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Prevalence of Corpus Uteri Cancer in Hong Kong
Corpus uteri cancer is one of the common gynecological cancers among women in Hong Kong. In 2022, there were 1,188 new cases of corpus uteri cancer , ranking it as the fourth most common cancer among women. Based on the age-standardized incidence rate, there were approximately 15.7 new cases per 100,000 women in Hong Kong. Although the incidence rate of uterine corpus cancer in Hong Kong is lower than that in Western countries, its age-standardized incidence rate has shown a significant upward trend over the past few decades, with the peak age of onset being 56.
Although the incidence of corpus uteri cancer is increasing, fortunately, its mortality rate is relatively low. In 2022, there were 109 deaths, and according to data from 2012 to 2021, the overall five-year relative survival rate was as high as 84%. This is mainly because its symptoms (such as abnormal vaginal bleeding) are relatively obvious, making it easier for patients to become alert and seek medical attention early. If the cancer is detected and treated while still at a localized stage (Stage I or II), the cure rate can be as high as 97%.
Symptoms of Corpus Uteri Cancer
Early-stage corpus uteri cancer often presents with subtle symptoms that may be mistaken for menstrual irregularities, frequently delaying diagnosis and treatment.
Early and Intermediate Stage Symptoms: Abnormal vaginal bleeding including prolonged/frequent menstruation with heavy flow or intermenstrual bleeding in premenopausal women; postmenopausal bleeding or abnormal vaginal discharge after menopause.
Advanced Stage: Symptoms become more pronounced, including pelvic pain during sexual intercourse and urination, abnormal bowel habits (such as constipation), formation of hard masses in the lower abdomen, and discharge of pus and blood from the vagina.
Important Note: The abovementioned symptoms are not exclusive to corpus uteri cancer. If any suspicions arise, immediate medical consultation is strongly advised.
Understanding Cancer Causes
The medical community has not yet fully understood the exact causes of corpus uteri cancer, though it may be associated with the following risk factors:
These factors only indicate elevated risk probabilities rather than definitive outcomes. Medical consultation is recommended for a personalised assessment.
Common Diagnostic Methods
To accurately determine the stage of corpus uteri cancer, the following imaging scans may be utilised:
Through these diagnostic examinations, physicians will determine the cancer stage. Corpus uteri cancer is typically classified into 4 stages:
Stage I: The tumour remains confined to the uterine corpus or endometrium.
Stage II: Cancer cells have spread downward to the cervix but remain within the uterus.
Stage III: Cancer extends beyond the uterus, affecting the ovaries, vagina, or pelvic/aortic lymph nodes, indicating significant spreading potential.
Stage IV: Distant metastasis has occurred, with cancer cells spreading through lymphatic or blood circulation to organs beyond the pelvic cavity – most commonly affecting adjacent bladder/rectum, or distant sites like liver, lungs, bones, or brain.
Primary Treatment Methods
Generally, corpus uteri cancer grows relatively slowly and rarely spreads beyond uterine tissue, resulting in cure rates exceeding 90% for early-stage cases. The primary treatment modalities are surgery and radiation therapy, which may be used individually or in combination depending on the patient’s condition.
For early and intermediate stage corpus uteri cancer, primary treatment involves surgical removal of the uterus, cervix, fallopian tubes and ovaries, supplemented with both internal and external radiation therapy.
Advanced-stage corpus uteri cancer with widespread metastasis may involve invasion of the bladder, rectum, or even distant organs like the liver and lungs. In such cases, systemic treatments including chemotherapy are typically employed, often combined with adjuvant therapies like hormone treatment.
Surgical resection serves as the primary treatment method for corpus uteri cancer. When imaging confirms the tumour hasn’t widely metastasised, physicians typically perform complete removal of the uterus and adjacent normal tissue to ensure complete eradication of malignant cells.
Total Hysterectomy represents the standard procedure, involving the removal of the uterus and cervix, with concurrent salpingo-oophorectomy (fallopian tubes and ovaries) in most cases. Resected tissues undergo pathological examination to determine cancer type and extent of spread.
For early-stage tumours, total hysterectomy alone may suffice. If pathology reveals myometrial or cervical invasion, postoperative radiation therapy is considered to reduce recurrence risk.
Since ovarian estrogen production may stimulate residual cancer growth, prophylactic oophorectomy is routinely recommended except in exceptional circumstances. This induces surgical menopause with associated symptoms (cessation of menstruation, infertility, hot flashes, palpitations). Fertility-preserving alternatives should be discussed preoperatively when relevant.
Surgical Approaches Include:
Radiation therapy targets and kills cancer cells with high-energy rays while minimising the impact on normal cells. There are two types: external radiation therapy and internal radiation therapy. For Corpus Uteri Cancer, radiation therapy includes the following three approaches:
Side Effects of Radiation Therapy
Radiation therapy uses high-energy radiation to destroy cancer cells. As the radiation passes through the body to reach the tumour, it inevitably affects some normal tissues, damaging healthy cells and causing side effects. These may include menopause-like symptoms such as cessation of menstruation and infertility.
Side effects can be systemic or localised and typically appear one to two weeks after treatment starts. Systemic side effects include fatigue, nausea, diarrhoea, and low blood cell counts. Patients can manage these symptoms with adequate rest or appropriate medication, and they usually subside after treatment is completed.
Localised side effects depend on the treatment area and nearby organs. Both internal radiation therapy (delivered through the vagina) and external pelvic radiation can affect the vagina, bladder, and rectum. Patients may experience vaginal shortening, narrowing, dryness, loss of elasticity, pain, or discharge. Consulting a doctor about using vaginal washes or estrogen creams may help relieve discomfort. Under medical guidance, silicone vaginal dilators can also be used to stretch the vagina and reduce pain during intercourse. If a patient experiences urgency or blood in their urine or stool, they should consult their doctor about whether anti-inflammatory medications can help alleviate symptoms.
Chemotherapy is a systemic treatment where drugs are typically administered intravenously, allowing them to travel through the bloodstream to reach all parts of the body. The principle of chemotherapy is to target rapidly growing cells, including cancer cells. While chemotherapy drugs can effectively kill cancer cells, they also inevitably damage healthy cells, leading to various side effects.
Chemotherapy is primarily used for advanced or recurrent Corpus Uteri Cancer to help shrink tumours, slow tumour growth, and relieve symptoms. It may also be used as adjuvant therapy after surgery or in combination with radiation therapy.
Two standard chemotherapy drug combinations for Corpus Uteri Cancer include carboplatin with paclitaxel and cisplatin with doxorubicin. Doxorubicin may cause heart-related side effects, cisplatin can affect kidney function, and paclitaxel may lead to nerve damage, causing numbness or tingling in the limbs. Before starting chemotherapy, patients should discuss the drug names, dosages, potential side effects, and management strategies with their doctor. The entire treatment course spans several months, with rest periods between cycles to allow the body to recover from side effects.
Side Effects of Chemotherapy
During treatment, chemotherapy drugs also damage normal cells, particularly fast-growing cells such as bone marrow cells responsible for blood production, hair follicle cells, and mucosal cells in the digestive tract. This leads to side effects including fatigue, weakened immunity, nausea, loss of appetite, diarrhoea, and hair loss. Most of these side effects are temporary and will gradually subside after treatment is completed.
It is important to note that chemotherapy may affect fertility. Those with plans for pregnancy should consult a gynaecologist before starting treatment to discuss fertility preservation options.
The ovaries produce estrogen and progesterone. In some cases of Corpus Uteri Cancer, tumours have progesterone receptors. Administering synthetic progesterone as hormone therapy can help slow the growth of cancer cells.
*Sources:
Cancer Online Resource Hub
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
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