Endometrial Cancer: Symptoms, Stages & Minimally Invasive Treatment

What is Endometrial Cancer?

Endometrial cancer, also called endometrial carcinoma/uterine cancer, develops when cells in the endometrium (the inner lining of the uterus) begin to grow uncontrollably.

This is the most common type of cancer that starts in the uterus. These gynecological malignancies affect women, especially after menopause.

Fortunately, because it often causes a noticeable symptom—abnormal vaginal bleeding—the majority of women who present with it are found at an early stage, which is why the survival rate is so high.

The number of patients who present to us with endometrium cancer has shot up tremendously over the last decade, primarily due to the changing lifestyle patterns commonly seen in Indian women.

As a specialist in gynecological cancers, I, Dr. Jay Mehta, along with my team, focus on providing personalized, evidence-based treatment for women diagnosed with endometrial cancer—combining advanced surgical expertise with compassionate care.

Endometrial cancer is actually one that has pretty easy symptoms to spot. The single most important factor that every patient should be worried about is called postmenopausal bleeding.

How Does Post-Menopausal Bleeding Indicate Possible Endometrial Cancer?

Most women with uterine cancer present with bleeding during or after menopause. Once a woman goes through menopause (defined as no periods for one year), they should not have any further vaginal bleeding.

• According to the medical textbook, every patient who has postmenopausal bleeding should be considered and treated as a patient who has cancer of the endometrium unless it is proven otherwise.

• After menopause, the endometrium typically undergoes atrophy (shrinks) and stops bleeding. However, due to external factors, especially obesity or estrogen influence, an abnormal basal endometrium can regrow. This regrowth’s fragile vascular supply gets sheared off, causing the sudden bleeding.

Other reasons for postmenopausal bleeding

While changes in the uterine lining (endometrium) are the most common reason for bleeding after menopause, there are other important factors we consider:

1. High Blood Pressure or Heart Issues: It is very common for women after menopause to have hypertension (high blood pressure) or other heart conditions.

• Hypertension can cause tiny blood vessels (microcapillaries) in the uterus to rupture, leading to bleeding.

• Taking antiplatelet agents (blood thinners) for a heart condition can make the endometrium more likely to bleed abnormally.

2. Age-Related Changes: Sometimes, bleeding is simply due to natural changes in the uterus associated with old age, which doctors call senile endometrial change. This is a rare but non-cancerous cause of abnormal bleeding.

3. Uterine Fibroids: We also must check for a submucous fibroid (a fibroid growing just under the uterine lining) that may have been present but ignored. This can cause a sudden, unexpected episode of bleeding in a postmenopausal woman.

What Non-Bleeding Symptoms May Indicate Endometrial Malignancy?

While bleeding is the primary signal, other symptoms may arise:

• A sudden change in the menstrual cycle’s length or heavy bleeding during the period (in premenopausal women).

• Pain in the lower abdomen or the pelvic region.

• Pain during or after sex.

• Late Symptoms: Only in cases of very advanced disease can one experience chronic fatigue and weight loss, which can be markers of late-stage endometrial cancer.

Advanced Symptoms and Key Differences

Weight loss and constant, severe tiredness (chronic fatigue) are usually markers of very advanced endometrial cancer.

Sometimes, weight loss happens because endometrial cancer is found alongside ovarian cancer.

However, we look closely at a patient’s overall health:

If a patient is thin and is suspected of having endometrial cancer, the tumor is generally a more aggressive form. These are typically classified as the rare, fast-growing types, such as serous, papillary, or clear cell cancer of the endometrium.

This distinction is crucial because it helps us quickly determine the likely aggressiveness of the disease and plan the appropriate, rapid treatment.

Whenever you experience any of these symptoms, it is crucial to consult a specialist. Though these symptoms are not always a sign of a severe condition, they demand immediate investigation. 

A specialist will guide you to identify the exact problem and recommend the appropriate treatment. Any bleeding after menopause, whether it be just bloodstains, a stain, or significant flow, needs to be evaluated

Most of the time, it is difficult to find out the exact reason for endometrial cancer. However, we know that certain factors significantly increase risk, which is why we are seeing rising trends in India.

What Are the Major Risk Factors for Developing Endometrial Cancer? 

In a country like India, especially among the women who are beyond the age of 50, the convergence of lifestyle factors creates a prime environment for this disease:

• Obesity (The Biggest Factor): Women who are obese are six times more likely to develop endometrial cancer. This is due to the peripheral adipose tissue (fat) converting hormones into a huge amount of circulating estrogen, which stimulates endometrial growth.

• Metabolic Syndrome: Hypertension, hyperlipidaemia, and diabetes are extremely common predisposing factors that drive the disease’s progress.

• Hormonal Fluctuations: Changes in the balance of progesterone and estrogen play a crucial role. Prolonged estrogen influence without adequate progesterone opposition increases risk.

• PCOS (In Younger Women): A lot of young women suffering from severe PCOS are also at increased risk due to chronic anovulation and unopposed estrogen exposure.

• Genetics: A family history of Lynch syndrome can significantly increase risk.

How Common is Endometrial Cancer?

• It is the most common type of gynecological cancer now, almost everywhere across the world.

• The main reason we are seeing this increase is directly linked to the rising trends of obesity globally, which increases the risk of this cancer.

What Are the Different Types and Grades of Endometrial Cancer?

The most common type of endometrial cancer is called endometrioid adenocarcinoma. For simplicity, we can categorize the cancer into two main groups based on how quickly it grows:

• Low Grade (Type 1): This cancer typically grows slowly and has a very good outlook (prognosis). This is the type most commonly associated with factors like obesity.

• High Grade (Type 2): These are the uncommon types (like papillary, serous, or clear cell subtypes). They are much more aggressive and spread more quickly.

Please Note: While the technical classification used by your pathologist or gynecologist is more complex, we use this simple Type 1/Type 2 distinction to make your understanding of your diagnosis and prognosis as clear as possible.

How is endometrial cancer classified into stages and substages?

The stage determines the extent of the disease and guides our treatment plan.

• Stage 1: Cancer is only present in the uterus. (High cure rate!)

• Stage 2: Cancer cells have spread to the cervix portion of your body.

• Stage 3: Cancer has spread outside the uterus to nearby structures like the ovaries, fallopian tubes, vagina, or adjacent pelvic/aortic lymph nodes.

• Stage 4: This is the last stage, where cancer has spread beyond the pelvis to distant organs like the bladder, kidney, or other body parts.

While there is a detailed classification system for specialists, for you as a patient, the staging basically tells us how far the cancer has spread from the inner lining of the uterus:

• Myometrial Invasion: A key factor is whether the cancer has invaded more than 50% of the uterine muscle wall (myometrium). If it has gone deep, the disease is considered “upstaged” (more advanced).

• Spread to Other Organs: The disease is also considered “upstaged” if it has spread to nearby organs, such as the cervix, ovaries, fallopian tubes, or to the lymph nodes in the pelvis or near the aorta.

To accurately determine the final stage of the disease, we rely on minimally invasive surgery (either laparoscopic or robotic surgery). This is the gold standard for staging because it allows us to remove tissue and confirm the exact spread of the cancer based on the final lab report.

If we suspect endometrial cancer based on your symptoms and risk factors, a precise diagnosis is essential.

What Diagnostic Modalities Are Used for Suspected Endometrial Cancer?

We no longer live in an era where we rely on a blind procedure. The current gold standard for diagnosis is

1. Hysteroscopy with Visual Guided Biopsy: The best way to diagnose is to insert a hysteroscope (a flexible tube with a camera) into the uterus. This allows us to visually examine the problem and take a biopsy of the suspected mass under direct vision. This offers the most complete and accurate diagnosis.

2. Other Tests (If Biopsy is Inconclusive): We may also use standard procedures like Dilation and Curettage (D&C) if the initial biopsy is not sufficient.

Are There Screening Protocols for High-Risk Populations?

Currently, there is no official yearly screening protocol recommended for patients who are at a high risk of developing cancer of the endometrium. Vigilance regarding postmenopausal bleeding remains the key.

Don’t wait to treat uterine cancer. Dr. Jay Mehta, Uterine Cancer Specialist in India, offers advanced, minimally invasive surgery and expert, comprehensive care in Mumbai. Secure the best possible outcome. Book your specialist consultation immediately by calling  1800-268-4000.

The most effective treatment for endometrial (uterine) cancer is minimally invasive surgery, which remains the preferred approach for staging and treating patients with this condition.

This typically involves performing either Laparoscopic Surgery or Robotic Surgery, both of which offer excellent precision, faster recovery, and minimal scarring.

In our country, India, many places do not currently have this type of advanced facility. As a result, the majority of patients would still be consulted for undergoing open surgery, which adds to a huge amount of morbidity for all these patients because quite a lot of these patients are already obese, and this significantly delays their recovery.

Why Minimally Invasive Surgery Is Crucial? 

• Faster Recovery: Minimally invasive surgery significantly speeds up recovery time, which is especially critical for obese patients.

• Final Staging: It allows us to perform a final, comprehensive staging of the disease accurately.

After your operation, additional treatment is usually only needed if the cancer has spread slightly:

• If the cancer is found in the pelvic lymph nodes or has reached the cervical stroma (the deeper layer of the cervix), you will likely need postoperative treatment.

• This might involve local radiation, like vaginal brachytherapy, or a combination of six cycles of chemotherapy along with pelvic radiation.

How Do We Customize Your Surgery with Technology?

We believe you should be fully involved in deciding your treatment path, which is why we provide thorough counseling with our entire surgical team. During surgery, we use cutting-edge techniques to make the most accurate decisions possible:

1. Sentinel Lymph Node Biopsy: We often use a procedure called Sentinel Lymph Node Biopsy with micro-staging. This is a very precise way to check if the cancer has started to spread.

2. Advanced Technology: This procedure requires an advanced, minimally invasive system where we use infrared technology and a specialized dye to correctly identify and sample the key lymph nodes.

3. On-Table Decision: We then work immediately with an expert OncoPathologist (a cancer tissue specialist) who uses specialized tests (IHC) right there in the operating room. This allows us to make a precise, “on-table call” about whether or not we need to perform a full pelvic lymphadenectomy (removing more lymph nodes).

This meticulous process ensures we only perform the most necessary procedures, speeding up your recovery and improving your outcomes.

When a younger patient is diagnosed with endometrial cancer and wants to preserve fertility, we have to proceed with extreme caution.

The Cautious Option (Fertility-Sparing Treatment)

One path is to try fertility-sparing treatment, which involves:

• Giving the patient high doses of progesterone for a long time.
• Performing only localized surgical excision (removing just the tumor, not the whole uterus).

Why Caution is Needed: We must be very careful with this approach because keeping the entire system (uterus) comes with a heavy risk of the cancer coming back (recurrence).

The Recommended Option in Our Unit

For patients in India, the most straightforward and secure choice is to first ensure complete survival. We do this while taking steps to protect the patient’s future ability to have a biological child, giving them confidence in both health and fertility.

• Completion Surgery for Survival: We recommend completion surgery (removing the uterus) to ensure the patient has the best possible chance for a cured and insured survival.

• Genetic Material Preservation: In the same surgery, we perform ovarian cortex cryopreservation (freezing the ovarian tissue). This allows the patient to use their own genetic material later for fertility, giving them an extremely good outcome without compromising their survival.

The best defense against endometrial cancer is early diagnosis and expert, advanced treatment. Don’t delay your evaluation—your future health depends on it.

Finding out you have cancer while pregnant is rare and creates a very complex situation. Here’s how we approach it:

• The Safest Treatment: Surgery is generally considered the safest option for the baby during all stages of pregnancy.

• Chemotherapy Caution: The placenta acts like a barrier, blocking some chemotherapy drugs.

• Timing is Key: Chemotherapy may be considered during the second and third trimesters. However, using chemotherapy during the first trimester is strongly discouraged due to a high risk of birth defects or miscarriage.

We ensure that a highly experienced healthcare team manages pregnant women with cancer to protect both the mother and the developing baby.

What Factors Affect Survival and Recurrence in Endometrial Cancer?

The chance of successful survival and the risk of the cancer coming back (recurrence) are mainly determined by four key factors that we analyze after surgery:

• Amount of Myometrial Invasion: How deeply the cancer grew into the uterine muscle wall.

• Involvement of Pelvic Lymph Nodes: Whether cancer cells were found in the nearby lymph nodes.

• Size of the Tumor: The initial size of the cancerous growth.

• Histopathological Type of Cancer: Whether the cancer was a slow-growing type (like endometrioid) or an aggressive type (like serous or clear cell).

These are the most important factors we look at when predicting the long-term outlook of the disease.

When Does Endometrial Cancer Recurrence Usually Happen?

It is most common for recurrence to occur within the first 2 to 3 years following the primary diagnosis and surgical removal.

What is the Recommended Follow-Up Schedule?

A consistent, long-term follow-up plan is maintained for the first 5 years after treatment for all patients. Regular checkups during this period are crucial for catching any potential recurrence early.

The cost of endometrial cancer treatment in Mumbai, India, is highly individualized, and the total fee for your comprehensive care plan will vary depending on several important factors:

• Stage of the Disease: Treatment for an early stage is less complex than for advanced stages.

• Surgical Approach: Whether you receive laparoscopic, open, or advanced robotic surgery.

• Hospital and Center: The type of hospital (specialized cancer center vs. general facility).

• Additional Therapies: Whether your plan requires postoperative chemotherapy, radiation, or specialized targeted therapy.

Generally, the cost of expert treatment in India is significantly lower than in Western countries, and we assure you that this is achieved without compromising on the quality of care.

At our center in Mumbai, we uphold international standards of surgical and oncological care. We provide every patient with an accurate, tailored estimate and ensure you receive expert, life-saving treatment at a fraction of global prices, regardless of your budget.

We are committed to providing you with world-class surgical care at transparent, affordable prices here in Mumbai.

Don’t let financial uncertainty delay life-saving treatment.

Book your consultation with Dr. Jay Mehta, a top endometrial cancer doctor, to receive a precise diagnosis and a tailored cost breakdown for your entire treatment plan.  Call  1800-268-4000 to schedule your appointment now.

• Definition: Endometrial cancer is the most common gynecological malignancy, rising in India due to lifestyle changes.

• Key Symptom: Postmenopausal bleeding should always be evaluated immediately by a specialist.

• Gold Standard: Minimally invasive surgery (Laparoscopic/Robotic) is the treatment of choice for accurate staging and faster recovery.

• Accessibility: Our unit offers advanced surgical care using techniques like Sentinel Lymph Node Biopsy for precise treatment.

• Prognosis: The survival rate is high when detected early.