Endometrial cancer starts in the inner lining of the uterus, this is called the endometrium. It is the most common form of uterine cancer. Approximately 3% of women will be diagnosed with uterine cancer during their lifetime, and over 80% of those affected live at least five years after diagnosis.
The earliest and most frequent warning sign is abnormal vaginal bleeding. This can include unusual menstrual patterns, spotting between periods, or bleeding after menopause.
Treatment varies depending on the stage of the disease and a patient’s overall health. Options may include surgery (such as hysterectomy), radiation, chemotherapy, hormone therapy, targeted drugs, and immunotherapy.
According to the Centers for Disease Control and Prevention (CDC), endometrial cancer primarily affects postmenopausal women, though it can also develop during the transition into menopause. The American Cancer Society reports that the average age at diagnosis is about 60. Over 60,000 new cases are identified in the U.S. each year.
What Is Endometrial Cancer?
Endometrial cancer is a type of uterine cancer that develops in the endometrium, the inner lining of the uterus. It is the most frequently diagnosed uterine malignancy.
According to the National Cancer Institute, roughly 3 out of every 100 women will be diagnosed with this cancer. Fortunately, early detection and prompt treatment offer a high chance of long-term survival, with more than four in five women living beyond five years after diagnosis.
Signs and Symptoms
The most common symptom is irregular vaginal bleeding, which might include:
- Heavier or longer menstrual periods
- Spotting or bleeding between menstrual cycles
- Bleeding after menopause
Other potential symptoms include:
- Watery or pink-tinged vaginal discharge
- Lower abdominal or pelvic pain
- Discomfort during sexual intercourse
- Unexplained weight loss
If you experience any of these symptoms, especially after menopause, it’s important to seek medical evaluation. Although irregular bleeding may have benign causes, it can also be a sign of endometrial or other gynecologic cancers.
What Causes Endometrial Cancer?
The exact cause isn’t always clear, but hormonal imbalances—particularly involving estrogen and progesterone—are strongly linked. High levels of estrogen without sufficient progesterone can cause the endometrial lining to grow excessively, increasing the risk of cellular changes that may lead to cancer.
If these abnormal cells mutate, they may grow uncontrollably, eventually forming a tumor. Researchers continue to study the underlying factors that trigger these changes.
Risk Factors
Several factors can increase the likelihood of developing endometrial cancer:
Age and Hormones
- Most cases are diagnosed between the ages of 45 and 74
- Increased lifetime exposure to estrogen (early menstruation, late menopause, or never being pregnant)
- Hormone-producing ovarian tumors (e.g., granulosa cell tumors)
- Polycystic Ovary Syndrome (PCOS), which disrupts hormone balance
Medical History and Medications
- Estrogen-only hormone replacement therapy (HRT) raises the risk
- Tamoxifen, used for breast cancer, may slightly increase uterine cancer risk
- Birth control pills and intrauterine devices (IUDs) are associated with reduced risk
Other Factors
- Obesity (BMI ≥30) significantly increases risk due to elevated estrogen levels from fat tissue
- Type 2 diabetes, which often coexists with obesity
- Family history, especially Lynch syndrome or inherited colorectal cancer
Endometrial Hyperplasia
This non-cancerous condition involves thickening of the endometrium. While it may resolve on its own, some forms can progress to cancer if left untreated. Treatment may include hormone therapy or minor surgical procedures.
Staging of Endometrial Cancer
Cancer is staged based on how far it has spread:
- Stage I: Limited to the uterus
- Stage II: Spread to the cervix
- Stage III: Reached nearby pelvic structures
- Stage IV: Extended beyond the pelvis, possibly to distant organs
How It’s Diagnosed
If symptoms are present, the following steps may be part of the diagnostic process:
- Physical and pelvic exams
- Transvaginal ultrasound to examine the uterine lining
- Endometrial biopsy, often done in-office
- Hysteroscopy or dilation and curettage (D&C) for further tissue analysis
Types of Endometrial Cancer
The majority are endometrioid adenocarcinomas, which begin in glandular cells. Less common types include:
- Uterine carcinosarcoma
- Serous carcinoma
- Clear cell carcinoma
- Squamous cell carcinoma
Treatment Options
Treatment depends on the cancer’s type, stage, and the patient’s health:
- Surgery: Most often a hysterectomy, possibly with removal of ovaries and fallopian tubes
- Radiation therapy: May involve external beams or internal implants
- Chemotherapy: Drug therapy to kill or stop cancer cells from growing
- Hormone therapy: Especially useful for hormone-sensitive tumors
- Targeted and immunotherapy: Newer options for advanced or resistant cases
Emotional and Psychological Support
A cancer diagnosis can be emotionally overwhelming. Access to counseling, support groups, or mental health services can be beneficial during treatment and recovery.
Prevention and Risk Reduction
While not all cases can be prevented, you can take steps to lower your risk:
- Maintain a healthy body weight
- Stay physically active
- Report any abnormal bleeding to your doctor promptly
- Discuss the risks and benefits of hormone therapy
- Consider birth control pills or an IUD if appropriate
- Undergo genetic counseling if you have a family history of certain cancers
Final Thoughts
Endometrial cancer is one of the most treatable gynecologic cancers when caught early. Be vigilant about any unusual vaginal bleeding or related symptoms and seek timely medical advice. Early detection and proactive care can make a significant difference in outcomes.