Women should take abnormal bleeding seriously

Dr Huemer, how does uterine cancer compare to other tumours of the female genital organs?

Uterine body cancer or endometrial cancer is the most common form of cancer in the genital area of women, ahead of ovarian cancer and cervical cancer. Alongside breast cancer, it used to be the most common gynaecological disease. Thanks to very good screening and the HPV vaccination, we have almost eradicated cervical cancer. Compared to ovarian cancer, which is often detected late and is very aggressive, we don't fear cervical cancer as much because we usually detect it at an early stage.

Why is that?

In most cases, endometrial carcinoma occurs in the postmenopause. The average age of onset is around the age of 65. Affected women report abnormal bleeding, which they promptly have checked by a gynaecologist. However, there are also younger women who develop the disease. Important signs can be irregular or very heavy bleeding.

Are there any risk factors?

Above all, there is an association with metabolic syndrome, which is characterised by overweight women who are more prone to high blood pressure and diabetes. This is a major risk factor, which is mainly due to diet and increasing lack of exercise in our affluent society.

In addition, compared to the past - also thanks to a variety of treatment methods - people are more reluctant to have their wombs removed, so that most women still have their wombs in old age.

How do you diagnose endometrial cancer?

If a woman has atypical bleeding, an ultrasound is performed first. If there is even a slight suspicion, the gynaecologist will examine the tissue histologically. This involves removing tissue from the uterus using a pipette. Even if the tissue is unremarkable, we recommend an additional uterine endoscopy and a possible scraping of the tissue, a so-called curettage, based on the positive ultrasound findings.

How do you determine the degree of spread?

Once the diagnosis has been confirmed, a so-called staging operation is performed to clarify the degree of spread. This involves removing the uterus, ovaries and fallopian tubes. In addition, so-called sentinel lymph nodes are removed. This has long been known from breast and skin cancer and has now also become established in certain stages of endometrial cancer. The question of whether tumour cells have settled or not is decisive in determining whether follow-up therapy in the form of radiotherapy is necessary.

They have a lot of experience with the sentinel lymph node concept at Bethesda Hospital in Basel. They were one of the first teams to use this method. How does the procedure work?

We use laparoscopy, i.e. keyhole technology, to locate the sentinel lymph nodes on both sides of the pelvis that are closest to the uterus. If we concentrate only on these lymph nodes, it is possible to analyse even the smallest tumour metastases in much greater detail with many incisions. If the sentinel lymph nodes are free of tumour cells, it can be assumed that the lymph nodes behind them are also inconspicuous.

What are the advantages of analysing the sentinel lymph nodes alone?

There are fewer complications than when all lymph nodes are removed. These include poorer lymph drainage, the possible development of lymph cysts or swollen legs. Because we operate laparoscopically, the procedure is also considerably less invasive for the patient. In most cases, the patient is back on her feet on the same day and can return home one or two days after the operation.

What are the chances of recovery?

Patients with early endometrial cancer have very good chances of recovery. In many cases, no follow-up therapy is necessary.