What Are the Early Signs of Endometrial Cancer?

Abnormal vaginal bleeding is the one to watch for. Around nine in ten women with this cancer notice it, and it usually appears early. Sometimes that means spotting or bleeding after menopause. Other times it is a period that gets heavier, or drags on, or turns up every three weeks instead of four. Blood is hard to ignore, and that helps: most women are seen while the cancer is still inside the uterus, where it is easiest to treat. Plenty of bleeding changes turn out to be nothing serious. A pattern that keeps repeating deserves a visit all the same.

According to Dr. Tanuja Uchil, Obstetrician and Gynecologist, in Mumbai, “I tell women that bleeding outside their usual pattern deserves a proper look, and that goes double once periods have stopped. In most cases the cause is something benign. We still check because the uterine lining gives an early signal when something is wrong, and treatment is simpler when we act on it.”

Endometrial cancer symptoms get missed because there is always another explanation on hand, whether that is a heavy month, a stressful spell or perimenopause.

• Abnormal vaginal bleeding: Bleeding after menopause is never routine, and even one spot counts. Before menopause, watch for periods that get heavier, last longer or show up early, and for spotting in between. Not everyone bleeds, either. Up to 15 percent of cases have no bleeding at all, so don’t count on it as an alarm.
• Unusual discharge: Sometimes the first thing a woman notices is a thin, watery or pink-tinged discharge, with no blood yet. Brown is possible too, and so is a smell. Pictures of discharge online will not settle anything, because they look so different from case to case. Only an exam can.
• Pelvic pain or pressure: Pain low in the belly, a heavy feeling down there, pain during sex. These are less common than bleeding. When they do show up, the tumor is often already sizeable.
• Symptoms in the 30s and 40s: Under 40 is uncommon, fewer than 3 percent of cases, so doctors usually rule out other causes first. But if there are risk factors like obesity, ovulation problems or very long gaps between periods, heavy bleeding shouldn’t be put off. Plenty of women this age hear “it’s hormones” for months.

If the bleeding keeps happening, the next step is usually onco-gynecology care, where examination, scans and a tissue sample can all be arranged.

Take a lining of 6 mm: perfectly normal at 28, worth a closer look at 62 if there is bleeding.

• Thickness and risk: Past menopause the lining should be thin. The thicker it gets, the more likely it is to be cancer or a pre-cancer change. There is no single number that works for every patient.
• Signs on ultrasound: A transvaginal ultrasound may show a thick or uneven lining, fluid inside the cavity or a growth. Any of those is a flag, not an answer. It tells the doctor where to look next.
• A thick lining is not always cancer: Polyps can do it. So can hormone therapy, tamoxifen and simple overgrowth, which is called hyperplasia. On a scan they all look alike.
• Biopsy gives the answer: Cancer is confirmed only when a lab looks at a sample of the lining. An endometrial biopsy takes a few minutes and usually needs no overnight stay.

The measuring side is covered in more detail in this guide to endometrial thickness and what counts as normal.

Most of these cancers grow slowly, and the bleeding brings women in early, so many are caught inside the uterus. Beyond the uterus, treatment gets harder.

• Stage 1 and curability: Stage 1 is the tumor still sitting in the uterus. Often bleeding is the only symptom. Surgery alone cures many of these cases, and that is a good reason not to put a bleeding change off.
• Speed of spread: The usual type, low-grade endometrioid, grows slowly. Serous and clear cell cancers are the exceptions. They can spread early.
• Treatment options: Surgery usually comes first. That means removing the uterus, tubes and ovaries, which is called a hysterectomy, and sometimes a few lymph nodes nearby. After that, radiation, chemotherapy, hormone therapy or immunotherapy may be added, depending on the stage, the grade and tumor testing.
• When the disease is advanced: When it has spread widely and treatment has stopped working, the goal is comfort. People tend to sleep more and eat less. A palliative team looks after pain, bleeding and breathlessness, and supports the family too.

What onco-gynecology is and when to see a specialist explains who treats these cancers. Knowing that early can shorten the wait for answers.

In short, bleeding that is out of character for you is the main early sign, and any bleeding once periods have stopped needs checking. Watery fluid and pelvic pressure usually come later. A scan can show a thick lining but cannot confirm cancer, a tissue sample does. When it is found inside the uterus it is often curable, and most bleeding changes turn out to be harmless.

• PMC, NIH: Signs and Symptoms Associated with Uterine Cancer in Pre- and Postmenopausal Women
• PMC, NIH: New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know?

Disclaimer: This blog is for educational and informational purposes only and should not be considered professional advice.