Cancer Type

Uterine body cancer Introduction

The uterine body is an important organ of the female reproductive system, composed of the endometrium and the myometrium (muscular outer layer). Most cancers of the uterine body originate in the endometrium, and therefore, cancers growing in this area are called endometrial cancer, accounting for 90% of all uterine body cancer cases.

Endometrial cancer is one of the top ten most common cancers in Hong Kong and the fourth most common cancer among women. In 2018, a total of 1,165 new cases were recorded, with 115 deaths.

iI. Symptoms of endometrial cancer

Early

Early-stage uterine cancer often presents with subtle symptoms, which patients may mistake for menstrual irregularities, leading to delayed diagnosis and missed opportunities for timely treatment.

Early and middle

Early and mid-stage symptoms: abnormal vaginal bleeding, including long and frequent menstrual periods before menopause, heavy menstrual bleeding, or bleeding between periods; bleeding after menopause, or abnormal vaginal discharge after menopause.

Late

Late stage: Symptoms are obvious, including pain in the pelvic cavity during intercourse and urination, abnormal bowel habits (such as constipation), hard lumps in the lower abdomen, and purulent or bloody discharge from the vagina.

Please note that the above symptoms are not limited to endometrial cancer. If you suspect any cancer, you should seek medical attention as soon as possible.

iii. Risk factors for endometrial cancer

To date, the medical community does not fully understand the causes of endometrial cancer, but it may be related to the following risk factors:

Age

Women over 60 years of age, especially postmenopausal women, have an increased risk of developing endometrial cancer.

Menstruation

Women who experience early menarche (before age 12) or late menopause (after age 52) accumulate more menstrual cycles throughout their lives, meaning their bodies are exposed to estrogen for a longer period, thus increasing their risk of uterine cancer. Conversely, women with irregular menstrual cycles also have a higher risk of uterine cancer.

Never given birth

During pregnancy, estrogen levels drop sharply. Therefore, women who have never given birth accumulate more menstrual cycles throughout their lives and are exposed to estrogen for a longer period of time, increasing their risk of developing endometrial cancer.

Overweight

Obese women have a higher risk of developing endometrial cancer than the general population, especially those who become obese after menopause. This is because a woman's menstrual cycle is regulated by the interplay of estrogen and progesterone. After menopause, the ovaries stop producing these hormones, but body fat continues to produce estrogen. Excessive accumulation of body fat can lead to an overproduction of estrogen, increasing the risk of cancer.

Hormone drugs

Women who are receiving estrogen replacement therapy, and women who are taking hormone supplements after menopause.

Family medical history

If a close relative, such as a mother, sister, or daughter, is diagnosed with breast cancer, ovarian cancer, or colorectal cancer before the age of 50, the chance of developing endometrial cancer is also higher.

Personal medical history

Because the causes of breast cancer, ovarian cancer, or colorectal cancer may be related to endocrine factors such as estrogen, these patients also have a higher risk of developing endometrial cancer. Taking tamoxifen, a drug used to treat breast cancer, for more than two years can stimulate endometrial hyperplasia, increasing the risk of endometrial cancer in women.

Polycystic ovary syndrome patients

Polycystic ovary syndrome (PCOS) can cause the body to produce more estrogen, thus increasing the risk of endometrial cancer.

Women with abnormal endometrial hyperplasia

If the endometrium undergoes abnormal proliferation and thickening, the chance of cell mutation is also higher, thereby increasing the risk of developing endometrial cancer.

The above risk factors only increase the chances of developing endometrial cancer, but do not mean that you will definitely develop endometrial cancer.

iV. Diagnostic methods for endometrial cancer

Preliminary inspection

Inquire about medical records and conduct a basic clinical physical examination.

Examination of the pelvic cavity:
The doctor uses the index and middle fingers to palpate around the cervix, or uses a speculum (commonly known as "duckbill forceps") inserted into the patient's vagina to observe the vulva.

Endometrial biopsy:
The doctor inserts a speculum into the patient's vagina, and through the speculum, a small tube is inserted into the uterus to aspirate a small amount of endometrial tissue, which is then observed under a microscope. The process takes about one to two minutes.

Vaginal ultrasound:
The doctor will insert a tubular ultrasound device into the vagina and gently move it to scan the vagina, uterus, fallopian tubes and ovaries. The sound waves reflected back from the internal organs will form an image to observe whether there are any abnormalities.

Hysteroscopy and biopsy:
The examination can be performed under local or general anesthesia. The doctor will insert a lens with a light source at the tip into the uterus through the vagina and cervix to extract suspicious tissue, which will then be examined by a pathologist under a microscope.

Dilation and curettage (D&C) procedure:
Dilation and curettage (D&C) is the most accurate method for diagnosing endometrial cancer. After the patient is anesthetized, the doctor inserts a speculum into the vagina, through which surgical instruments are then inserted into the uterine cavity. The doctor gently scrapes different areas of the uterine body with the instruments, removing endometrial tissue or other tissues for further testing. This procedure does not require incisions or stitches, and the entire process, including anesthesia, takes approximately 10 to 15 minutes.

Further investigation

To further determine the stage of endometrial cancer, imaging scans can be used to determine the stage. This includes:

Upper abdominal ultrasound scan

Computer scanning

Magnetic resonance imaging (MRI)

Through these various examinations, the doctor will stage the patient's condition. Endometrial cancer is generally classified into four stages:

Issue 1

The tumor is only confined to the uterine body or endometrium.

Issue 2

Cancer cells spread downwards from the uterus to the cervix, but remain confined within the uterus.

Issue 3

Cancer cells can spread beyond the uterus, affecting the ovaries, vagina, or lymph nodes near the pelvis/aorta, with the potential for widespread metastasis.

Issue 4

Cancer cells have spread to distant sites, invading organs outside the pelvic cavity via lymph or blood. Common sites include the bladder and rectum located in front of and behind the uterus, and even more distant sites such as the liver, lungs, bones, and brain.

V. Treatment methods for endometrial cancer

Generally speaking, endometrial cancer grows relatively slowly and is not prone to spreading to tissues outside the uterus. Therefore, the cure rate for early-stage endometrial cancer can reach over 90%. The main treatment methods for endometrial cancer are surgery and radiation therapy, which can be used alone or in combination, depending on the patient's condition.

Treatment for early and mid-stage uterine cancer primarily involves surgical removal of the uterus, cervix, fallopian tubes, and ovaries, supplemented by internal and external radiation therapy.

Late-stage endometrial cancer can spread widely, potentially invading the bladder, rectum, and even affecting the liver and lungs. Doctors typically treat it with systemic medications such as chemotherapy, supplemented by other therapies like hormone therapy.

Surgery

Surgical removal is a common treatment for endometrial cancer. Generally, if scans confirm that cancer cells have not spread widely, doctors will directly remove the uterus and a small portion of normal tissue adjacent to the tumor to ensure that all cancer cells are removed.

Total hysterectomy is the most common surgical procedure, involving the removal of the uterus and cervix, and in most cases, the fallopian tubes and ovaries are also removed. The removed tissue will be analyzed to determine the type of cancer cells and the extent of their spread.

Early-stage tumors only require a total hysterectomy. If the pathology report shows that cancer cells have invaded the uterine muscle layer or cervix, radiation therapy will be considered after surgery to reduce the chance of recurrence.

The estrogen secreted by the ovaries can promote the growth of cancer cells and increase the risk of recurrence. Therefore, except in special circumstances, doctors generally recommend that patients have their ovaries removed to prevent future problems. After oophorectomy, patients may experience menopausal symptoms such as amenorrhea, infertility, hot flashes, and palpitations. If patients plan to have children, they should consult their doctor before treatment.

There are three methods for removing a hyster:

Open abdominal surgery ：Suitable for patients with large uterus, large tumors, or those that are difficult to remove.

Transvaginal：Suitable for tumors with small uteri and those that are easier to remove.

Laparoscopy：Suitable for stage I and II patients or some stage III patients

Radiotherapy

The principle of radiation therapy is to target and kill cancer cells with high-energy rays while minimizing the impact on normal cells. It is divided into external beam radiation therapy and internal beam radiation therapy. Radiation therapy for endometrial cancer includes the following three regimens:

1. If a patient is not suitable for a total hysterectomy, the doctor may use radiation therapy as the primary treatment method. External beam radiation therapy uses a linear accelerator to emit radiation that is directed at the lesion and the entire pelvic cavity, thereby destroying the tumor.

2. Internal radiation therapy: This involves placing radioactive material into the top of the vagina and inside the still-exposed uterus for internal radiation therapy. Doctors usually administer the treatment in one or more sessions, and the patient may need to stay in the hospital.

3. External beam radiation therapy: If the patient's tumor has spread to other pelvic areas, the doctor will arrange external beam radiation therapy after surgery.

Side effects of radiation therapy

Radiation therapy uses high-energy radiation to destroy cancer cells. When the radiation enters the body, it usually has to pass through some normal tissues before reaching the tumor. Along the way, it inevitably damages normal cells and causes side effects, including menopausal symptoms such as amenorrhea and infertility.

Side effects are categorized into systemic and local, and will appear gradually within one to two weeks after the start of treatment. Systemic side effects include fatigue, nausea, diarrhea, and low blood cell count, which can be relieved by rest or appropriate medication. Side effects will gradually subside after the course of treatment is completed.

Local side effects vary depending on the irradiated site and adjacent organs. Whether it's internal radiation therapy via the vagina or external radiation therapy into the pelvic cavity, radiation can affect the vagina, bladder, and rectum. Patients may experience vaginal shortening, dryness, loss of elasticity, pain, or discharge. It is recommended to consult a doctor about the use of vaginal douches or estrogen ointments to relieve discomfort. Under a doctor's guidance, a silicone vaginal speculum can also be used to stretch the vagina and relieve discomfort during intercourse. If the patient experiences urgency and blood in their urine or stool, it is advisable to consult a doctor about the use of anti-inflammatory agents to relieve discomfort.

Endometrial cancer is one of the top ten most common cancers in Hong Kong and the fourth most common cancer among women. In 2018, a total of 1,165 new cases were recorded, with 115 deaths.

Chemotherapy

Chemotherapy is a systemic treatment; the drugs are typically administered intravenously and transported throughout the body via the bloodstream. Its principle is to exert a therapeutic effect by attacking rapidly growing cells. Although chemotherapy drugs can kill cancer cells, normal cells are inevitably damaged by the drugs, causing various side effects.

Chemotherapy is mainly used for advanced and recurrent endometrial cancer to help shrink tumors, slow tumor growth, and relieve symptoms; it can also be used as adjuvant therapy after surgery or in combination with radiotherapy.

Two common chemotherapy drug combinations used for endometrial cancer include carboplatin and paclitaxel, and cisplatin and doxorubicin. Doxorubicin can cause heart problems, cisplatin may affect the kidneys, and paclitaxel may affect the nerves, causing numbness and tingling in the limbs. Before undergoing chemotherapy, patients should consult their doctor to understand the drug names, dosages, side effects, and management methods. The entire treatment course lasts several months, with several weeks of rest after each dose to allow the body to recover from the side effects.

Side effects of chemotherapy

During treatment, normal cells are also damaged by chemotherapy drugs, especially rapidly growing bone marrow hematopoietic cells, hair follicle cells, and digestive tract mucosal cells, leading to side effects such as fatigue, decreased immunity, nausea, loss of appetite, diarrhea, and hair loss. Most of these side effects are temporary and will gradually subside after a period of time following the completion of treatment.

It is worth noting that chemotherapy may affect reproductive function. If you are planning to have children, it is recommended that you consult an obstetrician-gynecologist before starting treatment and prepare for artificial insemination.

Hormone therapy

The ovaries secrete estrogen and progesterone. Some uterine cancers contain progesterone bodies, and hormone therapy with synthetic progesterone can slow the growth of cancer cells.