Endometrial cancer: causes, symptoms and diagnosis

Endometrial cancer happens when the cells in the lining of the womb (the endometrium) grow abnormally. It is also called womb cancer or uterine cancer, and it is the most common cancer of the female reproductive system. The good news is that endometrial cancer is usually found early, and when it is, it can often be cured.

In this post I explain what causes endometrial cancer, the symptoms to look out for, and how it is diagnosed and treated.

What causes endometrial cancer?

Cancer develops when cells grow out of control instead of dividing in an orderly way. In endometrial cancer, abnormal cells in the womb lining form a growth called a tumour, and these cells can sometimes spread to other parts of the body. Higher levels of the hormone oestrogen appear to play an important part in how endometrial cancer develops.

Cancer Research UK explains the risks and causes of womb cancer in more detail.

Symptoms of endometrial cancer

The most common symptom is abnormal vaginal bleeding. Because this is usually noticed early, most women are diagnosed at a stage when treatment works well. Symptoms can include:

• bleeding or spotting between periods, or any bleeding after the menopause
• very long, heavy or frequent bleeding in women over 40, which can be a sign of precancerous changes
• a thin, white or clear vaginal discharge after the menopause
• lower tummy or pelvic pain, or a lump in the lower tummy
• difficulty or pain passing urine, or pain during sex
• weight loss

These symptoms often have a less serious cause. Even so, they should always be checked by a doctor, because finding endometrial cancer early improves the chance of successful treatment. Any bleeding after the menopause, even a single episode of light spotting, should be reported to your GP promptly. It is the symptom I most want women to act on, because acting quickly gives the best chance of finding endometrial cancer at an early, curable stage.

How is endometrial cancer diagnosed?

Your doctor will start by asking about your medical history and any family history of cancer. They will then examine your tummy for lumps or swelling and carry out an internal (pelvic) examination, and may take a cervical smear. Further tests may include:

• a transvaginal ultrasound scan, to look at the womb lining and the ovaries (see gynaecological ultrasounds)
• a biopsy, a small sample of the womb lining, checked for abnormal cells
• sometimes a hysteroscopy or a dilation and curettage (D&C) to remove and test more of the lining

Staging endometrial cancer

If endometrial cancer is found, your doctor will give it a stage based on all your test results. Staging describes the size of the cancer and whether it has spread. That helps your team plan treatment and predict recovery. Generally, lower numbers mean a less advanced cancer and higher numbers a more advanced one. There is more than one staging system, so it is worth checking that you and your doctor are talking about the same one.

Treating endometrial cancer

You may be referred to a gynaecological oncologist, a specialist in cancers of the female reproductive system. Treatment depends on the stage, the size of the tumour and how aggressive the cell type is. It usually involves surgery to remove the womb, often by keyhole, as described on our total laparoscopic hysterectomy page. Surgery may be followed by radiotherapy, chemotherapy, hormone therapy, or a combination.

Our endometrial cancer page has more detail, and NICE sets out when symptoms should be referred urgently. If you are worried about any of these symptoms, you can book an appointment with Mr Jafaru Abu at The Park Hospital, Nottingham.