Cancer of the uterus is the 3rd commonest cancer of the female genital tract in Singapore. It usually affects the endometrium (lining of the uterus). If it is found and treated early, the cure rate is very good - it can be over 90% when the disease is at an early stage. The more advanced the disease is, the lower the cure rate. This is why early detection is so important.
At present, there is no simple way to screen for uterine cancer. The key to finding the disease in an early stage is being alerted to its symptoms which include:
The cause of any abnormal bleeding needs to be looked into by your doctor.
Except when combination hormone therapy is being taken, any bleeding or spotting after menopause is abnormal, no matter when amount or colour. Ask your doctor about any bleeding or spotting you have after menopause.
There are several things you can do to lower your risk of uterine cancer and to improve the changes of early detection :
In Singapore, the majority of uterine cancer is diagnosed after 40 years of age, most commonly between 50 and 70 years old.
Some women have a higher risk of uterine cancer:
It is also thought that some women who take oestrogen alone after menopause may be at risk for cancer of the uterus. If oestrogen is given along with another hormone, progesterone, this combination protects against the risk of uterine cancer.
Women who have ever used the most common type of birth control pills, combination (oestrogen plus progesterone) birth control pills, have a reduced risk of uterine cancer. This protection persists for at least 10 years after a woman stops taking the pill.
A woman may have some or all of the risk factors described here and never have uterine cancer. But women at risk should be aware of the symptoms of uterine cancer and discuss their concerns with their doctor. Regular check-ups, including pelvic examinations, are important.
The procedures used to diagnose cancer of the uterus include an endometrial biopsy, in which tissue from the uterus is removed and examined in a laboratory. Sometimes, hysteroscopy may be done. This is a procedure in which the inside of the uterus is examined with an instrument called a hysteroscope, which resembles a thin telescope. Sometimes, the patient may have to have a procedure called dilatation and curettage (D&C) in the hospital. In D&C, 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 Pap smear test, while an important part of a regular check-up, is not a dependable test for uterine cancer. It can detect cancer or pre-cancer of the cervix, but may indicate uterine cancer in about half the cases.
If a woman is found to have cancer of the uterus, surgery will be performed to determine the extent of the disease (stage) and how it should be treated. Stage refers to the extent (if any) to which the cancer has spread. The stages range from early to advanced (I through IV). Staging helps your doctor decide what treatment will have the best chance for success.
About 75% of the women diagnosed with uterine cancer have stage I disease. Of these women, 85 - 90% will have no evidence of cancer 5 years or more after treatment. As the cancer becomes more advanced, the chance for a cure decreases.
Most patients have both hysterectomy (removal of the uterus) and salpingo-oophorectomy (removal of the ovaries and fallopian tubes). Tissue from lymph nodes in the pelvic area may also be tested to find out if the cancer has spread. Some cases of uterine cancer may also require radiation therapy after surgery.
If tests show that the cancer has spread or recurred after surgery and radiation therapy, your doctor may recommend additional drug therapy. Progestin (a hormone) therapy or chemotherapy may be used to treat uterine cancer that has spread to other organs.
You will have several tests performed which will allow the doctors to have a complete picture of the state of your health before you undergo the surgery.
The physiotherapist will visit you before and after the operation to discuss the importance of deep breathing and coughing after the surgery.
Your doctor and the anaesthetist will visit you in the ward before your operation. Both doctors will explain the operative procedures.
After the surgery, you will wake up in the recovery ward but you may not remember anything until several hours later in the ward. You will experience pain and probably nausea. This will be worse over the first 2 days and gradually improve over the following days. The nursing staff will give regular injections for the pain and nausea until this settles, as this will enable you to move in and out of bed with greater ease.
An intravenous drip is inserted in your arm to provide the fluid you need, as you will not able to drink any significant amount of fluid during the first few days - usually only sips of water or ice to suck.
You will have a catheter inserted into your bladder to drain away the urine. This may be inserted into the bladder outlet (the urethra) or into the bladder through the abdominal wall. This remains in your bladder for 2 - 10 days depending on your type of surgery. You may have a drain (or two) attached to a drainage bottle. The purpose of this is to drain the raw areas at the operation site and prevent accumulation of blood and fluid.
Your surgical stockings will need to be worn until you are fully mobile.
Exercising your legs and lungs every hour is very important, as this improves the circulation and prevents clots from forming.
You will be assisted out of bed as soon as your condition permits. Again this improves the general circulation and exercises the abdominal muscles.
There may be vaginal bleeding for several days after your operation, necessitating the wearing of the pad.
You may not be able to pass wind for some days and it may be a further few days before you have a bowel motion. The build up of wind (gas) can cause abdominal discomfort during this time. The nursing staff will be able to advise you on ways to help relieve this.
You will have clips or stitches in your wound and these will remain for 7 - 10 days.
You may be surprised when you go home at how weak you will feel and how easily you will tire. So at first you should not have any domestic responsibilities, especially lifting. Gradually you will feel better and be able to do more. You shouldn't drive a car for at least two weeks after you leave the hospital.
If you have a job outside the home, this can usually be resumed in approximately six weeks. If your job involves a lot of physical work or prolonged standing, it may take longer to get back to work.
Women who have had a hysterectomy for cancer are often concerned about how the surgery will affect their sexuality. It is not uncommon for women to ask questions like "When will I be able to have sex again? Will it be painful? Will I feel less of a woman? How will my partner react?" Those women who require radiotherapy or chemotherapy after their hysterectomy may have further questions.
Women will find sex initially uncomfortable as it will take time for the wound to heal. Most doctors will advise refraining from sexual intercourse until the stitching at the top of the vaginal has healed properly - usually about six weeks.
Having a hysterectomy does not mean women lose their femininity although some women may experience these feelings. It can be helpful to talk about your concerns with your partner or someone close to you. You may also wish to discuss any emotional or sexuality concerns with the social worker, nurse or doctor you feel most comfortable talking to.
If you have cancer of the uterus, you may have many fears and concerns. Talk these fears and concerns over with your doctor. Remember that you are not alone. Your doctor and the other people involved in your care will do everything possible to help you get well. Together, you and the members of your healthcare team can work to reduce the chances of further problems and find ways to keep you as healthy as possible.