Endometrial Cancer: Who Are At Risk

Women who are obese are at greater risk of developing endometrial cancer, a type of cancer of the uterus that is highly curable if detected early. Diabetes and hypertension are other lifestyle-related conditions that increase a woman’s risk of endometrial cancer, the fourth most common cancer in Singapore among women.

The uterus has two layers: an outer lining of muscle and an inner lining called endometrium which thickens and sheds during a woman’s menstrual cycle. Endometrial cancer, also known as uterine cancer or womb cancer, affects the inner lining of the uterus.

Another type of uterine cancer is uterine sarcoma, which affects the outer lining and is less common.

“Excess fat, which alters the body’s balance of hormones, increases a woman’s risk of getting uterine cancer,” says Dr Wong Wai Loong, Deputy Head & Consultant, KK Gynaecological Cancer Centre, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.

Causes and risk factors of endometrial cancer

While the exact cause of endometrial cancer is unknown, a high level of oestrogen has been found to play a role in its development. There are many risk factors, in addition to obesity, diabetes and hypertension, associated with this cancer. These other risk factors include:

• Early menstruation – before the age of 12
• Irregular and infrequent periods – less than 4 periods in a year
• Late menopause
• Nulliparity – never been pregnant
• Oestrogen-only replacement therapy (ERT)
• Hormone therapy drug tamoxifen for breast cancer
• Polycystic ovarian syndrome (POS)
• Hereditary non-polyposis colorectal cancer (HNPCC) or a family history of HNPCC
• Ovarian tumours, e.g. granulosa cell tumours that secrete oestrogen

According to the Singapore Cancer Registry, endometrial cancer is the highest among women aged 50-59.

“Endometrial cancer can occur at any age, but 70 per cent of the time, it occurs after the age of 50,” says Dr Wong. “Factors such as a high fat diet and more women not having children are responsible for an increase in the number of cases worldwide.”

Endometrial cancer symptoms

Endometrial cancer symptoms include the following:

• Abnormal vaginal bleeding – this can be of different types such as:
  • Post-menopausal bleeding
  • Frequent vaginal bleeding in the period leading up to menopause
  • Irregular menstrual bleeding
  • Spotting or bleeding between periods
  • Prolonged periods of vaginal bleeding
  • Blood-tinged, watery discharge from the vagina
• Bleeding after intercourse
• Abdominal swelling or bloating (swollen tummy)
• Pelvic pain
• Pain during intercourse
• Change in bowel or urinary habits
• Unexplained weight loss

“Most cases of endometrial cancer present early with abnormal vaginal bleeding. Post-menopausal bleeding is the most common symptom,” says Dr Wong. “Abdominal swelling and change in bowel and urinary habits are late endometrial cancer symptoms,” he adds.

Any woman who suffers from abnormal vaginal bleeding should seek medical attention immediately.

Diagnosis of endometrial cancer

A biopsy, or taking of a small sample of endometrium tissue, is required to diagnose endometrial cancer. This can be carried out as an outpatient procedure, e.g. hysteroscopy, or as a minor day surgical procedure.

Dilatation and curettage (D&C) is the term for a surgical procedure used to remove a tissue sample from the endometrium for testing.

A transvaginal ultrasound may also be carried out to detect any abnormalities, such as thickening of the endometrium.

“The prognosis of endometrial cancer is good if it is diagnosed early,” says Dr Wong.

Read on to learn about endometrial cancer treatment and prevention.

Ref: R14