Endometrial cancer, also known as uterine cancer, is a type of cancer that begins in the lining of the uterus called the endometrium. It is the most common gynecologic cancer in developed countries, affecting thousands of women each year. Early detection is crucial for successful treatment outcomes, which is why understanding and recognizing the warning signs is essential for every woman.
While endometrial cancer primarily affects postmenopausal women, it can occur in younger women as well. The good news is that this type of cancer often presents symptoms in its early stages, giving women the opportunity to seek medical attention promptly. Being aware of these symptoms can make a significant difference in early diagnosis and treatment success.
In this comprehensive guide, we’ll explore the most common symptoms of endometrial cancer, what causes this condition, and answer frequently asked questions to help you stay informed about your reproductive health.
1. Abnormal Vaginal Bleeding
Abnormal vaginal bleeding is the most common and often the first symptom of endometrial cancer, occurring in approximately 90% of diagnosed cases. This symptom can manifest in several different ways depending on your menopausal status.
For postmenopausal women: Any vaginal bleeding after menopause is considered abnormal and should be evaluated by a healthcare provider immediately. Even light spotting or staining should not be dismissed as normal, as it could be an early warning sign of endometrial cancer.
For premenopausal women: Watch for unusual bleeding patterns such as:
- Bleeding between periods (intermenstrual bleeding)
- Periods that are significantly heavier than usual
- Periods that last longer than seven days
- Menstrual cycles shorter than 21 days
The bleeding occurs because the cancerous cells in the endometrium cause the tissue to break down irregularly, leading to abnormal discharge of blood. While many conditions can cause abnormal bleeding, it’s crucial to have this symptom evaluated to rule out endometrial cancer.
2. Unusual Vaginal Discharge
Many women with endometrial cancer experience abnormal vaginal discharge that is not blood-tinged. This discharge can vary in appearance and characteristics, making it an important symptom to monitor.
The discharge associated with endometrial cancer may be:
- Watery or thin in consistency
- Pink, brown, or clear in color
- Foul-smelling or odorless
- White or yellowish
- Present continuously or intermittently
This symptom is particularly significant in postmenopausal women, as any new vaginal discharge after menopause warrants medical evaluation. The discharge occurs when the tumor affects the normal functioning of the endometrial tissue, causing it to produce abnormal secretions. Even if the discharge seems minor or doesn’t cause discomfort, it should be discussed with your healthcare provider, especially if it persists or changes in character.
3. Pelvic Pain and Cramping
Pelvic pain is a common symptom that typically appears in more advanced stages of endometrial cancer, though some women may experience it earlier. The pain can range from mild discomfort to severe cramping and can significantly impact quality of life.
Characteristics of pelvic pain associated with endometrial cancer include:
- Persistent or intermittent pain in the lower abdomen
- Cramping sensations similar to menstrual cramps but occurring outside of menstruation
- Pain that gradually worsens over time
- Discomfort that doesn’t respond well to over-the-counter pain relievers
- Pain that may radiate to the lower back or legs
The pain occurs when the tumor grows larger and begins to stretch the uterine walls or press against surrounding organs and tissues. As the cancer progresses, it may cause the uterus to enlarge, leading to additional pressure and discomfort in the pelvic region. While pelvic pain can be caused by numerous conditions, persistent or unexplained pain should always be evaluated by a medical professional.
4. Pain During Sexual Intercourse
Pain during sexual intercourse, medically known as dyspareunia, is another symptom that some women with endometrial cancer experience. This symptom can be distressing and may affect intimate relationships, but it serves as an important warning sign that shouldn’t be ignored.
The pain during intercourse may manifest as:
- Sharp or stabbing pain during penetration
- Deep aching pain during or after intercourse
- Discomfort in the pelvic region that persists after sexual activity
- Increased sensitivity in the vaginal or pelvic area
- Bleeding following intercourse
This symptom occurs because the cancerous growth in the uterus can make the surrounding tissues more sensitive and prone to irritation. The tumor may also cause inflammation in the pelvic region, making sexual activity uncomfortable or painful. While many conditions can cause painful intercourse, new or worsening pain, especially when accompanied by other symptoms, should prompt a visit to your healthcare provider.
5. Pelvic Mass or Feeling of Fullness
As endometrial cancer progresses, some women may notice a palpable mass in the pelvic area or experience a persistent feeling of fullness or pressure in the lower abdomen. This symptom typically indicates a more advanced stage of the disease.
Signs to watch for include:
- A hard or firm mass that can be felt in the lower abdomen
- Bloating that doesn’t resolve with normal digestive remedies
- A sensation of heaviness in the pelvic region
- Visible swelling or distension of the lower abdomen
- Feeling of pressure against the bladder or rectum
This symptom develops when the tumor grows large enough to be detected through the abdominal wall or when it causes the uterus to enlarge significantly. The mass may be discovered during a self-examination or routine physical exam. The feeling of fullness occurs because the enlarged uterus takes up more space in the pelvic cavity, potentially compressing nearby organs. Any unexplained pelvic mass or persistent feeling of fullness should be evaluated promptly by a healthcare professional.
6. Unexplained Weight Loss
Unintentional weight loss is a symptom that can occur with various types of cancer, including endometrial cancer. While it’s often associated with more advanced disease, it’s an important symptom that requires medical attention.
Key characteristics of cancer-related weight loss include:
- Loss of 10 pounds or more without trying to lose weight
- Decreased appetite or early satiety (feeling full quickly)
- Weight loss that occurs over several weeks or months
- Loss of muscle mass and general weakness
- Weight loss accompanied by other symptoms like fatigue
Unexplained weight loss occurs in cancer patients for several reasons. The cancer cells consume a significant amount of the body’s energy and nutrients. Additionally, the body’s immune response to cancer can increase metabolism, causing weight loss even when caloric intake remains normal. Some women may also experience decreased appetite due to the general effects of cancer on the body. If you’re experiencing significant weight loss without changes to your diet or exercise routine, especially when combined with other symptoms on this list, it’s important to consult with your healthcare provider.
7. Difficulty or Pain During Urination
Urinary symptoms can occur when endometrial cancer grows large enough to affect the bladder or when the tumor spreads to nearby urinary structures. While these symptoms may seem unrelated to a uterine problem, the close proximity of the uterus to the bladder means that uterine abnormalities can affect urinary function.
Urinary symptoms associated with endometrial cancer may include:
- Pain or burning sensation during urination
- Increased frequency of urination
- Urgent need to urinate
- Difficulty starting or maintaining urine flow
- Feeling of incomplete bladder emptying
- Blood in the urine (hematuria)
These symptoms develop when the tumor presses against the bladder or when cancer cells invade the bladder wall in advanced cases. The pressure from an enlarged uterus can also affect the normal positioning and function of the bladder, leading to urinary difficulties. While urinary symptoms are commonly caused by urinary tract infections or other bladder conditions, persistent or recurrent urinary problems, especially when accompanied by other endometrial cancer symptoms, warrant thorough medical evaluation.
Main Causes and Risk Factors of Endometrial Cancer
Understanding what causes endometrial cancer can help you assess your personal risk and take appropriate preventive measures. While the exact cause isn’t always clear, research has identified several factors that increase the risk of developing this type of cancer.
Hormonal Imbalances
The primary cause of endometrial cancer is an imbalance between estrogen and progesterone hormones. Estrogen stimulates the growth of the endometrial lining, while progesterone helps regulate this growth. When there’s too much estrogen without adequate progesterone to balance it, the endometrium can develop abnormal cells that may become cancerous over time.
Obesity
Being overweight or obese significantly increases the risk of endometrial cancer. Fat tissue produces estrogen, and excess body fat can lead to higher estrogen levels in the body. Women who are obese have two to four times the risk of developing endometrial cancer compared to women of healthy weight.
Age and Menopause
Most cases of endometrial cancer occur in women over 50 years of age, with the average age of diagnosis being 60. The risk increases significantly after menopause, though younger women can also develop this cancer.
Never Having Been Pregnant
Women who have never been pregnant have a higher risk of endometrial cancer. Pregnancy causes hormonal changes that protect the endometrium, and having multiple pregnancies further reduces risk.
Early Menstruation and Late Menopause
Starting menstruation before age 12 or going through menopause after age 55 increases risk because it exposes the endometrium to estrogen for a longer period.
Diabetes and Metabolic Syndrome
Women with diabetes or metabolic syndrome have an increased risk of endometrial cancer, possibly due to associated hormonal imbalances and obesity.
Hereditary Factors
Having a family history of endometrial, ovarian, or colon cancer increases risk. Certain inherited conditions, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), significantly increase the risk of developing endometrial cancer.
Previous Breast or Ovarian Cancer
Women who have had breast or ovarian cancer have an elevated risk of developing endometrial cancer, partly due to shared risk factors and genetic predispositions.
Polycystic Ovary Syndrome (PCOS)
Women with PCOS often have hormonal imbalances characterized by elevated estrogen levels and irregular ovulation, which increases their risk of endometrial cancer.
Prevention Strategies for Endometrial Cancer
While not all cases of endometrial cancer can be prevented, there are several evidence-based strategies that can significantly reduce your risk. Implementing these lifestyle changes and staying proactive about your health can make a meaningful difference.
Maintain a Healthy Weight
Achieving and maintaining a healthy body weight is one of the most effective ways to reduce your risk of endometrial cancer. Regular physical activity combined with a balanced diet can help you maintain a healthy weight and balance hormone levels. Aim for at least 150 minutes of moderate-intensity exercise per week.
Use Birth Control Pills
Taking combination birth control pills (containing both estrogen and progesterone) can significantly reduce the risk of endometrial cancer. Studies show that women who use oral contraceptives for several years have a substantially lower risk, and this protective effect can last for years after stopping the pills. However, discuss the benefits and risks with your healthcare provider to determine if this option is right for you.
Manage Underlying Health Conditions
Proper management of conditions like diabetes, PCOS, and metabolic syndrome can help reduce your risk. Work with your healthcare provider to control blood sugar levels, maintain healthy blood pressure, and address hormonal imbalances.
Consider Hormone Therapy Carefully
If you’re taking estrogen hormone therapy after menopause, make sure it includes progesterone (unless you’ve had a hysterectomy) to balance the effects of estrogen on the endometrium. Always discuss the risks and benefits of hormone therapy with your doctor.
Regular Gynecological Check-ups
Schedule regular pelvic exams and gynecological visits, especially as you get older. While there’s no standard screening test for endometrial cancer in average-risk women, routine check-ups allow your doctor to identify any concerning symptoms early.
Know Your Family History
If you have a family history of endometrial, ovarian, or colon cancer, inform your healthcare provider. You may benefit from genetic counseling and more frequent monitoring. Women with Lynch syndrome may need more aggressive preventive measures.
Eat a Healthy Diet
A diet rich in fruits, vegetables, whole grains, and lean proteins while low in processed foods and saturated fats can help maintain hormonal balance and healthy weight. Some research suggests that diets high in phytoestrogens from soy products may offer protective benefits.
Report Abnormal Bleeding Immediately
Don’t ignore abnormal vaginal bleeding, especially after menopause. Early reporting of symptoms can lead to earlier diagnosis when the cancer is most treatable. Any postmenopausal bleeding should be evaluated by a healthcare provider promptly.
Frequently Asked Questions About Endometrial Cancer
What is the difference between endometrial cancer and uterine cancer?
Endometrial cancer and uterine cancer are often used interchangeably because endometrial cancer is the most common type of uterine cancer, accounting for more than 90% of cases. Endometrial cancer specifically starts in the lining of the uterus (endometrium), while uterine cancer is a broader term that includes any cancer occurring in the uterus, including the less common uterine sarcomas that start in the muscle or supporting tissues.
At what age does endometrial cancer typically occur?
Endometrial cancer most commonly affects women after menopause, with the average age of diagnosis being around 60 years old. About 75% of cases occur in women over 55. However, approximately 15-25% of cases are diagnosed in premenopausal women, and it can occasionally occur in women under 40, particularly those with certain risk factors like obesity or PCOS.
Is all postmenopausal bleeding cancer?
No, not all postmenopausal bleeding is caused by cancer. In fact, only about 10% of postmenopausal bleeding cases are due to endometrial cancer. Other common causes include endometrial atrophy (thinning), polyps, hormone therapy, and infections. However, because cancer is a possibility, all postmenopausal bleeding should be evaluated by a healthcare provider to determine the cause.
Can endometrial cancer be detected by a Pap smear?
No, Pap smears are designed to detect cervical cancer, not endometrial cancer. While a Pap smear may occasionally show abnormal endometrial cells, it’s not a reliable screening tool for endometrial cancer. If endometrial cancer is suspected, your doctor will likely perform an endometrial biopsy, transvaginal ultrasound, or other specialized tests.
How quickly does endometrial cancer develop?
The development of endometrial cancer varies from person to person. In many cases, it develops slowly over several years, often progressing from precancerous changes (endometrial hyperplasia) to cancer. However, some types of endometrial cancer can develop more rapidly. This is why it’s important to report any abnormal symptoms promptly, as early detection significantly improves treatment outcomes.
Can young women get endometrial cancer?
Yes, though it’s less common, young women can develop endometrial cancer. Women under 40 account for about 5% of cases. Young women at higher risk include those who are obese, have PCOS, have never ovulated regularly, have Lynch syndrome, or have other hormonal imbalances. Young women experiencing abnormal bleeding or other concerning symptoms should not dismiss them simply because of their age.
Is endometrial cancer hereditary?
While most cases of endometrial cancer are not hereditary, about 5% are associated with inherited genetic conditions, most commonly Lynch syndrome. Women with Lynch syndrome have up to a 60% lifetime risk of developing endometrial cancer. Having a family history of endometrial, ovarian, or colon cancer may indicate increased risk, and genetic counseling may be recommended.
What should I do if I notice symptoms?
If you notice any symptoms of endometrial cancer, especially abnormal vaginal bleeding or unusual discharge, schedule an appointment with your healthcare provider promptly. Don’t wait to see if symptoms resolve on their own. Bring a list of all your symptoms, when they started, and any other relevant health information. Early evaluation leads to earlier diagnosis, which significantly improves outcomes if cancer is present.
Can endometrial cancer spread to other parts of the body?
Yes, if left untreated, endometrial cancer can spread beyond the uterus to other parts of the body, including the ovaries, lymph nodes, bladder, rectum, and distant organs. However, endometrial cancer is often detected early because it typically causes symptoms like abnormal bleeding in the early stages. When detected and treated early, before it has spread, the prognosis is generally very good.
Does having fibroids increase the risk of endometrial cancer?
Having uterine fibroids (benign tumors of the uterine muscle) does not directly increase your risk of developing endometrial cancer. These are separate conditions. However, both fibroids and endometrial cancer can cause similar symptoms, such as abnormal bleeding, which is why proper evaluation of any abnormal symptoms is important to distinguish between these conditions.
References:
- American Cancer Society – Endometrial Cancer
- National Cancer Institute – Uterine Cancer
- Mayo Clinic – Endometrial Cancer
- NHS – Womb (Uterine) Cancer
- Cancer Council Australia – Uterine Cancer
The information on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions related to your health.
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