Uterine cancer: Symptoms, diagnosis, treatment

The uterus is a pear-shaped organ located between a woman’s hip bones (pelvis). When a woman is pregnant, the foetus develops in the uterus, also known as the womb.

Uterine cancer refers to the cancer that starts in the body of the uterus and not the cervix. Cervical cancer is a different type of cancer. The most common type of uterine cancer is endometrial cancer. It originates in the endometrium, the inner lining of the uterus.

What are the risk factors for uterine cancer?

The following risk factors may increase your risk of developing uterine cancer:

• Women aged between 40-74 years old
• Obesity
• Taking oestrogen without progesterone for hormone replacement
• Women who have not had children
• Irregular ovulation and often missing periods
• Diabetes
• Polycystic Ovarian Syndrome (PCOS)
• Endometrial hyperplasia (abnormal thickening of the endometrium)
• Family history of endometrial cancer
• Tamoxifen therapy

What are the symptoms of uterine cancer?

The most common symptom of uterine cancer is abnormal bleeding from the vagina. This includes:

• Menstrual bleeding that is heavier than normal.
• Bleeding in between menstrual cycles (when a woman does not have her period).
• Bleeding after menopause.
• Vaginal discharge that can range from pink and watery to dark and foul smelling.

Approximately 9 out of 10 uterine cancers are detected due to postmenopausal or abnormalvaginal bleeding. Hence, uterine cancer is frequently diagnosed early.

If you are experiencing abnormal bleeding, particularly if you have gone through menopause, you should consultyour doctor immediately. These symptoms may also result from conditions other than cancer. However, consult your doctor if you experience any of the symptoms above.

How is uterine cancer diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Transvaginal ultrasound: To help identify any abnormal masses or changes in the thickness of the uterine lining.
2. Endometrial biopsy: This test may be done at your doctor’s clinic. A small sample of the endometrium is extracted and viewed under the microscope.
3. Hysteroscopy: A thin, lighted tube called the hysteroscope is inserted through the vagina and cervix into the uterus to visually examine the uterine lining and take a sample if necessary.

How is uterine cancer treated?

The treatment recommended by your doctor will depend on several factors, including the type and stage. Surgery is the primary treatment option. Following surgery, or if surgery is not an option, you may undergo chemotherapy, radiotherapy, or a combination of these treatments.

1. Surgery
   • Total hysterectomy: Removal of the uterus and cervix.
   • Bilateral salpingo-oophorectomy (BSO): Removal of both ovaries and fallopian tubes.

   Lymph nodes and other tissue may be excised and examined to ascertain if they have cancer.

2. Radiotherapy

   Radiation inhibits the growth of cancer cells by exposing them to high-energy X-rays.

   There are two types:

   • Vaginal brachytherapy (VB): Delivers radiation from a device temporarily inside the vagina to target cancer cells directly.
   • External-beam radiation therapy (EBRT): Uses radiation from outside the body. The area to be treated (radiation "field") is planned carefully to limit radiation exposure to healthy tissue.
3. Chemotherapy

   Chemotherapy is the recommended course of treatment for patients diagnosed with advanced-stage and recurrent endometrial cancer. Chemotherapy is typically administered via intravenous (IV) injection. Chemotherapy is generally administered in cycles, wherein a phase of treatment is followed by a phase of rest to help the body's recuperation.

What can I do to reduce the risk of developing uterine cancer?

Currently, there are no foolproof methods to prevent uterine cancer. However, there are steps you can take to lower your risk of developing the disease:

• Maintain a healthy weight and be physically active
• Hormonal contraceptives
• Pregnancy and breastfeeding

Make an appointment at Pantai Hospitals

Early detection of uterine cancer makes it easier to treat the disease with effective and appropriate treatment. A dedicated multidisciplinary team of gynae-oncologists at Pantai Hospitals is available for consultation to provide patients with the best care and assistance.

Get in touch with us to book an appointment today if you have any concerns or questions regarding uterine cancer.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.