Endometrial Cancer

Endometrial cancer is cancer arising from the lining of the uterus.

What are the risk factors for endometrial cancer?

There are many risk factors for endometrial cancer, although not every woman with endometrial cancer has risk factors in their history. Risk factors include:

• Age 
• Obesity
• Diabetes
• Metabolic syndrome (combination of obesity, high blood pressure and high sugar)
• Polycystic ovary syndrome (PCOS)
• No children
• Early age of 1^st period
• Late age of last period (menopause)
• Family history of endometrial cancer
• Taking tamoxifen for breast cancer
• Taking estrogen-only hormone replacement therapy (HRT)
• Endometrial hyperplasia
• Genetic conditions e.g. Lynch syndrome 

What are the symptoms of endometrial cancer?

The most common symptom is abnormal bleeding. These can include:

• Heavy periods
• Long periods
• Bleeding in between periods 
• Bleeding after menopause

What tests do I need to diagnose endometrial cancer?

Your gynaecologist will need to take a detailed medical history and perform a pelvic examination for you. A Pap smear/HPV test will be taken if you have not had one recently, as cervical cancer can also have similar symptoms. A transvaginal pelvic ultrasound will be done to check your uterus, uterine lining thickness and ovaries. One of the following tests will be recommended to obtain tissue from your uterine lining for microscopic analysis:

• Endometrial pipelle: a thin, soft straw will be inserted into your uterus through the cervix and gentle suction used to biopsy cells from the uterine lining. This can be done in the clinic and does not need anaesthesia.

• Dilation and curettage (D&C): this is a day surgery done under general anaesthesia, where your cervix is dilated and a curette (instrument) inserted into your uterus to gently scrape tissue from your uterine lining. This may be combined with a hysteroscopy, which allows direct visualisation of your uterine cavity.

My biopsy has confirmed endometrial cancer. What’s next?

Your biopsy should state if you have a low-grade or high-grade cancer – this is a description of how abnormal the cancer cells look and how likely/fast they are likely to spread. Staging of the cancer is next. You will be asked to go for further imaging e.g. CT or MRI scans to check if the cancer has spread within your uterus or outside your uterus to the other parts of your body. In general –

Stage 1: cancer is found in the uterus only

Stage 2: cancer has spread to the cervix (neck of womb) only

Stage 3: cancer has spread beyond uterus and cervix but is still confined within the pelvis

Stage 4: cancer has spread outside of the pelvis

What is the treatment for endometrial cancer?

This depends on your age, general health, medical conditions and stage of cancer. Treatment can involve surgery, chemotherapy, radiotherapy or hormone therapy. Your gynae-oncologist will be able to discuss with you about the options suitable for you.

Surgery usually involves hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries) and/or possible lymphadenectomy (removal of lymph nodes in the pelvis and abdomen to check for cancer involvement).

For chemo- and radio-therapy, your gynae-oncologist will manage you together with a medical oncologist to optimise your treatment.

Photo Credit: Lolaia / Wikimedia Commons