Abnormal Bleeding for Over 2 Weeks? Get Checked for Uterine Cancer

The two major cancers affecting the uterus are cervical cancer and endometrial cancer. While cervical cancer was once the fourth most common cancer among Korean women in 1999-2001, regular screenings and preventive vaccines have pushed it down to 11th place as of 2022, according to the Korea Central Cancer Registry.

In contrast, endometrial cancer is on the rise due to obesity and delayed childbirth. In 2022, there were 3,743 new cases of endometrial cancer, surpassing cervical cancer's 3,174 cases.

Fortunately, both cancers have five-year survival rates of 90-95% when detected early. However, many patients miss optimal treatment windows by postponing gynecological visits.

"Most uterine cancers can be caught early with proper screening," said Professor Eo Kyung-jin of the Department of Obstetrics and Gynecology at Yongin Severance Hospital. "The government provides free cervical cytology tests every two years for women over 20. In alternate years, women should get ultrasound examinations on their own to check endometrial thickness."

Infection-Related Cancer Declining, Hormone-Related Cancer Rising

Cervical cancer has a clearly identified cause: HPV (Human Papillomavirus). While over 200 types of HPV commonly infect the cervix through sexual contact, most are naturally eliminated by the immune system within one to two years. However, persistent infection with high-risk strains such as types 16 and 18 can cause genetic changes in cervical cells, potentially leading to cancer.

Vaccines that prevent high-risk HPV infection are available. Combined with cervical cytology and HPV testing, vaccination can effectively prevent cervical cancer.

Endometrial cancer is linked to female hormones and influenced by obesity, westernized diets, lack of exercise, and delayed pregnancy and childbirth. These lifestyle changes have contributed to the increasing incidence of endometrial cancer.

Watch for Abnormal Bleeding

Both cervical and endometrial cancer can cause abnormal bleeding in early stages. "Post-menopausal bleeding is unexplainable bleeding that must be investigated," Professor Eo emphasized. "Young women should also see a gynecologist if bleeding occurs outside their menstrual period for more than two weeks."

The government provides free Pap tests every two years for women over 20, though the Korean Society of Gynecologic Oncology recommends annual screening. "Getting tested privately in years without government screening can catch most cancers early," Professor Eo noted. "Endometrial abnormalities can be easily detected through transvaginal ultrasound."

Minimally Invasive Surgery Now Standard

While minimally invasive procedures like laparoscopic and robotic surgery are increasingly common worldwide, a 2018 U.S. study suggesting better outcomes with open surgery for cervical cancer sparked debate.

"After that study, open surgery became the global standard for cervical cancer," Professor Eo explained. "However, experienced surgeons in Korea still use robotic or laparoscopic approaches for small lesions or very early-stage patients. Medical societies have concluded that minimally invasive surgery is acceptable when conditions are met and surgeons are confident."

For early-stage endometrial cancer, laparoscopic or robotic surgery is nearly universal. In cases with low-grade, typical endometrial cancer, hormone therapy can preserve the uterus.

First-stage cervical cancer has a five-year survival rate exceeding 90%, while endometrial cancer exceeds 95%. "When caught early, surgery alone may suffice, or minimal additional radiation and chemotherapy yields excellent outcomes," Professor Eo said.

Fertility preservation is also possible. Four years ago, Professor Eo performed robotic surgery on a cervical cancer patient planning to marry, removing only part of the uterus. "The patient remained cancer-free for four years and recently came to my office with her newborn after a successful pregnancy," she said.

For advanced cases where surgery is not possible, chemotherapy is used. "For high-risk patients after surgery, we now add immunotherapy drugs to conventional chemotherapy and radiation," Professor Eo said. "With markers like PD-L1 and MMR/MSI, drugs such as Keytruda (pembrolizumab) and Jemperli (dostarlimab) are now covered by health insurance starting this year, giving patients more options."

HPV Vaccination Available for Women in Their 40s

Cervical cancer should be prevented through HPV vaccination. While adolescent vaccination is ideal, women in their 40s can still receive the vaccine. "The government recommends two doses six months apart for adolescents aged 9-13 without sexual experience, when antibody response is strongest," Professor Eo said.

Starting next year, free HPV vaccination will extend to male adolescents, considering prevention of oral and anal cancers and partner protection.

Middle-aged women with sexual experience can also benefit from HPV vaccination. While it does not eliminate existing HPV infections, it provides antibodies against strains not yet contracted. "We vaccinate women up to their mid-40s if they want it," Professor Eo said, noting that adult vaccination requires three doses at approximately 200,000 won (about $140) each.

"It's heartbreaking to see patients miss their golden window for treatment because they were too busy, scared, or found gynecological visits inconvenient, despite knowing something was wrong," Professor Eo said.