Symptoms
The most common symptom is abnormal vaginal bleeding, including:
- Any bleeding after menopause, even light spotting
- Bleeding between periods or heavier or prolonged periods
- Unusual vaginal discharge
- Less commonly, pelvic pain or discomfort
Most abnormal bleeding is not caused by cancer. However, any bleeding after menopause should be investigated, even if it occurs only once.
Risk factors
Risk factors include increasing age, higher body weight, diabetes, polycystic ovary syndrome and certain medications, including tamoxifen. Some endometrial cancers are associated with inherited conditions, particularly Lynch syndrome.
Endometrial cancer can also occur in women without any recognised risk factors.
Tests and diagnosis
Assessment usually involves a pelvic ultrasound and sampling of the uterine lining (endometrial biopsy).
An endometrial biopsy can often be performed in the consulting rooms. Alternatively, a hysteroscopy may be recommended, allowing direct examination of the uterine cavity and collection of tissue samples.
If cancer is diagnosed, additional imaging such as CT or MRI may be recommended to help assess the extent of disease and plan treatment.
The biopsy also provides information about the type and grade of cancer. Additional molecular testing may help determine prognosis and guide treatment decisions.
Treatment
Treatment depends on the type and extent of cancer, molecular characteristics and individual circumstances. Management is generally discussed through a multidisciplinary team.
Surgery is the main treatment for most patients and usually involves removal of the uterus, cervix, fallopian tubes and ovaries. This can often be performed using minimally invasive laparoscopic or robotic surgery.
Assessment of the lymph nodes may also be recommended, frequently using a technique called sentinel lymph node biopsy, which identifies the first lymph nodes most likely to be involved if cancer has spread.
Radiotherapy or chemotherapy may be recommended after surgery for patients with a higher risk of recurrence. Many patients with early-stage, low-risk disease do not require additional treatment.
Hormonal therapy, immunotherapy or targeted treatments may be appropriate in selected circumstances, particularly for advanced or recurrent disease.
For some younger patients with carefully selected early-stage cancers who wish to preserve fertility, hormonal treatment with close monitoring may be considered as an alternative to immediate surgery.
Genetics and Lynch syndrome
Lynch syndrome is an inherited condition associated with an increased risk of endometrial, bowel and several other cancers.
Tumour testing is commonly performed to identify features that may suggest Lynch syndrome. Where appropriate, referral for genetic counselling and further testing may be recommended.
Identifying an inherited cancer syndrome can have important implications for both the patient and their relatives.
Common questions
Will I need a hysterectomy?
Hysterectomy is the standard treatment for most patients with endometrial cancer. The recommended approach depends on the cancer characteristics, your general health and individual circumstances.
Can surgery be performed using keyhole or robotic techniques?
Many patients are suitable for minimally invasive surgery, which generally allows a shorter hospital stay and faster recovery than open surgery. The most appropriate approach depends on the extent of disease and other clinical factors.
Will I need chemotherapy or radiotherapy?
Not necessarily. Many patients with early-stage endometrial cancer are treated with surgery alone. Recommendations for additional treatment depend on the final pathology and molecular findings.
Do I need a referral?
Yes. A referral from your GP or specialist is needed for a Medicare rebate. Please address this to Dr Shaun McGrath at Arc Specialist Care.
Further information and support
- Cancer Council Australia: Uterine cancer
- Cancer Australia: Endometrial cancer
- Cancer Council: Understanding Cancer of the Uterus
Cancer Council provides free information and support on 13 11 20.
Seeing us in Brisbane
Ask your GP or specialist for a referral to Dr Shaun McGrath at Arc Specialist Care, then call us to book.
This information is general in nature and does not replace individual medical advice. Investigation and treatment recommendations depend on your specific circumstances.