Cancer
Uterine cancer is one of the most common gynaecological cancers affecting women
particularly after menopause. In South Africa it is the second most common gynaecological cancer, with cervix cancer coming in at number one.
Early detection is key
“Looking back, the signs were there, waving at me,” says Jenny*, who was diagnosed with Stage 2 uterine carcinoma two years ago. “Heavy periods became irregular periods, which then became periods that outstayed their welcome. Eventually, I had a period that simply refused to leave, accompanied by bloating, pelvic pain, severe back pain, and fatigue that crept up on me. The real red flag? Internal procedures at the gynaecologist became unbearable – even inserting a tampon felt like someone was renovating my insides with a jackhammer.”
As Dr Elizabeth Hugo, a specialist gynaecologist and gynaecological oncologist at Mediclinic Vergelegen explains, “uterine cancer is often detected at an early stage because it typically causes obvious symptoms, such as bleeding in the menopause. Because this symptom often prompts women to seek medical attention early, many cases are diagnosed before the cancer has spread.”
What is uterine cancer?
Uterine cancer develops in the uterus (womb), the pear-shaped organ where a baby grows during pregnancy. “The most common type is endometrial cancer, which begins in the lining of the uterus called the endometrium,” says Dr Hugo. “Ninety percent of uterine cancer arises from the lining of the womb, which is called the endometrium, says Dr Hugo. “A much rarer and more aggressive type is uterine sarcoma, which develops in the muscles or supporting tissues of the uterus.”
What are the symptoms?
The tell-tale symptom of uterine cancer is abnormal vaginal bleeding, particularly after menopause.
Other symptoms may include:
- Bleeding between menstrual periods
- Menstrual periods that are heavier, last longer than usual or after the age of 55
- Watery, pink or blood-stained vaginal discharge
- Pelvic pain or pressure
- Pain during sexual intercourse (less common)
Dr Hugo reassures that these symptoms do not always mean cancer is present. “In the case of patients presenting with bleeding in the menopause, there is a 60% chance that it is caused by thinning of the uterine and vaginal lining, 30% will be caused by polyps or thickening of the womb lining and around 10% of cases will be caused by endometrial cancer” she says. “However, any unexpected or unusual or change in vaginal bleeding should always be assessed by your doctor.”
Who is at risk?
You might have a higher risk of developing uterine cancer. If you:
- Are menopausal and usually over 50
- Live with obesity, Type 2 diabetes and / or high blood pressure
- Have never been pregnant
- Have a history of polycystic ovaries with less than four menstrual cycles per year
- Started your periods at an early age, or reached menopause later than average
- Have a family history of uterine or colorectal cancer or certain inherited genetic conditions
- Take unopposed estrogen hormonal therapy. “It is important to know that there should be progesterone in your hormonal therapy regime if you have not had a hysterectomy or have a history of endometriosis,” Dr Hugo adds.
How is uterine cancer diagnosed?
Your doctor will begin with a medical history and physical examination. Further investigations may include:
- A pelvic examination
- A transvaginal ultrasound to assess the thickness of the uterine lining
- An endometrial biopsy, where a small sample of tissue is removed from the lining of the uterus for laboratory analysis
- A hysteroscopy, which uses a small camera to examine the inside of the uterus
If cancer is confirmed, additional imaging such as CT or MRI scans may be performed to determine whether the disease has spread.
Treatment options for uterine cancer
“Treatment depends on the type of uterine cancer, its stage, the patient's overall health and future fertility wishes,” Dr Hugo notes. For most women, surgery is the primary treatment. This usually involves a hysterectomy (removal of the uterus), together with removal of the fallopian tubes and ovaries.
In some cases, nearby lymph nodes may also be removed to determine whether the cancer has spread. “Sentinel lymphnode dissection is a new approach that is available to some patients,” Dr Hugo adds. “This approach reduces the side effects such as leg swelling after a full removal of all pelvic nodes.”
Depending on the stage and characteristics of the cancer, additional treatments may include:
- Radiation therapy to destroy remaining cancer cells
- Chemotherapy, particularly for more advanced or aggressive cancers
- Hormone therapy for cancers that are hormone-sensitive
- Targeted therapy or immunotherapy for selected patients with advanced or recurrent disease
“Treatment plans are often developed by a multidisciplinary team that may include a radiation oncologist, social worker, psychologist and other healthcare professionals to ensure each patient receives personalised care,” Dr Hugo says.
Can uterine cancer be prevented?
There is no guaranteed way to prevent uterine cancer (except for having a hysterectomy), but certain lifestyle choices may help reduce the risk. “Maintaining a healthy weight, staying physically active, managing diabetes and high blood pressure, eating a balanced diet and going to regular gynaecological check-ups all contribute to overall health and may lower risk,” says Dr Hugo. “The use of oral contraceptives as well as the Mirena device are also associated with reduced risk.”
The importance of early diagnosis
The outlook for uterine cancer is generally very good when it is diagnosed early. “Many women are successfully treated with surgery alone and go on to live healthy, cancer-free lives,” says Dr Hugo.