Endometrial cancer is the most common cancer of the female reproductive organs. It begins in the endometrium, which is the inner lining of the uterus (womb). This cancer most often affects women after menopause, though it can occur earlier. The most common early warning sign is abnormal vaginal bleeding, especially bleeding after menopause. In pre-menopausal women, the most common early warning sign is bleeding in between normal menstrual periods or prolonged period bleeding. Because symptoms often appear early, many cases are diagnosed at an early stage when treatment is highly effective.
The uterus is a hollow, muscular organ in the pelvis where a baby develops during pregnancy. Its inner lining is called the endometrium, which thickens and sheds during menstrual cycles. The muscular wall is called the myometrium. The lower part of the uterus is the cervix, which connects to the vagina. Endometrial cancer starts in the lining and may grow into deeper layers of the uterus or nearby organs if not treated.
The most common type is endometrioid adenocarcinoma, which usually grows slowly and is often diagnosed early. Less common types include serous carcinoma, clear cell carcinoma, and carcinosarcoma, which tend to behave more aggressively.
The most common symptom is unexpected vaginal bleeding, particularly after menopause. Other symptoms include bleeding between periods, pelvic pain, or unusual vaginal discharge. Any post-menopausal bleeding or persistent abnormal bleeding should be checked promptly by a doctor.
Endometrial cancer is often linked to long-term exposure to the hormone oestrogen without enough balancing progesterone, this is a condition described as "unopposed oestrogen." Several factors can increase this risk.
The risk rises with increasing age, particularly after menopause. Being overweight or obese is one of the most important risk factors, as body fat produces additional oestrogen. Diabetes and high blood pressure are also commonly associated conditions.
Women who have never been pregnant, start menstruation at a young age, or go through menopause later in life have longer lifetime exposure to oestrogen and slightly higher risk. Certain hormone treatments, such as oestrogen-only hormone replacement therapy, can increase risk if not balanced with progesterone.
A history of polycystic ovary syndrome (PCOS), which can cause irregular ovulation and hormone imbalance, is another risk factor. Some women have an inherited condition called Lynch syndrome, which increases the risk of endometrial and other cancers.
While having one or more risk factors does not mean a woman will develop cancer, awareness of these factors and seeking medical attention for abnormal bleeding can lead to early diagnosis and highly effective treatment.
While endometrial cancer cannot be totally prevented, women who have been pregnant and women who've been on the oral contraceptive pill have a lower lifetime risk of endometrial cancer.
Diagnosis usually involves an ultrasound scan and a biopsy to sample the uterine lining. If cancer is confirmed, surgery is performed to remove the uterus and assess how far the cancer has spread. Imaging scans may also be used. This process, called staging, helps guide treatment decisions.
Early-stage disease is usually treated with surgery to remove the uterus, cervix, and sometimes the ovaries and lymph nodes. Some women may also need radiotherapy. At NCIS, the standard of care for most endometrial cancer is a form of day surgery. Robotic surgery allows the surgeon to remove the cancer entirely and also perform staging surgery in a low-impact format that allows patients to feel better and function normally after surgery. Ask your doctor about this form of low-impact cancer surgery.
Advanced-stage disease often requires a combination of surgery, radiotherapy, and chemotherapy. Hormone therapy or targeted treatments may be used in selected cases.
For women younger than and around age 50, surgery to remove the ovaries may result in the symptoms of menopause occurring quite suddenly. This may require a short course of supportive hormone therapy to ensure that women continue to enjoy a good quality of life after the endometrial cancer is treated.
