December 7, 2023
December 7, 2023

Endometrial Cancer Symptoms, Diagnosis, and Treatment Options

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Endometrial Cancer Symptoms, Diagnosis, and Treatment Options

Among the myriad health challenges women face, endometrial cancer is formidable, impacting an estimated 417,000 women worldwide each year. In the United States alone, over 66,000 new cases are diagnosed annually, with a staggering 13,000 women succumbing to the disease.

The five-year survival rate for endometrial cancer detected early is an astonishing 95%, while the number for late-stage diagnoses decreases to 16%. These numbers emphasize the importance of awareness, early detection, and proactive healthcare. 

In this article, we’ll go beyond the statistics. You’ll learn subtle endometrial cancer symptoms and risk factors, empowering you to make more informed decisions about your health and lifestyle. We will also discuss diagnostic and treatment options for those facing cancer.

What Is Endometrial Cancer and Where Does It Spread?

Endometrial cancer affects the cells that form the lining of your uterus, also called the endometrium. Most endometrial cancer is primary which means that it started there and did not spread from another site. However, endometrial cancer can metastasize or spread to other organs. It may first spread into the uterus and then to other reproductive organs such as an ovary or the cervix. Eventually, it can spread to the bladder, liver, lymph nodes, and bone if not successfully treated.

What Are the Most Common Endometrial Cancer Symptoms?

Recognizing the symptoms of endometrial cancer is vital for early detection and treatment. While symptoms can vary among individuals, there are common signs that should prompt medical consultation.

Abnormal Vaginal Bleeding

The most prevalent and significant symptom is vaginal bleeding which can manifest as the following:

  • Bleeding between periods in premenopausal women
  • Menstrual cycles that are heavier or longer than usual
  • Vaginal bleeding or spotting in postmenopausal women, which should always be evaluated as it's not typical after menopause

Pelvic Pain

Persistent or intermittent pelvic pain can be an indication of endometrial cancer, especially if it's a new symptom for the individual. This can include:

  • Dull aches to more severe cramps or pressure in the pelvic area
  • Painful intercourse
  • Pain when urinating or difficulty emptying the bladder

Unusual Vaginal Discharge

It’s normal to have vaginal discharge, especially for premenopausal women. Normal discharge contains skin cells, bacteria, mucus, and fluid produced by the vagina and cervix. Abnormal discharge can include the following:

  • A discharge that is watery or mixed with blood 
  • Any significant change in nature or quantity

Changes in Urination and Bowel Habits

Although less common, changes in bowel and bladder habits that may indicate endometrial cancer symptoms are: 

  • Increased urinary frequency or urgency
  • Severe painful bowel movements, constipation, and even rectal bleeding
  • Back pain that improves after defecation

Unexplained Weight Loss

Sudden, unexplained weight loss can sometimes be a symptom of various types of cancer, including endometrial cancer.

Enlarged Uterus or Abdominal Area

In advanced stages, the endometrial tumors might cause the uterus or the abdominal area to enlarge.

Risk Factors: When Should You Suspect Endometrial Cancer?

Endometrial cancer symptoms illustration

Endometrial cancer, like many cancers, arises from a complex interplay of genetic, hormonal, and environmental factors. Understanding these factors can help assess your personal risk and make informed lifestyle and healthcare choices. Endometrial cancer symptoms are associated with the following risk factors:

Age: The peak age of diagnosis is between 55 and 64 years, with a median age of 62. Endometrial cancer is uncommon in women under the age of 45. The risk increases with age, particularly after menopause.

Race: Endometrial cancer presents an equal lifetime risk of about 3% for both Black and white women in the U.S. This indicates that race (as a biological factor) does not impact the development of the disease. While the lifetime risk of having the disease is the same, there are other differences to consider, such as the stage at diagnosis, access to healthcare, treatment outcomes, and even survival rates between different racial groups. Therefore, the experience and outcomes of the disease can vary.

For example, despite an overall survival rate exceeding 80%, Black women are nearly twice as likely to die from this disease. This disparity is attributed to factors such as delayed diagnosis, social isolation, and inequitable treatment, highlighting the urgent need for addressing healthcare inequalities to improve outcomes for Black women facing endometrial cancer.

Obesity: Increased body fat can lead to higher estrogen levels, especially in postmenopausal women, elevating the risk of endometrial cancer.

Early menstruation and late menopause: Starting periods before age 12 and experiencing menopause at age 55 or older extends exposure to estrogen, thereby increasing risk.

Infertility or never having children: These factors may increase risk due to prolonged estrogen exposure without the hormonal balance provided by progesterone during pregnancy.

Personal history of breast or ovarian cancer: This may indicate a genetic predisposition or shared risk factors.

Family history: A history of endometrial, ovarian, or colon cancers, particularly hereditary nonpolyposis colorectal cancer (Lynch syndrome), increases the risk.

Lynch Syndrome: Hereditary non-polyposis colon cancer (HNPCC) is an inherited predisposition to cancer that can increase the risk of endometrial cancer. The lifetime cumulative risk of endometrial cancer for women with Lynch syndrome is 40% to 60%, equal to or greater than their risk of colorectal cancer.

Hormonal imbalances: An excess of estrogen without sufficient progesterone can lead to endometrial hyperplasia, a precursor to cancer.

Estrogen replacement therapy: Unopposed estrogen (HRT without progesterone) can increase the risk, underscoring the importance of balanced hormone therapy.

Tamoxifen treatment: Used for breast cancer treatment, tamoxifen has a dual effect on the endometrium and can increase the risk of developing endometrial cancer.

Diabetes: Living with diabetes, particularly type 2, may have an increased risk, possibly due to shared risk factors like obesity.

Previous pelvic radiation therapy: Radiation treatment for other types of pelvic and gynecological cancers can increase the risk.

History of Polycystic Ovary Syndrome (PCOS) or Atypical Endometrial Hyperplasia (AEH): PCOS and AEH are conditions associated with higher estrogen levels and are linked to higher risks for developing endometrial and other cancer types.

Manage Your Risks to Prevent Endometrial and Uterine Cancer

Endometrial cancer symptoms: woman smiling at the camera while eating

While there's no sure way to prevent endometrial cancer, you can do a few things that may help lower your risk. Protective factors that decrease the risk of uterine and endometrial cancer include pregnancy and breastfeeding, hormonal contraceptives, weight loss, physical activity, and vitamin C. For those with a family history of cancers linked to Lynch syndrome, genetic counseling and regular screenings may be recommended.

Understanding your risk factors can help in early detection of endometrial cancer symptoms and prevention strategies. However, having one or more risk factors does not mean that a woman will develop endometrial cancer, just as women without any risk factors can still develop the disease. 

Regular health check-ups and discussions with healthcare providers about personal risk factors are essential for proactive health management.

The Benefits of Early Detection and Treatment of Endometrial Cancer

Early detection of uterine and endometrial cancer significantly boosts survival rates. When diagnosed at an early stage, where the cancer is confined to the uterus, the chances of successful cancer care and long-term survival are much higher. 

Because early-stage endometrial cancers are often less aggressive and more responsive to treatment, early diagnosis can lead to more effective treatment with fewer complications. 

Uncovering endometrial cancer symptoms early often means more treatment options are available, including less invasive surgical procedures and the potential to preserve fertility in younger people. 

Other early detection and treatment benefits include: 

  • A reduced likelihood of cancer returning after treatment, leading to a better long-term prognosis 
  • Improved survival rates and quality of life 
  • The ability to return to your normal activities with minimal disruption

How Is Endometrial Cancer Diagnosed?

Endometrial cancer symptoms: doctor writing in a notebook

Diagnosing endometrial cancer involves the following procedures and tests. These diagnostic methods help determine the presence of cancer and assess its stage and extent.

Internal pelvic exam: This is often the first step, where a doctor feels for any lumps or changes in the shape of the uterus.

Pap test (Pap smear): Although primarily used for detecting cervical cancer, a Pap test can sometimes find early endometrial cancers. However, it's not a standard test for endometrial cancer.

Endometrial biopsy: This is a diagnostic test where a tissue sample is taken from the uterus and examined under a microscope to check for cancer cells. It takes about 15 minutes and is a relatively low-risk procedure. 

Dilation and curettage (D&C): If an endometrial biopsy isn't conclusive or more information is needed, a D&C may be performed. It involves scraping the lining of the uterus and examining the cells.

Transvaginal ultrasound: This diagnostic imaging test uses sound waves to create images of the uterus. It can help determine if the endometrium is abnormally thickened, which may suggest cancer.

Endometrial Cancer Treatment Options and Management

Endometrial cancer treatment is multifaceted, involving a combination of surgical, radiological, pharmaceutical, and supportive strategies. Each patient's treatment plan is tailored to their specific needs, taking into account the cancer stage, type, and overall health.

Surgical Treatments

Hysterectomy is the surgical removal of the uterus and is often the primary treatment for endometrial cancer. This procedure effectively removes the primary site of the cancer.

Salpingo-oophorectomy involves the removal of the fallopian tubes and ovaries and is often performed in conjunction with a hysterectomy to prevent the spread of cancer.

Lymph node dissection is the removal of lymph nodes in the pelvic area to check for the spread of cancer.

Radiation Therapy

Brachytherapy is internal radiation therapy that places radioactive material directly into or near the cancer.

External beam radiation is used from outside the body and can be directed at the cancer site. It’s often used after surgery or for advanced stages of cancer.

Chemotherapy and Immunotherapy

These treatments use drugs to destroy cancer cells and are administered depending on the cancer's stage and type. Immunotherapy boosts the body's immune system to fight cancer.

Hormone Therapy

This involves using medications to alter hormone levels, particularly useful in cancers stimulated by hormones like estrogen.

Be Proactive: Calculate Your Endometrial Cancer Risk

Endometrial cancer symptoms: doctor talking to her patient

When you embrace a proactive approach to your health, you shift from being a passive recipient of information to an active participant in your well-being. Pay attention to changes in your body, such as unexplained weight loss, persistent pain, or unusual bleeding. Don't hesitate to consult your healthcare practitioner if you have early endometrial cancer symptoms.

Ezra's risk factor calculator is a valuable tool that can help you assess your cancer risk and encourage you to take proactive steps to protect your health. Use it as a starting point and a catalyst for further discussion with your healthcare provider.

Remember, a proactive mindset is not about fear or anxiety; it's about empowerment, taking control of your health, and making informed decisions to safeguard your well-being.