Endometrial (Uterine) Cancer Screening

If you're experiencing unexpected vaginal bleeding or discharge, you might assume that your period is about to arrive. However, if you are postmenopausal, this is an abnormal condition and is something that should be evaluated by a specialist.

While it's possible that it's not caused by anything harmful, if you're postmenopausal or have risk factors for endometrial cancer, a specialist evaluation can help detect endometrial issues early on, when outcomes are best.

What is endometrial cancer?

Endometrial cancer, also known as uterine cancer, is a type of cancer that originates in the lining of the uterus, known as the endometrium. This lining is where the early foetus (embryo) implants and continues to grow.

It is one of the most common gynaecologic cancers that usually affect postmenopausal women. Cancerous changes in the lining of the womb typically take place in a woman's late 40s, with endometrial cancer most commonly diagnosed in women in their 50s and 60s.

However, unlike ovarian cancer, this condition is usually detected in the first stage of development, also known as FIGO Stage I. This is because even early or pre-cancerous changes in the endometrial lining usually cause symptoms like abnormal bleeding in postmenopausal women, giving you an opportunity to take action.

What are the types of uterine cancer?

Endometrial cancer can be classified into two distinct groups – type I and type II –  based on how the cancer cells are structured, behave, and look under a microscope.

• Type I:

  • This is the most common form and is often associated with oestrogen hormone changes. This type typically develops slowly and is usually caught early when treatment is most successful.

• Type II:

  • This less common type is not oestrogen-dependent and can develop more quickly. Since it often presents at an advanced stage, early detection through specialist evaluation is particularly important for this type.

Type I endometrial cancers are the most common type, and if they are found early through proper testing, the chances of successful treatment are significantly higher.

When should I go for a doctor evaluation for endometrial cancer?

Unlike some other cancers, there is no standard or routine screening test for endometrial cancer if you don't show any symptoms. However, if you are experiencing symptoms, specialist evaluation is recommended to determine the cause. You should seek specialist evaluation if you experience:

• Abnormal vaginal bleeding or discharge, especially after menopause

• Persistent pelvic pain, pressure or discomfort

• Difficult or painful urination

• You can feel a mass in your pelvic area

• Unexplained weight loss

• You experience vaginal bleeding more than once a month if you still have menstrual periods.

Although experiencing these symptoms doesn't necessarily mean you have this cancer, it's recommended that you seek evaluation by a specialist, especially since most endometrial cancers are detected early, when outcomes are favourable. You may also benefit from screening if you have:

• A family history of endometrial, ovarian, or colorectal cancer

• Never having been pregnant

• Starting your period too early (before the age of 12)

• Lynch syndrome or a genetic predisposition

• Risk factors such as obesity, diabetes, or prolonged oestrogen exposure

How are screenings for endometrial cancer done?

Although there is no standard or routine screening test for endometrial cancer if you are not showing any symptoms, there are tests that may be recommended if you are experiencing symptoms or have risk factors. These tests include:

• Transvaginal ultrasound:

  • A transvaginal ultrasound involves inserting an ultrasound probe into the vagina to create detailed images of the pelvic organs. This imaging test uses sound waves to create detailed images of the womb, aiding the identification of any abnormalities.

• Endometrial biopsy:

  • This procedure involves inserting a small, flexible tube into the uterus to collect a tissue sample from the endometrium. The sample is examined under a microscope to check for the presence of cancer or other abnormal cells.

• Dilatation and Curettage (D&C):

  • This procedure involves dilating (opening) the cervix and removing uterine tissue with the aid of a thin, lighted tube inserted through the cervix (hysteroscopy).

  • This allows the doctor to visualise the endometrial cavity and scoop tissue from the uterus using a spoon-shaped tool called a curette for later diagnosis.

You might be recommended to undergo annual screening for uterine cancer with transvaginal ultrasound and endometrial biopsy if you are aged 30–35 and at high risk of uterine cancer.

Thomson Medical’s 4-in-1 women cancer evaluation

While most endometrial cancers cause symptoms such as postmenopausal bleeding, which allow for early detection, the symptoms can sometimes be similar to those of other medical conditions.

This can lead women to ignore the symptoms and not realise they have the cancer until it has progressed. This is particularly important if you have risk factors such as hormone therapy use, never having been pregnant, or starting your period before age 12.

If you are experiencing symptoms or have risk factors, Thomson Women’s Clinic & Cancer Surgery offers a 4-in-1 women's cancer evaluation programme, which includes:

• Consultation & examination with a gynaecologic oncologist

• Pap smear

• HPV test

• Pelvic (transvaginal) ultrasound scan

This evaluation helps our specialists determine whether your symptoms require further testing and how often the tests should be done.

FAQ

What increases the risk of endometrial (uterine) cancer?

How common is endometrial cancer?

In Singapore, endometrial cancer is the fourth most common cancer in women. Over 2,900 cases were reported between 2016 and 2020, and the incidence has been steadily rising in recent years.

What age is typical for endometrial cancer?

Endometrial cancer is most frequently diagnosed between the ages of 55 and 65, with a median age of diagnosis of 64 years. While the risk increases with age, developing this cancer before the age of 45 is uncommon.

Can endometrial cancer cause weight gain?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations for your specific conditions, schedule a consultation with our women's cancer specialist at Thomson Women's Clinic and Cancer Surgery.

References

1. Johns Hopkins Medicine, Endometrial Cancer, 2024.

2. PDQ® Adult Treatment Editorial Board. PDQ Endometrial Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated 13 November 2020.