# Endometrial cancer
What is it
Endometrial cancer is a malignant tumor that develops in the lining of the uterus, the endometrium. This lining normally sheds menstrual blood monthly and rebuilds itself under the influence of hormones. In endometrial cancer, cells grow uncontrollably in this tissue.
The disease occurs mainly in women after menopause, although it can also develop before that age. In many countries, the number of cases is rising, partly because endometrial cancer is now detected and diagnosed more often, and partly due to an increase in risk factors.
There are different types of endometrial cancer. The most common type is adenocarcinoma (approximately 80% of all cases). Other rarer forms have different characteristics and may progress differently.
Causes
The exact cause of endometrial cancer cannot be summarized in a single factor, but there are risk factors that increase the chances.
**Hormonal factors** play an important role. An excess of estrogen without sufficient balance from progesterone increases the risk. This can occur with overweight (because fat tissue produces estrogen), with certain hormonal conditions, and with the use of certain hormone treatments.
**Age and menopause**: the disease usually occurs after age 50. After menopause, the natural hormonal protection that progesterone provides stops.
**Heredity**: in some families, cancer occurs more frequently, sometimes due to certain inherited genetic abnormalities that normally suppress cancer formation. However, this concerns a small proportion of all cases.
**Other factors** that increase the risk include diabetes, certain medications (especially tamoxifen for breast cancer), and prolonged inflammation in the body.
It is important to know that having risk factors does not mean someone will certainly develop cancer. Many women with one or more risk factors never develop this disease.
How the disease progresses
Endometrial cancer usually develops slowly. It often begins with abnormal cell growth in the endometrium, which doctors call hyperplasia. This is not yet cancer, but some forms of hyperplasia can eventually develop into cancer.
Once malignant tumor cells develop, they can grow at different rates. This depends on the type of cancer and certain properties of the tumor cells (which doctors call "biological characteristics" or "grading"). Some forms grow slowly, others more aggressively.
**Local growth**: the tumor first grows in the endometrium itself. Subsequently, it can penetrate deeper into the tissue (into the muscle layer of the uterus, the myometrium). Then the tumor can reach the membrane surrounding the uterus and possibly spread to nearby organs.
**Metastases**: cancer can spread via the lymphatic system to lymph nodes in the pelvis and higher in the abdomen. It can also spread via the bloodstream to other organs, such as the lungs, liver, or bones.
The speed of this process varies greatly from person to person and from tumor type. Regular follow-up helps detect changes.
Symptoms by phase
The first symptoms usually occur at an early stage, which is an advantage with this disease.
**Phase 1 – Early signs**
The most noticeable symptom is abnormal vaginal bleeding:
- Bleeding after menopause (unusual vaginal bleeding after a period without menstruation)
- Irregular or heavy menstrual bleeding before menopause
- Likely bloody or bloodstained discharge
Many women seek medical help at this point because this symptom is unusual. This helps detect cancer early. Some may also experience pain in the lower abdomen or pelvis, or pain during sexual intercourse.
**Phase 2 – Local growth**
As the tumor grows larger, symptoms may increase:
- Heavier or more frequent bleeding
- Lower abdominal pain, sometimes radiating to the back
- Possible weight loss without clear reason
- Fatigue
**Phase 3 – Further spread**
With more advanced disease, the following may occur:
- Pain in the pelvis or abdomen
- Changes in bowel function or urination (if the tumor affects nearby tissues)
- Possible abdominal swelling
- Increasing fatigue and general malaise
With metastases to other organs, symptoms arise depending on where the cancer grows (for example, a slight cough with lung metastases, bone pain with bone metastases).
**Important**: many of these symptoms can also be caused by other, benign conditions. Only a doctor can determine what is wrong.
What it means for daily life
A diagnosis of endometrial cancer brings major changes.
**Medical treatments** (usually surgery, sometimes combined with radiation or medication) require time and energy. Recovery afterwards can also take weeks to months. Many women experience fatigue, which can limit their daily activities.
**Physical consequences**: an operation to remove the uterus (hysterectomy) means, among other things, that menstruation stops and pregnancy is no longer possible. This can have emotional impact, especially for younger women. Radiation can cause side effects such as diarrhea, urinary problems, or prolonged fatigue. Medications can have different effects depending on the type.
**Work and daily life**: during the acute treatment phase, many women are unable to work or perform household tasks at full capacity. Gradually, most return to their normal life, but this happens at their own pace.
**Emotional burden**: a cancer diagnosis is stressful, even though endometrial cancer is often treatable. Fear of recurrence, grief over lost fertility, and the long follow-up period can demand psychological energy. Many hospitals offer psychological support.
**Relationships and sexuality**: physical consequences of treatment (pain, fatigue) and emotional impact can affect intimacy. Open communication with your partner and professional help can assist here.
**Financial**: although healthcare costs in the Netherlands are largely covered by insurance, there can be indirect costs (transportation, loss of income) that are burdensome.
Most women find that life after treatment can become reasonably normal again, although with a different awareness.
Outlook
The outlook for endometrial cancer depends on several factors: the stage (how far the cancer has already spread), the type of tumor, and the patient's health.
**Early detected cancer** (when it is still limited to the endometrium or the uterus itself) has significantly better prospects than cancer that has already metastasized. This is a reason why recognizing early symptoms is important.
In many countries, **five-year survival data** (the proportion of women who are still alive at least 5 years after diagnosis) range between 70-80% for all stages combined. This figure has increased over recent decades. But this average says nothing about any individual case – your own prognosis may be more or less favorable.
Women with cancer limited to the uterus or locally advanced cancer have better average outcomes than those with cancer that has already spread throughout the body.
**Molecular characteristics** of tumor cells (properties that doctors determine through laboratory examination) nowadays help better predict how aggressive a tumor is and how well it responds to certain treatments. This makes prognosis more personalized.
**Recurrences** (return of cancer) can occur months or years after treatment. Ongoing follow-up helps detect this early.
In recent years, new treatments have also been in development, which expands possibilities. But no prediction is certain for an individual.
Frequently asked questions
**Is endometrial cancer always fatal?**
No. Endometrial cancer is serious, but many women are cured, especially if the disease is detected early. Most cases are diagnosed at a relatively early stage because abnormal bleeding is a warning sign. Of course, much depends on personal factors and tumor characteristics.
**If I have abnormal bleeding, do I definitely have cancer?**
No. Many causes of abnormal bleeding are not malignant: hormonal fluctuations, polyps, inflammation, and many others. A doctor can perform an examination to find out what is going on. But abnormal bleeding (especially after menopause) should always be checked.
**Can I still have children if I have endometrial cancer?**
In most situations, surgical treatment removes the uterus, making future pregnancies impossible. At very early stages, fertility-preserving treatments can be considered in exceptional cases (preservation of the uterus with a very specific approach), but this is not standard and must be discussed extensively. This is something to discuss with your doctor early on if it is important to you.
**How long does treatment take?**
This varies greatly. An operation can take several hours, with recovery taking several weeks at home. If radiation is needed, this usually takes several weeks with multiple sessions per week. Medication treatments can last months. Follow-up appointments usually continue for years. Your doctor can outline a personal schedule.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._