Warning signs of endometrial cancer
Also known as uterine cancer, endometrial cancer begins from abnormal cells at the inner lining of the uterus (called the endometrium). In Australia, cancer of the uterus is the most diagnosed type of gynaecological cancer with more than 3000 women diagnosed every year.
There is no screening test for endometrial cancer, but there are signs and symptoms that appear early on in the development of endometrial cancer that should alert women. If you have recently had a Cervical Screening Test and received a normal result, you should still have any abnormal symptoms checked by a doctor because a Cervical Screening Test does not detect endometrial cancer.
Early warning signs of endometrial cancer can include:
Bloody, smelly or watery vaginal discharge
- Bleeding between periods (spotting)
- Unusually heavy periods
- Vaginal bleeding after menopause
- Discomfort or pain in the abdomen
- Difficulty or pain urinating
- Unexplained weight loss
- Pain during intercourse.
If you have one or more of these symptoms you should speak to a doctor as soon as possible.
The most common symptom of endometrial cancer is abnormal vaginal bleeding, particularly any bleeding after menopause is a sign of a problem. Endometrial cancer predominately affects post-menopausal women. In postmenopausal women, even one episode of bleeding (or even a streak of blood) is abnormal for women after menopause and needs to be investigated. All postmenopausal women who present to a GP with vaginal bleeding should be referred to a gynaecologist.
The diagnosis of endometrial cancer needs to be established by a gynaecologist who will perform an endometrial (Pipelle) biopsy. The procedure takes a small sample of tissue from the inner lining of the uterus. This procedure is performed in a gynaecologist’s office, without the use of general anaesthesia, then the sample of tissue is sent to a laboratory to test for cancer or other abnormal cells.
Another option is a hysteroscopy, which is a procedure to look inside the uterus. This procedure is a minor day surgery performed under general anaesthesia. The cervix is widened (dilated) and a thin telescope is inserted into the uterus to look inside. It is combined with a curettage, which samples the lining of the uterus to collect some tissue.
Medical imaging (ultrasound and CT scans) and blood tests are also routinely taken.
Endometrial cancer risk factors
Obesity is the strongest risk factor linked to developing endometrial cancer. Among all cancers, endometrial cancer has the highest association with obesity.
Furthermore women who had breast cancer are also at a higher risk of developing endometrial cancer. This may be due to shared risk factors (obesity), genetic constellations, or breast cancer treatment (Tamoxifen).
Another risk factor is a genetic predisposition, which is called Lynch syndrome. Lynch syndrome is an inherited genetic mutation which gives people an increased chance of developing certain cancers including uterine, bowel, stomach and urinary tract cancers. Those diagnosed with lynch syndrome have higher chance of developing these cancers at a younger age (before 50 years).
Other risk factors for endometrial cancer include: early menarche, late menopause, polycystic ovary syndrome, infertility or failure to ovulate, family history, hypertension, type 2 diabetes, thyroid disease, or having never given birth. The risk of endometrial cancer also increases with age. For women on HRT, the addition of progesterone has been shown to decrease the risk of endometrial cancer.
The oral contraceptive pill and the use of an intrauterine device are linked to a lower risk of endometrial cancer. Keeping a healthy lifestyle such as maintaining a healthy body weight and regular physical activity can also reduce the risk of endometrial cancer.
If you have any signs or symptoms of endometrial cancer, they are persistent and unusual, you should speak to your GP in the first instance. Prior to your appointment keep a menstrual calendar and record how long and how often you have been experiencing the symptoms. Many benign and treatable problems can also be a cause of these symptoms, not just endometrial cancer. Most of the time these symptoms will have a less serious reason, however it is important to know the cause so you can receive early treatment. Putting up with abnormal symptoms is never a good idea because it can mask serious conditions that cannot be detected otherwise.