk factors include:

• Starting menstruation early – before the age of 12
• Late menopause
• Never having been pregnant
• Older age
• Obesity
• Irregular and infrequent periods – less than 4 periods in a year
• Oestrogen-only replacement therapy (ERT)
• Endocrine therapy drug called Tamoxifen for breast cancer
• Polycystic ovarian syndrome (PCOS)
• Family history of breast, uterine, ovarian or colon cancer

Tests and procedures used to diagnose uterine cancer include:

• Pelvic examination
  • Your doctor will examine the uterus, vagina, ovaries and rectum to look for any lumps or abnormalities.
• Ultrasound scan
  • Ultrasound scans use sound waves to create an image of the pelvic region to identify abnormalities in the endometrium or any abnormally sized/shaped organs. A trans-vaginal ultrasound may be performed to get a better view of the uterus by inserting a wand-like ultrasound device into the vagina.
• Hysteroscopy
  • During a hysteroscopy, the doctor inserts a thin, flexible, lighted tube (hysteroscope) through the vagina and cervix into the uterus. The hysteroscope allows the doctor to examine the inside of the uterus and endometrium.
• Endometrial biopsy
  • A biopsy is required for a definite diagnosis. A small amount of uterine tissue is removed using suction from a thin tube inserted through the cervix into the uterus. This tissue is then examined under the microscope to look for cancer cells.
• Dilatation and curettage (D&C)
  • D&C is a surgical procedure to remove tissue for testing. During the procedure, the cervix is slightly widened and tissue is gently scraped or suctioned from the lining of the uterus and the cervix, for examination in a laboratory.

Surgery for Uterine Cancer

Treatment for uterine cancer usually involves surgical removal of the uterus (hysterectomy), fallopian tubes and ovaries (salpingo-oophorectomy). The surgeon may also remove lymph nodes for testing. Surgery also allows doctors to assess the extent of spread of the cancer (stage of the cancer) and decide what treatment will have the best chance for success.

The procedure can be done by minimally invasive surgery or open surgery. The surgeon will assess each patient’s condition and recommend the most suitable surgery method.

Following surgery, additional or adjuvant treatment such as chemotherapy and radiotherapy may be required depending on the stage, grade and subtype of the cancer.

Chemotherapy for Uterine Cancer

Chemotherapy is sometimes recommended after surgery if there is an increased risk that the uterine cancer might return. It is sometimes used before surgery to shrink the cancer so that it is more likely to be removed completely during surgery.

Chemotherapy may also be recommended for treating advanced or recurrent uterine cancer that has spread beyond the uterus.

Radiotherapy for Uterine Cancer

Radiotherapy uses powerful energy beams, to kill cancer cells. In some instances, the doctor may recommend radiation to reduce the risk of uterine cancer recurrence after surgery.

Brachytherapy (internal radiotherapy) is usually given for early stage disease while external beam radiotherapy is given for more advanced disease.

Hormone therapy for Uterine Cancer

Hormone therapy is used to slow the growth of certain types of uterine cancer. These are generally adenocarcinomas and are grade I or II tumours. Tests may be performed to predict how the cancer responds to hormone therapy prior to starting the treatment.

Targeted drug therapy for Uterine Cancer

Targeted drug treatments for uterine cancer work by blocking specific weaknesses present within cancer cells, causing the cancer cells to die. Targeted drug therapy is usually combined with chemotherapy for treating advanced uterine cancer.

Immunotherapy for Uterine Cancer

Immunotherapy might be considered if the uterine cancer is advanced and other treatments have not helped.

At SingHealth healthcare institutions, our multi-disciplinary care team includes surgical oncologists, medical oncologists, radiation oncologists, fertility specialists, palliative-care doctors, specialist nurses, medical social workers and other allied health professionals, who work together to ensure the best outcome for every patient.