Endometrial cancer

Risk factors

The risk of endometrial cancer is associated with:

• Increasing age, more common after menopause
• Hormonal factors, prolonged exposure to estrogen
• Overweight and obesity, which is a major risk factor
• Reproductive history, such as not having had children
• Early start of menstruation or late menopause
• Polycystic ovary syndrome (PCOS)
• Inherited genetic factors, such as Lynch syndrome

Some factors may lower risk, including use of combined hormonal contraceptives, hormone replacement therapy, and regular exercise.

Screening and early detection

There is no routine screening program for the general population. However, symptoms usually appear early.

Possible symptoms include:

• Bleeding after menopause
• Vaginal bleeding between periods
• Abnormal discharge, especially after menopause

These symptoms are often caused by conditions other than cancer, such as fibroids, which are benign muscle tumors. However, they should always be evaluated by a doctor.

Diagnosis and treatment

If endometrial cancer is suspected, evaluation may include:

• Gynecological examination
• Ultrasound
• Tissue sampling (biopsy)
• Additional imaging to assess disease spread

Treatment depends on the stage and type of cancer, and may include:

• Surgery, usually removal of the uterus (and often ovaries and fallopian tubes)
• Radiotherapy
• Chemotherapy
• Hormone therapy in some cases

Living with and beyond endometrial cancer

Most people diagnosed with endometrial cancer have a good prognosis, but recovery varies.

Common effects of the disease or the treatment include:

• Physical symptoms, such as fatigue
• Emotional challenges, including anxiety or concerns about recurrence
• Changes in daily life, including work and relationships

In Sweden healthcare-based support include:

• A multidisciplinary care team for diagnosis, treatment, and follow-up
• A contact nurse (kontaktsjuksköterska) who provides information and
• coordinates care
• Cancer rehabilitation services (Cancerrehabiliteringsmottagning) that support physical, emotional and social recovery

Fertility and family planning

Endometrial cancer mainly affects women after menopause, but it can also occur at younger ages.

Treatment often affects fertility:

• Removal of the uterus makes pregnancy impossible
• Removal of the ovaries may cause early menopause

In selected cases, it may be possible to consider fertility-preserving treatment may be possible. Fertility and reproductive health are part of cancer care, and patients can receive individual counselling to support informed decisions.

Reducing inequalities in endometrial cancer care

Although endometrial cancer is often diagnosed at an early stage, differences in awareness, risk factors, and access to healthcare can contribute to unequal outcomes.

Key factors include:

• Awareness of symptoms, particularly postmenopausal bleeding, which is important for early diagnosis
• Access to healthcare, including timely assessment, diagnosis, and treatment
• Lifestyle-related risk factors, such as obesity, which is a major risk factor and is unevenly distributed across populations
• Socioeconomic factors, including differences in income, education, and health literacy

These differences can influence when endometrial cancer is diagnosed and the care people receive. Improving awareness of symptoms and ensuring equitable access to healthcare are important for reducing inequalities and improving outcomes for all.