Endometrial cancer (uterine cancer): What puts you at risk?

Women who are obese are at greater risk of developing endometrial cancer (also known as uterine cancer), a type of cancer of the uterus that is highly curable if detected early. 

Diabetes and high blood pressure (hypertension) are other lifestyle-related conditions that increase a woman’s risk of endometrial cancer (uterine 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 (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 Consultants from the KK Gynaecological Cancer Centre at KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.

Causes and risk factors of endometrial cancer (uterine 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 (uterine cancer) is the highest among women aged 50-59.

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

Symptoms of endometrial cancer (uterine cancer)

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 (uterine cancer) present early with abnormal vaginal bleeding. Post-menopausal bleeding is the most common symptom,” adds Consultants from the KK Gynaecological Cancer Centre. “Abdominal swelling and change in bowel and urinary habits are late endometrial cancer symptoms.”

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

How is endometrial cancer (uterine cancer) diagnosed

Tests and procedures used to diagnose uterine cancer include:

1) Pelvic examination

Your doctor will examine the uterus, vagina, ovaries and rectum to look for any lumps or abnormalities.

2) 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.

3) 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.

“The prognosis of endometrial cancer is good if it is diagnosed early,” says Consultants from the KK Gynaecological Cancer Centre.

Read on to learn about endometrial cancer (uterine cancer) prevention tips and treatment.

* According to the Singapore Cancer Registry Annual Report 2021.

Ref: H24 (ed)

More women cancer articles you may be interested in:

Top 10 Cancers Affecting Men and Women in Singapore

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Ovarian Cancer: Causes, Symptoms, Treatment and Prevention

Cervical Cancer: Symptoms, Screening and How to Prevent