Uterine Cancer Awareness: Early Detection Through Abnormal Bleeding Saves Lives

Uterine cancer (search)Search disease — cancer that arises from the uterus — affects approximately 68,000 women each year in the United States, and unlike many other cancer types, its incidence is rising. Yet the disease carries a reliable early warning sign that, when recognized, leads to diagnosis at the earliest, most treatable stages: abnormal vaginal bleeding.

"Post-menopausal bleeding can be a signal the body gives us that something is not right," explains gynecologic oncologist Larissa Meyer, M.D., of MD Anderson Cancer Center. "While not all postmenopausal bleeding is due to cancer, 90% of women with postmenopausal endometrial cancer (search)Search disease report experiencing abnormal vaginal bleeding. So, it certainly warrants an endometrial biopsy, which can usually be performed as a simple, in-office procedure."

Two Types of Uterine Cancer (search)Search disease

Uterine cancer (search)Search disease encompasses two distinct forms. Endometrial cancer (search)Search disease, which develops on the inner lining of the uterus, accounts for approximately 90% of cases. The remaining 10% are uterine sarcomas, which arise in the muscular wall or supportive tissues of the uterus. Because of the prominent warning sign of abnormal bleeding, 60% to 70% of uterine cancers are diagnosed at stage 1, when the disease is confined to the uterus and has not spread.

The Critical Warning Sign

For postmenopausal women, any bleeding is abnormal and should prompt immediate medical evaluation. Kirsten Arendes, diagnosed with stage 1 endometrial cancer (search)Search disease at age 51, recalls her experience: "I hadn't had a period for about 10 months. Then I had one super, super heavy period. I assumed it was normal for things to kind of come and go toward the end, though, so I didn't think anything of it. Then the same thing happened the following month. And the next one."

Maria Lozano, diagnosed with stage 3 endometrial cancer (search)Search disease at age 59, had a similar story. "After 10 years of not having my period, suddenly I was bleeding again," she says. "My sister told me I needed to see a doctor."

Dr. Meyer emphasizes that periods do not simply restart years after they have stopped. "If you're already in menopause and start bleeding again, get checked out. Because that's not normal."

Diagnostic Challenges in Younger Women

Detecting endometrial cancer (search)Search disease in premenopausal women presents greater difficulty. "It's trickier to diagnose in the premenopausal population," notes Meyer, "because a lot of women have never really menstruated normally, so changes associated with the development of cancer may not be as noticeable."

Aimee Williams, diagnosed with stage 3 endometrial cancer (search)Search disease at age 43, lived with unpredictable periods for three decades. "My periods were always unpredictable," she recalls. "They could be anywhere between 12 and 40 days apart, so I never really knew when they were coming. I thought that's just how my body was, so I dealt with it for 30 years."

The disease is increasing in younger populations by approximately 1% to 2% per year. Conditions such as PCOS, endometriosis, and obesity — which can cause irregular ovulation — also predispose women to endometrial cancer (search)Search disease. Some younger women only discover they have the disease when seeking help for infertility.

Treatment Approaches by Stage

For stage 1 endometrial cancer (search)Search disease, the standard treatment is a hysterectomy with removal of the tubes and ovaries, along with lymph node biopsies to check for spread. Most women can undergo this as a minimally invasive procedure and return home the same day. For more advanced disease, open surgery with a hospital stay may be required, and when cancer has spread to distant sites, chemotherapy or radiation may be employed rather than surgery.

In select younger patients who wish to preserve fertility, hormone-based treatment may be an alternative to surgery, though this requires meeting very specific, narrow criteria and thorough discussion with a physician.

Outcomes and Disparities

The prognosis for early-stage uterine cancer (search)Search disease is excellent. Approximately 95% of patients with stage 1 or stage 2 disease survive the cancer. However, significant racial disparities persist. Black women are twice as likely to die from uterine cancer as white women.

"We see non-white women coming in with more aggressive forms of endometrial cancer (search)Search disease, and oftentimes these women have more advanced stage disease by the time they come to get care," notes experts at the CU Anschutz Cancer Center. Contributing factors may include access to care, delays in diagnosis, socioeconomic factors, and differences in tumor biology across ethnic groups. Obesity is also identified as a major driver of risk.

The Role of Molecular Profiling

At centers like the CU Anschutz Cancer Center, molecular profiling is now performed on all patients undergoing uterine cancer (search)Search disease surgery. This provides information about the biology of each tumor and is being used in ongoing clinical trials to potentially de-escalate therapy — meaning patients with certain molecular profiles may receive less aggressive treatment without compromising outcomes.

"We're making a lot of progress in learning how certain molecular drivers influence the behavior of tumors," experts state, "and we're continuing to learn how to use that information to tailor therapy for each patient."

Other Symptoms to Recognize

Beyond abnormal bleeding, additional symptoms of endometrial cancer (search)Search disease include pelvic pain, unexplained weight loss, and abnormal vaginal discharge. Moina Faruqui, diagnosed with stage 4 endometrial cancer at age 65, experienced exhaustion and a foul-smelling, non-bloody vaginal discharge for approximately three months before her diagnosis.

About 75% of patients diagnosed with endometrial cancer (search)Search disease are already in menopause. Dr. Meyer's guidance is straightforward: "If you have concerns about your cycle, or if you think you're experiencing abnormal bleeding or any other symptom of endometrial cancer, talk to your gynecologist."