Endometrial Cancer – Uterine Cancer: Symptoms, Diagnosis, Treatment and Follow-Up
Endometrial cancer is a type of cancer that arises from the inner lining of the uterus, known as the endometrium. It is commonly referred to as uterine cancer. A significant proportion of uterine cancers originate from the endometrium, and the condition is more commonly seen after menopause.
Endometrial cancer often causes symptoms at an early stage. Therefore, recognizing the warning signs and seeking timely medical evaluation are very important for successful treatment.
What is the endometrium?
The endometrium is the tissue that lines the inside of the uterus. In women of reproductive age, it thickens every month under the influence of hormones and is shed as menstrual bleeding if pregnancy does not occur. After menopause, due to changes in hormone levels, the endometrium usually becomes thin and inactive.
Why is this important?
Because any bleeding from the uterus after menopause should not be considered “normal menstrual bleeding.” It should always be evaluated by a gynecologist.
Who is more likely to develop endometrial cancer?
Endometrial cancer is most commonly seen in postmenopausal women. However, it is not only a disease of advanced age; it can also occur in younger women.
Factors associated with an increased risk include:
Postmenopausal status
Obesity
Long-term unopposed estrogen exposure
Polycystic ovary syndrome
Never having given birth
Early onset of menstruation or late menopause
Metabolic diseases such as diabetes and hypertension
Family history of endometrial, colon, or certain other cancers
Hereditary cancer syndromes such as Lynch syndrome
History of tamoxifen use for breast cancer treatment
History of endometrial hyperplasia, especially atypical hyperplasia
It is important to remember that not everyone with risk factors will develop endometrial cancer. Likewise, the disease may also occur in people with no obvious risk factors.
What is the most important symptom?
The most common symptom of endometrial cancer is abnormal vaginal bleeding.
The key question is:
“Which type of bleeding should be taken seriously?”
Medical evaluation should not be delayed in the following situations:
Any vaginal bleeding after menopause, even a single drop
Bleeding between menstrual periods
Menstrual bleeding that is heavier or longer than usual
Bloody, brown, or watery vaginal discharge
Bleeding after sexual intercourse
Pain or pressure in the pelvic area
In advanced stages, weight loss, fatigue, or abdominal swelling
Postmenopausal bleeding in particular should always be investigated until proven otherwise. The fact that bleeding is light, short-lived, or stops on its own does not mean there is no underlying disease.
Is every abnormal bleeding cancer?
No. Abnormal bleeding may have many benign causes. Polyps, fibroids, hormonal irregularities, endometrial atrophy, infections, or certain medications may lead to bleeding.
However, the important point is this: the cause of bleeding should be evaluated with appropriate methods rather than guessed. When endometrial cancer is detected early, the chance of successful treatment is high.
How is endometrial cancer diagnosed?
Endometrial cancer cannot be definitively diagnosed by examination or ultrasound alone. A definite diagnosis requires taking a tissue sample from inside the uterus and examining it under a microscope.
The main methods used in the diagnostic process include:
1. Gynecological examination
The patient’s symptoms, age, menopausal status, medications, family history, and other medical conditions are evaluated. A pelvic examination is performed to assess the uterus, vagina, and surrounding structures.
2. Transvaginal ultrasound
Transvaginal ultrasound is used to evaluate the uterus, ovaries, and endometrial thickness. After menopause, a thickened or irregular endometrium may require further investigation.
However, ultrasound alone is not always sufficient to rule out cancer. If clinical suspicion persists, tissue diagnosis is required.
3. Endometrial biopsy
A small tissue sample is taken from the inner lining of the uterus. This procedure can often be performed in an outpatient setting. The sample is then examined in a pathology laboratory.
4. Hysteroscopy
Hysteroscopy is a method that allows direct visualization of the inside of the uterus using a camera. It is especially valuable when a polyp, focal lesion, or insufficient biopsy result is suspected. If necessary, a targeted biopsy can be taken from the suspicious area during the same procedure.
5. Staging and imaging
After a diagnosis of cancer is made, it is important to evaluate whether the disease is limited to the uterus or has spread. Magnetic resonance imaging, computed tomography, PET/CT, or other imaging methods may be used for this purpose. The choice of test depends on the patient’s clinical condition.
What is assessed in the pathology report?
Treatment planning in endometrial cancer is not based only on the statement “cancer is present.” The pathology report contains very important information that guides treatment.
Main features assessed include:
Histological type of the cancer
Tumor grade
Depth of invasion into the uterine muscle
Presence of lymphovascular space invasion
Spread to the cervix, fallopian tubes, ovaries, or surrounding tissues
Lymph node involvement
Molecular classification and markers
Today, molecular evaluation has become increasingly important in endometrial cancer. This assessment may help better understand the behavior of the disease and support personalized treatment planning.
How is treatment planned?
Treatment for endometrial cancer is planned according to the patient’s age, general health, fertility wishes, tumor type, stage, grade, extent of spread, and molecular features.
Treatment is usually managed with a multidisciplinary approach. A gynecologic oncologist, medical oncologist, radiation oncologist, pathologist, and radiologist may all be important members of the care team.
Surgical treatment
For most patients with endometrial cancer, the main treatment is surgery.
Standard surgery usually includes:
Removal of the uterus
Removal of the fallopian tubes and ovaries
Evaluation of lymph nodes when necessary
Surgical assessment and sampling for possible spread inside the abdomen
Today, minimally invasive surgical methods such as laparoscopic or robotic surgery may be preferred in suitable patients. Minimally invasive surgery may provide less pain, a shorter hospital stay, and faster recovery in appropriately selected cases.
In lymph node assessment, the sentinel lymph node technique may be used in some patients. This method is based on identifying and removing the first lymph nodes to which the cancer is most likely to spread, using special dyes or tracers.
Does every patient need chemotherapy?
No. Not every patient with endometrial cancer needs chemotherapy.
The treatment decision is based on the risk group of the disease. In early-stage, low-risk patients, surgery alone may be sufficient. In higher-risk patients, radiotherapy, chemotherapy, immunotherapy, targeted therapy, or combinations of these treatments may be considered.
When is radiotherapy used?
Radiotherapy may be used to reduce the risk of recurrence. It may be delivered as vaginal brachytherapy or as external beam radiotherapy.
The decision to use radiotherapy depends on the stage and grade of the tumor, the depth of invasion into the uterine muscle, lymphovascular invasion, and other risk factors.
Chemotherapy, immunotherapy and targeted therapies
Systemic treatments may be required in advanced-stage, high-risk, or recurrent endometrial cancer.
These treatments may include:
Chemotherapy
Immunotherapy
Targeted therapies
Hormonal therapies
In recent years, immunotherapy and targeted therapies have become increasingly important, especially according to the molecular characteristics of the tumor. Therefore, additional molecular tests may be requested in some patients.
Can the uterus be preserved in young patients who wish to have children?
In some highly selected patients with early-stage, low-risk disease, fertility-sparing treatment may be considered if the patient wishes to have children. This approach is not suitable for every patient.
It is generally considered only in patients with low-grade, appropriate histological type disease that appears limited to the inner lining of the uterus and shows no evidence of spread. In such cases, very close follow-up is essential. Hormonal treatments, regular biopsies, and imaging methods may be used during the treatment process.
This decision should be made in centers experienced in gynecologic oncology, after detailed counseling.
Why is follow-up important after treatment?
After treatment for endometrial cancer is completed, the follow-up period begins. The purpose of follow-up is to detect possible recurrences early, manage treatment-related side effects, improve quality of life, and support the patient’s general health.
Follow-up usually includes:
Regular medical visits
Gynecological examination
Evaluation of symptoms
Imaging and laboratory tests when necessary
The same follow-up schedule is not applied to every patient. Follow-up frequency is determined according to the stage of the disease, risk group, treatments received, and the patient’s general condition.
Which symptoms are important during follow-up?
After treatment, the physician should be informed if any of the following symptoms occur:
Vaginal bleeding or spotting
New pelvic pain
Abdominal swelling
Unexplained weight loss
Persistent cough or shortness of breath
Swelling in the legs
Significant changes in urinary or bowel habits
Persistent fatigue
These symptoms do not always mean that the cancer has returned. However, they should be evaluated.
Lifestyle and supportive care
Treatment of endometrial cancer is not limited to surgery, medication, or radiotherapy. The patient’s physical and psychological well-being is also an important part of care.
Healthy weight management, regular physical activity, balanced nutrition, control of conditions such as diabetes and hypertension, avoiding smoking, and regular medical follow-up are important for overall health.
During and after treatment, issues such as sexuality, menopausal symptoms, fatigue, lymphedema, bowel problems, and urinary symptoms may also arise. These are not topics to be embarrassed about; with appropriate support, they can often be managed.
Frequently asked questions
I had bleeding after menopause. Should I wait?
No. Bleeding after menopause should always be evaluated. Even if the bleeding is light or occurs only once, medical attention is recommended.
Can a Pap smear detect endometrial cancer?
A Pap smear is mainly used for cervical cancer screening. It does not reliably rule out endometrial cancer. In suspicious cases, a tissue sample from inside the uterus is required.
If the ultrasound is normal, is cancer definitely ruled out?
Not always. Ultrasound is an important evaluation tool, but it is not a definitive diagnostic method. If symptoms and clinical risk persist, biopsy may be necessary.
Can endometrial cancer be detected early?
Yes. Endometrial cancer often causes abnormal bleeding at an early stage. Therefore, prompt evaluation of abnormal bleeding, especially after menopause, is very important for early diagnosis.
Is it possible to return to normal life after treatment?
Many patients can return to their daily lives after treatment. The recovery time depends on the treatment performed, the patient’s general health, and whether additional treatment is needed. During follow-up, psychological support is as important as physical recovery.
Conclusion
Endometrial cancer is a gynecological cancer that often causes early symptoms and can be treated successfully when diagnosed early. The most important warning sign is abnormal vaginal bleeding. Bleeding after menopause should never be ignored.
With accurate diagnosis, appropriate surgical management, additional treatments when necessary, and regular follow-up, successful outcomes can be achieved in many patients.
This article is intended for general informational purposes. Diagnosis, treatment, and follow-up should be individualized for each patient. If you have symptoms or risk factors, consultation with a gynecologist is recommended.
