What are common signs of endometrial cancer?

Signs and symptoms of endometrial cancer include unusual vaginal bleeding or pain in the pelvis. Check with your doctor if you have any of the following:

• Vaginal bleeding or discharge not related to periods.
• Vaginal bleeding after menopause.
• Difficult or painful urination.
• Pain during sexual intercourse.
• Pain in the pelvic area.

Bleeding is the signal that matters most. The National Cancer Institute reports that 91% of women with endometrial cancer have postmenopausal bleeding. Almost nothing else on the list comes close.

What counts as unusual bleeding

After menopause, any bleeding at all is unusual. There is no small amount that is fine. A single spot on underwear, pink discharge, or one episode that never repeats all deserve a call.

Before menopause the line is less obvious. Watch for periods that are much heavier than your normal, bleeding between periods, and cycles that grow erratic in a new way.

The reason bleeding shows up early is anatomy. Endometrial cancer grows in the lining of the uterus. That lining sheds into a cavity that drains straight out. Cancers buried inside solid organs can grow for years in silence. This one usually cannot.

The reassuring half of the statistic

Most postmenopausal bleeding is not cancer. NCI reports that only 9% of women with postmenopausal bleeding turn out to have endometrial cancer. The other 9 in 10 have some other cause. Common ones are thinning of the vaginal or uterine lining, polyps, fibroids, or a hormone effect.

So the point of getting checked is not that you probably have cancer. It is that this symptom catches the disease while it can still be cured. NCI notes that 85% of endometrial cancers are found early, largely because symptoms show up early.

Why a Pap test does not cover this

Because endometrial cancer begins inside the uterus, it does not usually show up on a Pap test, so a sample of endometrial tissue is checked under a microscope.

A Pap test samples the cervix, which sits below the uterus. A normal Pap says nothing about the lining above it. Some people delay reporting bleeding because their Pap was clear. That is a costly mistake.

The workup usually starts with a transvaginal ultrasound, an office biopsy of the lining, or both. Ultrasound measures how thick the lining is. NCI describes a 4 mm cutoff as highly sensitive in women who are bleeding. It also flags many people who turn out to be fine. A thicker lining usually leads to a tissue sample, and that sample is what gives the answer.

When to move faster

Some people carry a much higher lifetime risk. Lynch syndrome is an inherited condition, also called HNPCC. It raises the lifetime risk of endometrial cancer to between 20% and 60% by age 70. NCI notes that guidelines for these women call for yearly transvaginal ultrasound with a biopsy of the lining. International guidance starts that between ages 25 and 35. The American Cancer Society starts it at 35.

There is no screening test for women at average risk, so symptoms do the work of screening here.

These signs can also be caused by other conditions. Endometrial cancer can usually be cured because it is usually diagnosed early. Your healthcare team can explain any next steps.