Siteman explains what every woman should know about endometrial cancer risk, symptoms and screening

Endometrial cancer is the fourth most common cancer for women in the United States. It also accounts for approximately 4 percent of cancer deaths in women. However, because it is usually diagnosed early, it is highly curable. Knowing what symptoms to look out for and getting screened for endometrial cancer can increase the chance of early diagnosis and cure.

What is endometrial cancer?

Endometrial cancer (also called endometrial carcinoma or uterine cancer) develops when cells in the endometrium – the inner lining of the uterus – begin to multiply out of the control. There are many risk factors for developing endometrial cancer. While endometrial cancer is uncommon in women under the age of 45, more and more cases are occurring in premenopausal women.

Do you have fears about endometrial cancer and its consequences? You’re not alone

It is entirely normal to worry if you are experiencing symptoms that may point to endometrial cancer. Common concerns include:

• Fears over needing to have your uterus removed
• Concerns about your health
• Anxiety related to your enjoyment of sexual activities after surgery
• Worry over fertility issues

At Siteman, our physicians will provide you with all the information and care you’ll need to fight your cancer and to put your mind at ease.

Pre- and postmenopausal endometrial cancer symptoms

While endometrial cancer usually affects women over the age of 45, it can still occur in premenopausal women. Risk factors for women under the age of 45 include obesity, diabetes and history of polycystic ovarian syndrome (PCOS). The principal symptom of endometrial cancer for premenopausal women is abnormal vaginal bleeding. In fact, any absence of bleeding (missed periods) without the use of hormonal contraceptives is cause for concern and is something to discuss with your provider. For postmenopausal women, symptoms may include:

• Abnormal vaginal bleeding or discharge
• Pelvic pain
• Unexplained weight loss
• Difficult or painful urination
• An enlarged uterus (detected during a pelvic exam)
• Pain during intercourse
• Weakness or pain in the lower abdomen, back or legs

Risk factors for endometrial cancer

Some women with endometrial cancer don’t have any known risk factors. However, there are still many factors that can increase your risk of developing endometrial cancer. These include:

• Age
• Obesity
• Type 2 diabetes and insulin resistance
• Polycystic ovarian syndrome (PCOS)
• More menstrual cycles (periods began before age 12)
• Never having been pregnant
• Going through menopause later in life
• Taking unopposed estrogen after menopause
• Taking tamoxifen (a drug that helps prevent and treat breast cancer)
• Radiation therapy
• Family history of breast, endometrial, colorectal or ovarian cancer
• Certain inherited disorders (including Lynch syndrome and HNPCC)

Race is also an important risk factor for endometrial cancer. Black women have a higher risk of death from endometrial cancer because they’re more likely to receive diagnoses at more advanced stages and to have high-risk cancer. Because Black women are more likely to have fibroids and other non-endometrial growths, endometrial cancer goes undetected more often among Black women than White women. Increasing awareness of risk factors may lead to earlier diagnosis and treatment for every person with a uterus.

Reducing the risk of endometrial cancer

There are certain factors that can greatly reduce your risk of developing endometrial cancer. These include:

• Taking birth control pills or using an intrauterine device (IUD)
• Maintaining a healthy weight
• Taking progesterone, if you take estrogen, to maintain a hormonal balance
• If you have diabetes, regularly monitoring blood glucose levels
• Pregnancy and breastfeeding

The Siteman approach

Siteman is a leader in cancer treatment, research, prevention, education and community outreach. Our providers have the expertise, experience and compassion to carry you through your cancer journey. A full team of multidisciplinary specialists meets each week to discuss all cases. They review each case and determine the best treatment plan for each patient.

Washington University Physicians at Siteman are some of the nation’s leading experts in gynecologic cancer research and care. In 2010, the National Cancer Institute (NCI) awarded Siteman and Washington University School of Medicine a prestigious Specialized Program of Research Excellence (SPORE) grant to study endometrial cancer and advance clinical care.

For premenopausal women with endometrial cancer, fertility preservation is a serious concern. Washington University’s Fertility & Reproductive Medicine Center offers a variety of options for fertility preservation. Their compassionate specialists understand the emotional and physical toll cancer takes on a woman’s body and are here to help.

How do I get screened for endometrial cancer?

There is no simple way to screen for endometrial cancer in women who show no symptoms. Additionally, Pap tests (which screen for cervical cancer) cannot detect endometrial cancer. This is why it is so important to be able to identify symptoms. If you believe you are at high risk for cervical cancer, your provider may perform an endometrial biopsy or a transvaginal ultrasound. An endometrial biopsy is performed at your gynecologist’s office, while a transvaginal ultrasound is performed by a sonographer at a radiology facility.

• Endometrial biopsy: you will lie on an examination table with your feet resting in stirrups, just as you would for a Pap smear. Your doctor will first perform a speculum exam. Then, they will insert a very thin, flexible tool that will gently suction out a tissue sample from the lining of your uterus. The procedure takes less than 5 minutes. Finally, Siteman pathologists will examine the sample under the microscope and issue a diagnosis, typically within one week.
• Transvaginal ultrasound: after emptying your bladder, you will lie on the examination table with your legs raised. The sonographer will then insert a special transducer that is slightly larger than a tampon and is designed to fit comfortably in the vagina. As the sonographer gently moves the transducer around the inside of your pelvis, it will emit sound waves which will generate images of your organs. The images you’ll see on the screen will show what is happening in your pelvis in real time. The procedure takes 30-60 minutes.

Our care team

The endometrial cancer team at Siteman comprises gynecologic oncologists, surgeons, radiation oncologists, genetic counselors and psychologists. The diverse expertise of our collaborative team allows our specialists to create personalized and compassionate treatment plans for each and every patient. Also, because of the link between obesity and endometrial cancer, our treatment team works closely with weight management specialists. These specialists include bariatric surgeons, medical weight management specialists and a psychologist who runs a popular cognitive behavioral weight management class on Zoom.

The importance of getting screened

There are currently no screening tests to detect endometrial cancer in women who are at average risk and have no symptoms. This is why it is so important for all women to understand the risks and symptoms, especially at menopause. The American Cancer Society recommends that women at increased risk for endometrial cancer see their provider whenever they have abnormal vaginal bleeding. Carefully monitoring your health and keeping an eye out for any changes will allow you to address any issues before they progress. The earlier you catch endometrial cancer, the easier it is to treat.

With the largest gynecologic oncology program in the Midwest and a team of nationally renowned gynecologic cancer physicians, Siteman is an ideal destination for endometrial cancer care.

You’ve been diagnosed with endometrial cancer. Now what?

If you have received an endometrial cancer diagnosis, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychological services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.