Endometrial Cancer
Endometrial cancer is the most common cancer of the uterine body and originates from the inner lining of the uterus. The most characteristic warning sign is unusual vaginal bleeding, especially after menopause, which is why prompt gynecological evaluation is crucial.
Symptoms of endometrial cancer
Endometrial cancer is often noticed early because it causes bleeding or discharge that does not match a woman's normal cycle. Symptoms do not always mean malignancy, but they require organized investigation rather than simple observation.
- Bleeding after menopause, even if minimal or occurring only once.
- Bleeding between periods or periods that become heavier, more frequent or prolonged.
- Pink, brown or watery vaginal discharge, especially in a postmenopausal woman.
- Pain or pressure in the lower abdomen and pelvis.
- Pain during intercourse or persistent discomfort without clear cause.
- Difficulty or pain on urination in more advanced cases.
- Fatigue, anemia or weakness when bleeding is recurrent.
When urgent gynecological evaluation is needed
Any bleeding after menopause is considered a pathologic symptom until proven otherwise. Early evaluation allows differentiation of benign causes such as polyps or atrophy from endometrial hyperplasia or cancer.
- New bleeding after menopause.
- Recurrent bleeding or spotting after months without a period.
- Bleeding in a woman taking tamoxifen or hormone therapy.
- Abnormal endometrial thickness on ultrasound.
- History of endometrial hyperplasia, Lynch syndrome or strong family history of cancers.
Risk factors for endometrial cancer
Risk increases when the endometrium is exposed to estrogen for prolonged periods without the protective effect of progesterone. History assessment helps identify which women need more immediate or closer investigation.
- Obesity and metabolic syndrome.
- Type 2 diabetes or chronic hypertension.
- Polycystic ovaries, chronic anovulation or irregular periods over a long period.
- Early menarche, late menopause or nulliparity.
- Estrogen therapy without progesterone or tamoxifen use.
- Lynch syndrome or family history of endometrial, colon or ovarian cancer.
- Endometrial hyperplasia, especially with atypia.
Diagnosis of endometrial cancer
Diagnosis is based on histological examination of the endometrium. Ultrasound shows endometrial thickness and morphology, but the definitive answer comes from biopsy or hysteroscopy when a suspicious finding is present.
- Detailed gynecological history: Age, bleeding pattern, medications, risk factors and family history.
- Clinical gynecological examination: Assessment of vagina, cervix, uterus and pelvis to exclude other sources of bleeding.
- Transvaginal ultrasound: Measures endometrial thickness and identifies polyps, fibroids or suspicious lesions.
- Endometrial biopsy: Tissue sample from inside the uterus for microscopic examination.
- Hysteroscopy: Direct visualization of the uterine cavity and targeted biopsy when a focal lesion is present.
- Dilation and curettage: Used when biopsy is insufficient or more complete sampling is needed.
Staging and imaging
After confirmation of diagnosis, staging shows whether the disease is confined to the uterus or has spread to the cervix, lymph nodes or other organs. Stage, histological type and grade determine the treatment plan.
- Pelvic MRI to assess myometrial invasion, cervical extension and lymph node risk.
- CT of the chest, upper and lower abdomen when assessment of disease spread is needed.
- Laboratory and preoperative workup according to age, general health and comorbidities.
- Histological and molecular characterization where indicated for better risk assessment and selection of adjuvant therapy.
What hyperplasia or thick endometrium means
A thick endometrium on ultrasound does not always mean cancer. It may be related to a polyp, hormonal stimulation or hyperplasia. However, the presence of atypia in hyperplasia significantly increases the likelihood of progression and requires specialized management.
- In postmenopausal bleeding, endometrial thickness is evaluated with particular attention.
- Endometrial polyps may cause bleeding and are often removed hysteroscopically.
- Hyperplasia without atypia can be managed conservatively in selected cases.
- Atypical hyperplasia needs close oncological evaluation, as it may coexist with or progress to cancer.
Treatment of endometrial cancer
Endometrial cancer treatment is individualized based on stage, histological type, grade, age and the woman's general condition. In most cases the initial treatment is surgical.
- Total hysterectomy with removal of fallopian tubes and ovaries is the standard treatment for most patients.
- Sentinel lymph node mapping may be used for staging with less morbidity in selected cases.
- Laparoscopic or robotic surgery can offer faster recovery when oncologically appropriate.
- Radiotherapy or brachytherapy is used when there is an increased risk of local recurrence.
- Chemotherapy is recommended for high-risk, advanced or recurrent disease.
- Hormonal therapy, immunotherapy or targeted therapies may play a role in specific cases depending on tumor characteristics.
Treatment and fertility preservation
In younger women with very early low-risk disease, conservative treatment with progestins may be discussed, only after strict selection and full counseling. Oncological safety comes first and close monitoring with repeated biopsies is required.
- Conservative management mainly concerns well-differentiated endometrioid carcinoma that appears confined to the endometrium.
- Before making a decision, reliable imaging and exclusion of deeper invasion or extrauterine disease are needed.
- A levonorgestrel intrauterine system or systemic progesterone may be used in selected patients.
- Pregnancy attempts are planned only after documented response and a clear oncological follow-up plan.
Follow-up after endometrial cancer treatment
Follow-up after treatment aims at early detection of recurrence, management of side effects and gradual return to daily life. Most recurrence symptoms are evaluated based on history and clinical examination.
- Regular visits with gynecological examination and discussion of new symptoms.
- Immediate contact with the doctor for new bleeding, pelvic pain, persistent weight loss or unexplained fatigue.
- Imaging when there is a symptom, clinical finding or increased risk.
- Support for menopause, sexual health, lymphedema, psychological burden and quality of life.
- Coordination with an oncologist or radiotherapist when adjuvant treatment has been given or systemic therapy is needed.
Symptoms
Endometrial cancer is often noticed early because it causes bleeding or discharge that does not match a woman's normal cycle. Symptoms do not always mean malignancy, but they require organized investigation rather than simple observation.
- Bleeding after menopause, even if minimal or occurring only once.
- Bleeding between periods or periods that become heavier, more frequent or prolonged.
- Pink, brown or watery vaginal discharge, especially in a postmenopausal woman.
- Pain or pressure in the lower abdomen and pelvis.
- Pain during intercourse or persistent discomfort without clear cause.
- Difficulty or pain on urination in more advanced cases.
- Fatigue, anemia or weakness when bleeding is recurrent.
Any bleeding after menopause is considered a pathologic symptom until proven otherwise. Early evaluation allows differentiation of benign causes such as polyps or atrophy from endometrial hyperplasia or cancer.
- New bleeding after menopause.
- Recurrent bleeding or spotting after months without a period.
- Bleeding in a woman taking tamoxifen or hormone therapy.
- Abnormal endometrial thickness on ultrasound.
- History of endometrial hyperplasia, Lynch syndrome or strong family history of cancers.
Risk increases when the endometrium is exposed to estrogen for prolonged periods without the protective effect of progesterone. History assessment helps identify which women need more immediate or closer investigation.
- Obesity and metabolic syndrome.
- Type 2 diabetes or chronic hypertension.
- Polycystic ovaries, chronic anovulation or irregular periods over a long period.
- Early menarche, late menopause or nulliparity.
- Estrogen therapy without progesterone or tamoxifen use.
- Lynch syndrome or family history of endometrial, colon or ovarian cancer.
- Endometrial hyperplasia, especially with atypia.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
Need an assessment?
Book an appointment at the Athens or Ioannina offices for a personalized evaluation with the doctor.