Radiation Therapy for

Endometrial Cancer

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What is endometrial cancer?

Typically, endometrial cancer starts in the uterus. The uterus is the pelvic organ where fetal development occurs. This type of cancer starts in the layer of cells that line the uterus (endometrium). The uterus can also develop other types of cancers, such as uterine sarcomas, but these are much less common than endometrial cancer. Endometrial cancer is one of the most common gynaecological cancers in Singaporean women. Changes typically occur in the late 40s, and are commonly diagnosed in women in their 50s and 60s.

Endometrial cancer is graded according to how much the cancer cells resemble the glands found in a normal endometrium. A higher percentage of cancer cells form glands in lower-grade cancers (grades 1 and 2). The cancer cells in higher-grade cancers (grade 3) are more disorganised and do not form glands. In grades 1 and 2, cancers do not generally spread rapidly to other tissues, nor are they very aggressive. Too much estrogen is believed to cause type lower-grade endometrial cancers. The condition is sometimes caused by atypical hyperplasia, an abnormal growth of cells within the endometrium. In higher-grade cancers, it is more likely that the cancer will spread outside of the uterus, with a poorer outlook.

Some signs and symptoms of endometrial cancer include:

  • Below are some of the signs and symptoms of endometrial cancer. Should you experience any of these symptoms, it is recommended to visit your doctor.

    • Abnormal Vaginal Bleeding
      Abnormal vaginal bleeding is a common symptom of endometrial cancer that affects 90% of women. This may include a change in period cycle, bleeding between periods or bleeding after menopause. Though abnormal bleeding can also be caused by non-cancer problems, it is still advisable to see your doctor in any irregular bleeding occurrences.
    • Pink or White, Watery Vaginal Discharge
      In some cases, women with endometrial cancer may experience bleeding in the form of vaginal discharge that is watery, pink or white instead of red.
    • Pelvic Pain
      Women with endometrial cancer may suffer from moderate-to-severe pelvic pain. As cancer grows, they may also feel pain in their abdomen and chest. Typically, pelvic pain occurs in the later stages of endometrial cancer.
    • Pain During Sexual Intercourse
      Painful sex, or dyspareunia, is a common symptom of endometrial cancer. Endometrial cancer patients may experience this problem because penetration and other movements related to intercourse can stretch and pull the endometrial growths.
    • Difficult or Painful Urination
      In some cases, endometrial cancer can cause bladder endometriosis. This condition occurs when endometrial-like cells grow inside or on the surface of the bladder, which may cause burning or pain during urination.

Causes

While the causes of endometrial cancer are not specifically known, doctors theorise that the interaction of estrogen and progesterone receptors on the surfaces of cells can lead to increased growth of the endometrium, which eventually develops into cancer. Mutations in the DNA cells can also cause endometrial cancer. Mutations transform normal, healthy cells into abnormal ones. A normal cell grows and multiplies at a certain rate, eventually dying at a set time, but an abnormal cell grows and multiplies out of control, without dying at a set time. A tumour is formed when abnormal cells accumulate. 

Scientists are learning more about how certain genes change when normal endometrial cells become cancerous. Genes responsible for cell growth can be affected by damaged or defective DNA. It is not uncommon for endometrial cancer to be hereditary. Certain families are more likely to develop these cancers if they inherit a defect in a gene that normally repairs DNA damage. DNA damage may persist and eventually cause cancer if these repair enzymes are not functioning properly. Such DNA repair defects have also been found in endometrial cancer cells from women who did not inherit them. In addition, certain risk factors can also predispose women to developing this cancer.

Risk Factors

There are several factors that contribute to an increased risk of endometrial cancer. It is important to understand such risks and prevent them where possible to reduce the likelihood of endometrial cancer.

  • Obesity
    The presence of fat tissue may increase a woman’s estrogen levels, which can lead to an increased risk of endometrial cancer. The risk of endometrial cancer is two to three times higher in overweight and obese women than in women who stay at a healthy weight.
  • Age
    Endometrial cancer is more common in women between 50 and 70 years old. As women age, their chances of developing endometrial cancer increase. The majority of women with endometrial cancer are diagnosed after the age of 55.
  • Diabetes
    Researchers have found that women with diabetes have twice the risk of developing uterine cancer compared to healthy, non-diabetic women. Although the reasons for this increased risk are not fully understood, some studies indicate that elevated levels of estrogen may be involved in the association between non-insulin dependent diabetes and endometrial cancer risk.
  • Early Menstruation or late Menopause
    According to the American Society of Clinical Oncology, women who go through early menstruation or late menopause are more likely to develop endometrial cancer. This is because their exposure to hormones such as estrogen is increased.
  • Undergoing Hormone Therapy
    Hormone therapy slows the growth of tumours with receptors to estrogen and progesterone. This affects how some endometrial tumours grow. High estrogen levels and low progesterone levels increase the risk of endometrial cancer.
  • Never Having Been Pregnant
    During pregnancy, hormonal balance shifts toward more progesterone being produced. Therefore, having many pregnancies may help prevent endometrial cancer. Women who have never been pregnant, especially if infertility is involved, have a higher risk of endometrial cancer.

What is Radiation Therapy?

Prostate cancer radiation treatment is an option recommended for patients diagnosed with prostate cancer. It uses high-energy X-rays generated from a radiation therapy machine called a LINAC to destroy cancer cells. Prostate cancer radiation treatment has long been used to kill tumours without the need for surgical operations. It inhibits cancer cells from multiplying by delivering ionising radiation to destroy cancer cells while minimising radiation damage to normal tissues. When these cancer cells die, the body naturally eliminates them. Healthy, normal tissues are then able to repair themselves in a way that cancer cells cannot, leading to a much higher proportion of tumour cell death compared to normal cells.

Prevention

The good news about endometrial cancer is that approximately 70% of cancers are diagnosed at the earliest stages of development, due to the noticeable symptoms of bleeding from the endometrial lining, allowing for prompt and effective treatment. Other ways to help prevent endometrial cancer include regular exercise, maintaining a healthy weight, and consulting your doctor on usage of birth control pills or hormone therapy.

By maintaining a healthy weight, the presence of fat tissues is much lower and thus, estrogen levels as well. This can reduce the risk of endometrial cancer. Taking birth control pills may also help. Birth control pills contain estrogen and progesterone, which work together to create a monthly menstrual cycle. When taken over a long period of time, it reduces the risk of an overgrowth of the uterine lining. However, it is highly recommended to consult your doctor regarding aspects such as birth control pills or hormone therapy as they possess the experience required to guide you in making a well-informed decision.

Most importantly, always go for regular check-ups. Check-ups enable you to detect issues early and treat them before they deteriorate. This may include an internal pelvic exam, pap test, endometrial biopsy, dilation and curettage or transvaginal ultrasound.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

Treatments

When it comes to endometrial cancer, there is no one size fits all solution and treatment options vary according to each patient and their condition. Talk to your doctor to find out which treatment is suitable for your condition.

Surgery

A hysterectomy may be conducted for the surgical removal of the uterus, cervix, or other nearby tissue such as ovaries, fallopian tubes, and local lymph nodes.

Radiation Therapy

In radiation therapy, X-rays, gamma rays and charged particles are used to treat cancer. External beam radiation therapy and brachytherapy are the most common ways to treat endometrial cancer. New techniques in image-based brachytherapy with directed magnetic resonance (MR) guidance offer better patient outcomes with fewer side effects.

Chemotherapy

Chemotherapy is the use of anticancer drugs to treat cancerous cells. Chemotherapy is often given after surgery to facilitate the effective destruction of cancer cells, and can be intravenous or swallowed. Endometrial cancer can be treated with chemotherapy, but it is also associated with side effects. While some chemotherapy side effects are mild and treatable, others can cause serious complications.

Hormone Therapy

Hormone therapy is a medication or surgical procedures that interfere with hormone activity. It can be used to slow the growth of certain types of endometrial cancers, chiefly utilising the sex hormone progesterone.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

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Frequently Asked Question

Type 1 endometrial cancer, which is often found only inside the uterus grows slowly. Type 2 endometrial cancer, which is less common, grows more rapidly and tends to spread to other parts of the body.

According to the American Cancer Society, it tracks 5-year relative survival rates for endometrial cancer. It is important to realise that survival rates are estimates and based on large numbers of people who had a specific cancer, but they cannot predict what will happen to an individual.

Endometrial cancer can spread to the rectum or bladder. The vagina, ovaries, and fallopian tubes are other areas that may be affected.

Endometrial cancer is curable when detected and treated early.

Recurrence of endometrial cancer is most likely in the first three years following treatment, although late recurrence is also possible.