What Are The Signs Of Endometrial Cancer?
Also known as uterine or womb cancer, endometrial cancer is the most common of all gynecologic cancers. Fortunately, unlike some other female cancers, it has one early sign which helps ensure an early diagnosis – that is, abnormal bleeding, with or without abdominal discomfort. The most common signs of the disease are:
1. Heavy or prolonged periods in premenopause women.
2. Vaginal bleeding in women after menopause.
3. Pelvic pain, particularly during intercourse (known as Dyspareunia).
Note: Some women may not have any symptoms.
Abnormal Vaginal Bleeding
Bleeding After Menopause
Any spotting or bleeding in postmenopause women should be investigated immediately and is taken very seriously by doctors. Bleeding caused by cancer may start as a watery, blood-streaked flow that gradually starts to contain more blood. A doctor will perform a pelvic examination and Pap test but the only way cancer can be ruled out is by removing a sample of uterine lining for biopsy. This can be carried out in the doctor’s office (an endometrial biopsy), or if more tissue needs to be removed by dilation and curettage (D&C procedure) in hospital. Occasionally a transvaginal ultrasound is used on women who cannot be easily biopsied (the elderly) or whose pelvis is not easily examined (obese women). If the lining of the womb can be seen and measures less than 5cm, then cancer is not likely to be present. Endometrial hyperplasia is a condition which causes the lining of the womb to thicken; it is often seen as a precursor to cancer (although it may clear of its own accord without developing into anything serious). Bleeding may also occur with this condition.
HRT like estrogen replacement therapy (ERT) can cause some irregular bleeding in menopausal women, particularly if the hormones are taken on a cyclic basis. Taking daily doses of estrogen with low levels of progestin can cause some bleeding for 3 to 6 months. Bleeding after this should be investigated and may require a biopsy. Women who take daily doses of estrogen and cyclic progestin for 10 or 12 days a month commonly experience light withdrawal bleeding when the progestin is withdrawn. This is quite normal.
Bleeding Before Menopause
Endometrial cancer or endometrial hyperplasia can cause heavy periods (menorrhagia) in women of childbearing age. A heavy bleed is defined as excessive or prolonged bleeding during a period. This means soaking a tampon or sanitary pad every hour for more than 3 hours or bleeding longer than 7 days. There may also be large clots of blood in the menstrual flow. It must be noted that in most cases it will not be a sign of cancer. More likely causes include:
1. Uterine Fibroids.
2. Underactive Thyroid.
4. Pelvic Inflammatory Disease (PID).
5. Uterine Polyps.
6. Adenomyosis (thickening of the endometrial lining).
Other causes of irregular bleeding:
7. Minor trauma to the vaginal tract due to vigorous sexual activity or douching.
8. Oral contraceptives can cause breakthrough bleeding. If spotting continues for more than 3 months the medication should be replaced by a higher dose of either estrogen or progesterone.
9. Irregular periods (anovulatory periods) are common in teenagers after menarche and women approaching menopause. This is where periods occur but no egg is released from the ovaries. It causes menstrual bleeds to become irregular.
Abnormal bleeding can also be signs of the following female cancers:
Symptoms of cervical cancer.
Symptoms of vaginal cancer.
Symptoms of fallopian tube cancer (although this is a very rare disease).
Symptoms of ovarian cancer (although bleeding is a less common sign of this disease).
Most women will experience pelvic pain at sometime in their life, and in the vast majority of instances it is nothing to worry about. However persistent pain where the cause is unknown or pain which appears during or after sexual intercourse should be reported to a doctor. Pelvic pain is defined as pain in the lower abdominal region. This is the reproductive part of a woman's body where a lot of important organs are crammed into a confined space. Due to space restrictions even a small tumor on the womb can put pressure on nearby organs causing pain. Pain is defined as either chronic (persistent for certain periods of time) or acute (sudden and severe). Although cancer is one cause, more common causes of chronic pelvic pain include:
1. Menstrual Cramps.
4. Uterine Fibroids.
5. Pelvic Adhesions.
6. Endometrial Polyps.
Occasionally chronic pelvic pain is a sign of female cancers, including endometrial, vaginal or ovarian cancer. When it does occur it is usually a sign that the disease is in an advanced stage (see Endometrial Cancer Staging). For example, a tumor which has narrowed the neck of the cervix can cause blood and pus to gather resulting in abdominal pain. Pelvic pain is not common in the early stages of endometrial cancer.
More common causes of acute pelvic pain:
1. Pelvic Inflammatory Disease.
2. Twisted ovarian cysts.
4. Ectopic Pregnancy.
Interesting: How is it treated? Endometrial cancer treatment
If a tumor places pressure on the bladder or urethra it can cause problems similar to symptoms of urinary tract infections, such as the need to urinate frequently and pain on urination.
Lower Back Pain
Less common, but lower back and leg pain can signal endometrial cancer, although it is more likely to occur with ovarian cancer.
If a tumor has developed and is pressing on organs of the digestive system it can cause a feeling of 'fullness' even after eating a light meal. It may also cause indigestion, excess gas, constipation, diarrhea and nausea. If any of these symptoms occur and last longer than 3 weeks, do report them to your doctor.
See also: Cancer symptoms for more general signs.
If you have any of the above symptoms arrange to see your doctor. If you are not happy with the outcome, seek a second opinion and if necessary ask for a referral to a gynecologic oncologist. While there are many other possible explanations for the symptoms, endometrial cancer is curable if diagnosed early.
Next: Diagnosis of endometrial cancer