Endometrial cancer: Symptoms, treatment, and prevention

What is endometrial cancer?

Endometrial cancer (endometrial carcinoma) begins in the inner lining of the uterus, which is also known as the endometrium. This lining changes throughout a person's menstrual cycle and plays a key role during pregnancy. 

With endometrial cancer, cells in the lining of the uterus start to grow uncontrollably and may spread to other parts of the body.

Endometrial cancer symptoms

Endometrial cancer often presents with noticeable symptoms that can help in early detection. 

The most common symptom is abnormal vaginal bleeding, which may occur between periods, after sex, or after menopause. 

Other signs or symptoms of endometrial cancer include:

• Abnormal vaginal discharge: This may have an unusual or unpleasant odour or a different colour or texture from what’s normal for you
• Unexplained weight loss
• Pelvic pain or discomfort
• Abdominal pain or swelling
• Problems with urination or bowel motions.

Who is at risk of endometrial cancer?

While the exact cause of endometrial cancer is unknown, it is sometimes linked to increased exposure to oestrogen, a hormone primarily produced by the ovaries. The following are several factors known to increase the risk of endometrial cancer:

• Age: Women’s risk increases with age, with most diagnoses occurring in post-menopausal women aged 60-65.
• Being overweight or obese: Obesity is a strong risk factor for endometrial cancer as fat tissue raises oestrogen levels and can thus stimulate endometrial proliferation.
• Genetic predisposition: Family history of endometrial, ovarian, or colorectal cancer, and inherited syndromes, such as Lynch syndrome and Cowden syndrome. 
• Reproductive history: Early menstruation (before 12), late menopause (after 55), or never having been pregnant extends exposure to oestrogen, raising risk.
• Hormonal medications: Long-term use of oestrogen-only hormone replacement therapy (without progestin) to ease menopausal symptoms can increase endometrial cancer risk, especially in women who still have a uterus. 
• Hormone therapy: For example, taking the drug tamoxifen for breast cancer prevention or treatment may also increase risk, though for many, the benefits outweigh this. 
• Medical conditions: Conditions such as diabetes, hypertension, polycystic ovary syndrome (PCOS), oestrogen-secreting ovarian tumours, and endometrial hyperplasia (thickened lining) are associated with a higher risk.

Diagnosis

Diagnosing endometrial cancer involves a combination of tests performed by your GP and team of specialists.

Pelvic exam

The doctor checks the vagina, cervix, uterus, and ovaries for abnormalities.

Pipelle biopsy 

A procedure which involves passing a thin tube (pipelle) through the cervix to take a tissue sample from the uterus's lining. The tissue sample is then sent to a laboratory where it is checked for abnormal cell growth.

Transvaginal ultrasound

This imaging test uses sound waves to create detailed pictures of the uterus and ovaries. It helps assess the thickness of the endometrium and detect tumours, signs of cancer, or any abnormalities. It also helps rule out other conditions which may be causing your symptoms.

Hysteroscopy

A thin, lighted tube called a hysteroscope is inserted through the vagina and cervix into the uterus. This allows the doctor to examine the uterus for any abnormalities. Hysteroscopy can also be used to take samples of the uterine lining or polyps for further examination.

Dilation and curettage (D&C)

This procedure involves dilating the cervix and scraping the uterine lining to collect tissue samples. D&C is done if more samples are needed after your biopsy or when the results of your biopsy are unclear. 

Endometrial cancer treatment

Treatment for endometrial cancer depends on the stage and type of cancer, as well as the patient's overall health and preferences. Common treatment options include:

• Surgery: Often the primary treatment, surgery may involve a total hysterectomy (removal of the uterus and cervix) and possibly a salpingo-oophorectomy (removal of the fallopian tube and ovary). Patients who undergo a hysterectomy can no longer become pregnant, while those whose ovaries are removed will experience menopause. If you want to conceive in the future, talk to your health care team about the risks and benefits of fertility-preserving treatments.  
• Radiotherapy: Radiation therapy, which can be delivered externally or internally, uses powerful energy to kill cancer cells. Radiotherapy is often used in advanced cancer or high-risk patients and typically done after surgery to target remaining cancer cells and reduce the risk of recurrence. It may also be used before surgery to shrink a tumour for easier removal, or if the patient isn’t well enough to undergo surgery.
• Chemotherapy: This treatment uses drugs to kill cancer cells and is typically used for recurrent or advanced cases where the cancer has spread beyond the uterus. Chemotherapy can be given before surgery to shrink the cancer and facilitate removal, or post-surgery to lower the risk of recurrence.
• Hormone therapy: This may be used if the patient plans to have children, or if surgery is too risky, the cancer has recurred, or has spread beyond the uterus. Hormones or hormone-blocking drugs are used to slow or stop the cancer's progression.

Can insurance help cover medical expenses?

Dealing with a diagnosis of endometrial cancer brings not only health worries but also financial pressure. 

Depending on your insurance, you may be able to use it to manage medical costs and replace lost income while you or your family caregiver can’t work. Ask your provider what your plan covers, so you can lower your out-of-pocket expenses and access necessary medical care promptly.

Below is an overview of how different types of insurance can help.

• Health insurance: The best health insurance policies in New Zealand are designed to cover private medical expenses, such as costly surgeries, hospital admissions, specialist consultations, diagnostic procedures, cancer treatments, and non-Pharmac-funded drugs.
• Trauma (critical illness) insurance pays out a lump sum if you're diagnosed with a serious illness, including many cancers. You can use the payout for medical costs, private healthcare, household bills, or any other expenses during your treatment and recovery.
• Income protection insurance: If your condition prevents you from working, having the best income protection insurance ensures you have funds to replace a portion of your lost earnings. This helps ease the financial burden while you focus on your health or quality time with your loved ones.

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Prognosis and survival rates

The prognosis for endometrial cancer largely depends on the cancer’s stage at diagnosis, how well it responds to treatment, and the patient’s overall health. 

Endometrial cancer typically has a positive outlook when detected and treated early, with a five-year survival rate of up to 90%. Many patients are completely cured, though others may experience a recurrence, typically within a few years after treatment. 

Can you prevent endometrial cancer?

While there's no guaranteed way to prevent endometrial cancer, adopting certain lifestyle choices may help reduce your risk. It's a good idea to discuss any concerns or preventive strategies with a healthcare professional to ensure they align with your individual health needs.

• Maintaining a good weight: Being overweight or obese is linked to a higher risk of endometrial cancer. Striving for a healthy weight through balanced eating and exercise is a positive step.
• Exercising regularly: Regular exercise can help you maintain a healthy weight, and has other protective effects on the body's systems. 
• Considering birth control pills: Using combined oral contraceptive pills (pills that contain the hormones oestrogen and progestogen) may offer some protection against endometrial cancer as well as ovarian and colorectal cancers. However, this option carries its own risks, so it's important to have a conversation with your doctor to discuss the pros and cons.

How Policywise can support you through endometrial cancer

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Not all insurance policies are the same. Policywise can help you sort out the duds, avoid the lemons, understand the fine print and exclusions, and get the right insurance for you and your family.

We make the important decision of where to buy your insurance super easy. We’ll answer your questions, provide experienced advice and quotes, and manage all the back and forth throughout the application process. Taking out your cover through us means you'll have our lifetime support and claims advocacy, and we'll help you negotiate a positive outcome at claim time. We can also take care of lodging any claims on your behalf and back you up if the going gets tough.

Check out the reviews on our homepage for how other New Zealanders have found our service, because now is the time to get your personal insurance sorted. Give your family or someone you love the most outstanding financial support possible. Book a 5-minute callback with Policywise today; our service is fast and free.