Gynaecological cancers
Endometrial Cancer: Symptoms, Diagnosis and Treatment
Endometrial cancer is a type of cancer that develops in the lining of the womb, known as the endometrium. It is the most common type of womb cancer and is more frequently diagnosed in women who have been through the menopause.
One of the most common signs of endometrial cancer is unusual vaginal bleeding, particularly bleeding after the menopause. Because abnormal bleeding can have many different causes, it does not necessarily mean that you have cancer. However, it is important to have any unusual or persistent bleeding assessed by a doctor.
At Gynae Solution, we understand that being referred for investigation can be worrying. Our aim is to provide thorough assessment, clear explanations and personalised specialist care throughout your diagnosis and treatment.
What Is Endometrial Cancer?
The womb, or uterus, is the organ where a pregnancy develops. The inner lining of the womb is called the endometrium. Throughout the menstrual cycle, this lining changes in response to hormones and is shed during a period if pregnancy does not occur.
Endometrial cancer develops when cells within the endometrium begin to grow and divide abnormally and uncontrollably. These abnormal cells can form a tumour and, in some cases, can spread into the muscle of the womb or to other parts of the body.
There are different types and grades of endometrial cancer. Understanding the specific type, grade and stage of the cancer is important when deciding on the most appropriate treatment.
The good news is that endometrial cancer is often diagnosed at an earlier stage because abnormal vaginal bleeding can occur relatively early. When diagnosed early, it is often highly treatable.
Symptoms of Endometrial Cancer
The most common symptom of endometrial cancer is unusual vaginal bleeding.
This may include:
- Vaginal bleeding after the menopause
- Bleeding or spotting between periods
- Periods that become heavier, longer or more frequent than usual
- Unusual vaginal discharge, including a watery, pink or blood-stained discharge
- Pelvic or lower abdominal pain
- Pain or discomfort during sexual intercourse
- A feeling of pressure, swelling or a lump in the lower abdomen
- Changes in bladder or bowel habits
- Unexplained weight loss
Any vaginal bleeding after the menopause should be investigated, even if it only happens once. Similarly, if your periods have changed significantly or you are experiencing unusual bleeding between periods, speak to your GP.
These symptoms can be caused by many conditions that are not cancer. However, having them checked promptly can help identify the cause and, if cancer is present, allow treatment to begin as early as possible.
Causes and Risk Factors
There is not always a single identifiable cause of endometrial cancer. However, certain factors can increase the likelihood of developing the condition.
Many of these risk factors are associated with prolonged exposure of the womb lining to the hormone oestrogen.
Risk factors may include:
- Increasing age
- Being overweight or obese
- Going through the menopause later in life
- Starting periods at a younger age
- Never having been pregnant
- Certain hormonal conditions
- Taking oestrogen-only hormone replacement therapy
- A history of certain ovarian conditions
- Having previously had breast or ovarian cancer
- A family history of endometrial or bowel cancer
- Inherited conditions such as Lynch syndrome
Having one or more risk factors does not mean that you will develop endometrial cancer. Equally, women without known risk factors can still develop the condition.
If you have a strong family history of endometrial or bowel cancer, your GP or specialist may recommend further assessment or genetic counselling where appropriate.
How Is Endometrial Cancer Diagnosed?
If you have symptoms that could be associated with endometrial cancer, your GP may refer you to a gynaecologist or specialist cancer service for further investigation.
Your assessment will begin with a discussion about your symptoms, medical history and family history. You may also have a physical or pelvic examination.
Further investigations may include:
Transvaginal Ultrasound
A transvaginal ultrasound uses a small ultrasound probe placed inside the vagina to produce detailed images of the womb and surrounding reproductive organs. It can assess the thickness and appearance of the endometrium and identify abnormalities that may require further investigation.
Hysteroscopy
A hysteroscopy allows the inside of the womb to be examined using a narrow camera called a hysteroscope. The camera is passed through the vagina and cervix into the womb.
This allows the specialist to look directly at the endometrium and identify areas that appear abnormal.
Endometrial Biopsy
A small sample of tissue from the lining of the womb may be taken and sent to a laboratory for examination. This can determine whether abnormal or cancerous cells are present.
A biopsy may be performed during a hysteroscopy or as a separate procedure.
MRI or CT Scan
If endometrial cancer is diagnosed, further imaging may be recommended to establish the size and location of the tumour and determine whether it has spread beyond the womb.
An MRI can provide detailed images of the pelvis and may help with treatment planning, while CT or other imaging may be used to assess other areas of the body where appropriate.
Staging and Grading
If cancer is confirmed, additional information from your investigations will be used to establish its stage and grade.
The stage describes how far the cancer has spread, while the grade provides information about how abnormal the cancer cells look and how they are likely to behave.
This information is important in helping your specialist team determine the most appropriate treatment for you.
Treatment Options
Treatment for endometrial cancer depends on a number of factors, including the type, grade and stage of the cancer, your general health and your individual circumstances.
Surgery
Surgery is often the main treatment for endometrial cancer, particularly when the cancer has been diagnosed at an early stage.
The most common procedure is a hysterectomy, which involves removing the womb. Depending on the type and stage of the cancer, the fallopian tubes and ovaries may also be removed.
In some circumstances, lymph nodes may also need to be assessed or removed to determine whether cancer cells have spread.
Where appropriate, minimally invasive techniques such as laparoscopic or robotic surgery may be considered. These approaches can offer benefits for selected patients, including smaller incisions and potentially a quicker recovery.
Mr Jafaru Abu has a particular interest in minimally invasive gynaecological surgery and was instrumental in the introduction of total laparoscopic hysterectomy for endometrial cancer.
Radiotherapy
Radiotherapy uses high-energy radiation to destroy cancer cells. It may be recommended following surgery to reduce the risk of the cancer returning, or in some circumstances as a primary treatment where surgery is not appropriate.
Radiotherapy can include external beam radiotherapy or brachytherapy, where radiation is delivered internally.
Chemotherapy
Chemotherapy uses medicines to destroy cancer cells or prevent them from growing. It may be recommended for certain higher-risk or more advanced forms of endometrial cancer, sometimes alongside other treatments.
Hormone Therapy
Some endometrial cancers are sensitive to hormones. Hormone therapy may therefore be considered for selected patients, particularly in certain advanced or recurrent cancers.
Targeted Therapy and Immunotherapy
For some patients with advanced or recurrent endometrial cancer, targeted medicines or immunotherapy may be appropriate.
These treatments work in different ways, including targeting specific characteristics of cancer cells or helping the body's immune system recognise and attack cancer cells. Whether these treatments are suitable will depend on the individual characteristics of your cancer.
Your specialist will explain the treatment options available to you and why a particular approach may be recommended.
Recovery and Aftercare
Recovery will depend on the treatment you receive and your individual circumstances.
If surgery is recommended, your specialist will provide detailed advice about your recovery, including caring for your wounds, managing discomfort, gradually returning to normal activities and recognising symptoms that may require further medical attention.
Recovery following minimally invasive surgery may be different from recovery following open abdominal surgery, and your expected recovery time will be discussed with you before your procedure.
Follow-up care is an important part of your treatment. Regular appointments allow your specialist team to monitor your recovery, discuss any ongoing symptoms and assess your response to treatment. Further investigations or scans may be arranged where appropriate.
Endometrial cancer treatment can also affect areas of your life such as fertility, sexual health, hormonal health and emotional wellbeing. These are important considerations, and you should feel comfortable discussing any concerns with your specialist team.
Risks and Benefits of Treatment
Every treatment has potential benefits and risks. These will depend on your diagnosis, the treatment recommended and your individual health.
The potential benefits of treatment may include removing the cancer, reducing the risk of recurrence, controlling the disease and improving long-term outcomes.
Surgery carries general risks such as bleeding, infection, blood clots and complications associated with anaesthesia. Depending on the procedure, there may also be specific risks involving the bladder, bowel, blood vessels or surrounding tissues.
Removal of the womb means that you will no longer be able to become pregnant. If the ovaries are also removed before natural menopause, this can result in an earlier onset of menopause and associated hormonal changes.
Radiotherapy, chemotherapy, hormone therapy and other treatments can also have side effects, which vary between patients.
Before recommending treatment, Mr Abu will discuss the potential benefits, risks and alternatives with you. You will have the opportunity to ask questions and understand the proposed treatment fully before making an informed decision about your care.
Specialist Endometrial Cancer Care
Being referred for investigation because of abnormal bleeding can understandably cause anxiety, particularly when you do not yet know what is causing your symptoms.
At Gynae Solution, we believe that patients deserve clear information, specialist expertise and compassionate care throughout their journey. Mr Jafaru Abu will take the time to understand your symptoms, explain the results of your investigations and discuss the treatment options available to you.
If you are experiencing unusual vaginal bleeding or have been referred for investigation of a possible endometrial abnormality, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
Patient leaflets
Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.
Total Laparoscopic Hysterectomy
The four ways the uterus can be removed, and how they compare on hospital stay, pain relief and recovery.
Single Incision Laparoscopic Surgery
Key-hole surgery through one incision in the navel, often called scarless surgery.
De-bulking Surgery
Why surgeons aim to remove all visible disease, and how the extent of surgery affects survival.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
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