Q: I am 50 years old and experiencing heavy bleeding. My mother had uterine cancer when she was about my age. Should I be concerned?
A: Abnormal bleeding should always be addressed with your gynecologist. Women with heavy or irregular bleeding who are over the age of 40 have an increased chance of a pre-cancer (endometrial hyperplasia) or uterine (endometrial) cancer.
African-American women are less likely to be diagnosed with uterine cancer, perhaps because of disparities in healthcare access, but they are two-and-a-half times more likely to die from the cancer. Women who have postmenopausal bleeding should also undergo testing for endometrial cancer.
There are several known risk factors for uterine cancer. As you age, your risk goes up. Other risks include taking estrogen therapy, having diabetes, eating a high-fat diet and suffering from polycystic ovary syndrome (PCOS).
The obesity epidemic in the United States has resulted in an increased incidence of uterine cancer. Women who are overweight or obese have a much higher chance of developing endometrial cancer because their fat cells produce weak forms of estrogen that can stimulate the lining of the uterus (endometrium).
Some families also have a cancer syndrome called Lynch syndrome. This is a cancer gene that increases the risk of inheritable colon cancer, ovarian cancer and urinary tract cancers.
It is the most common hereditary cause of endometrial cancer responsible for 2 to 3 percent of cases. Your gynecologist will take a thorough family history to ascertain if you should be tested for this cancer gene.
The most common symptoms of uterine cancer include:
- Unusual vaginal bleeding, spotting or discharge
- Vaginal bleeding after menopause
- Frequent, difficult or painful urination
- Pain during sexual intercourse
- Pain in the pelvic area
If you are experiencing any of these symptoms, it does not necessarily mean you have cancer – they can be indicative of other conditions, too. It’s best to make an appointment with your gynecologist for further testing.
Your gynecologist might perform an ultrasound to look for uterine-ovarian abnormalities. She might also consider a biopsy of the uterine lining.
If these findings are not consistent with pre-cancer or cancer of the uterus, she can counsel you on hormonal treatment versus surgical management for your bleeding. Diagnosis of an endometrial cancer will necessitate a consultation with a gynecologic oncologist, a specialist who routinely treats cancers of the female genital tract.
If you do, indeed, have uterine cancer, early detection improves your odds of beating it. Uterine cancer, if caught early, can be treated and cured with a simple hysterectomy; however, if it has spread outside the uterus the treatment might require both radiation and chemotherapy. Your gynecologic oncologist will discuss all of your options with you.
Dr. Joanne Williamson is an obstetrician-gynecologist at Memorial Health University Physicians, Provident OB/GYN Associates in Okatie.