Many gynecologic cancers advance without warning, but the most common form of uterine cancer announces its presence quite clearly. “The good news about endometrial cancer is that it has a warning sign, which is irregular bleeding for the younger woman and postmenopausal bleeding for the older woman,” says UAB gynecologic oncologist Larry Kilgore, M.D. “When you go through menopause at age 50 or so, you shouldn’t bleed anymore. If you do, it’s cancer until proven otherwise. Most diagnosed cases of endometrial cancer occur because of what’s known as postmenopausal bleeding.”

Researchers don’t entirely understand the causes of uterine cancer. They know that endometrial cancer is exacerbated by the hormone estrogen, but muscle or myometrial cells in the uterus may also become cancerous. However, the symptoms of uterine cancer, frequently including acute pain and vaginal bleeding, make it easy to detect early and treat before it spreads to other tissues.

“There’s really no screening test for it—this isn’t a Pap smear cancer, and there’s no blood marker that you can draw like a PSA for prostate cancer,” Dr. Kilgore notes. “But most women are pretty good about coming to the doctor if they are bleeding irregularly, and then the treatment is often very effective.”

If you know the risk factors and heed the warning signs, you can significantly increase the odds of successful diagnosis and treatment.

Risk factors include:

1. Age: Women over age 40 account for 95 percent of endometrial cancer cases.
2. Personal history: Breast cancer or ovarian cancer can also increase the risk of endometrial cancer.
3. Early menarche: The longer a woman’s endometrium has been exposed to estrogen, the greater her chance of developing endometrial cancer; a woman who starts her period before age 12 and continues into her 50s is at a higher risk.
4. Never having been pregnant: Researchers aren’t sure why pregnancy seems to protect against endometrial cancer, but the increased progesterone during pregnancy is thought to offset the increased estrogen.
5. Irregular ovulation: Irregular ovulation can increase a woman’s lifetime exposure to estrogen; there are many causes of irregular ovulation, including polycystic ovary syndrome.
6. Estrogen-only replacement therapy: Estrogen stimulates growth of the endometrium, but combination hormone replacement therapy (HRT) that includes progesterone actually lowers risk of endometrial cancer (although it may increase other health risks).
7. Obesity: Fat tissue is known to change some hormones into a form of estrogen, increasing a woman’s risk of endometrial cancer. In fact, obesity has more of an effect on the incidence of endometrial cancer than hormone therapy, Dr. Kilgore says. (See “Obesity and Estrogen: A Growing Problem.”)

Other warning signs include:

1. prolonged periods or bleeding between periods
2. more frequent vaginal bleeding or spotting during the years leading up to menopause, or any bleeding at all during menopause
3. a pink, watery, or white discharge from the vagina
4. pelvic pain (especially common late in the disease)
5. pain during intercourse
6. weight loss

Caperton Gillett