Endometrial Cancer Is Rising: Warning Signs Women Shouldn’t Ignore

Endometrial cancer cases are rising — and abnormal bleeding is the warning sign women should never ignore. Who is most at risk, why are more women being diagnosed, and what symptoms should prompt a call to your doctor?

In this episode of Baptist Health Talk, host Sandra Peebles speaks with Dr. John Diaz, gynecological oncologist at the Herbert Wertheim Cancer Institute, about what women need to know about endometrial cancer, from early warning signs and risk factors to diagnosis, treatment and fertility-preserving options.

•  Why endometrial cancer cases are increasing in the U.S. and around the world 
•  How obesity and prolonged estrogen exposure can raise risk 
•  The abnormal bleeding patterns women should report — including after menopause 
•  Other warning signs such as pelvic pain, bloating and abnormal discharge 
•  Why endometrial cancer can also affect younger women 
•  How doctors diagnose endometrial cancer and why there is no routine screening test 
•  Treatment options for early and advanced disease, including immunotherapy 
•  When fertility-sparing treatment may be possible 
•  How family history and Lynch syndrome can affect risk

Host:
Sandra Peebles
Award-Winning Journalist

Guest:
John P. Diaz, M.D.
Chief of Gynecologic Oncology
Herbert Wertheim Cancer Institute
Chair, Obstetrics & Gynecology, FIU

If you found this episode helpful, we also recommend the following:

Can Cervical Cancer Be Cured? A Gynecologic Oncologist Answers

Eradicating Cervical Cancer: Possible or Impractical?

Transcript

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SPEAKER_01 0:00

So, besides bleeding, what other um warning signs should women look out for?

SPEAKER_02 0:05

Bleeding is the most common. Again, abnormal bleeding, but there are other signs that could be shown: pelvic pain, bloating, abnormal discharge. This is where women really need to be their own advocates. If you notice something is different about your body, you need to report them.

SPEAKER_00 0:19

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for health care prevention and wellness.

SPEAKER_01 0:29

I'm your host, Sandra Peebles. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today we're talking about endometrial cancer, the most commonly diagnosed gynecological cancer in the United States. Cases are on the rise, and there's one early sign, one early warning sign that you should never brush off. Today we'll explain why more women are being diagnosed, what doctors want you to know about some of the more aggressive types of endometrial cancer, and who is most at risk. By the end of this episode, you'll know the warning signs to watch for, the risk factors that matter most, and when it's time to talk to your doctor. We are joined by Dr. John Diaz, gynecological oncologist at the Herbert Wertheim Cancer Institute. Thank you so much for being here with us today and answering all our questions that we have. So before we begin in the subject of why cases are rising, let's define and talk about what is endometrial cancer.

SPEAKER_02 1:27

Yeah. So endometrial cancer is a cancer that starts in the lining of the uterus. That's called the endometrial lining. And so we often refer to it as endometrial cancer or uterine cancer, but it's those cancers that start inside the lining of the uterus.

SPEAKER_01 1:40

So is it the same? Uterine cancer and endometrial cancer?

SPEAKER_02 1:44

Endometrial cancer talks specifically about cancers that start within the endometrial lining, but we often refer to it as uterine cancer. There are other cancers that start within the wall of the uterus, like a uterine sarcoma, and those are different than endometrial cancer, but people often use that term interchangeably.

SPEAKER_01 2:00

Let's talk about the rise in cases. What's happening that's causing this that doctors are seeing more and more cases of endometrial cancer?

SPEAKER_02 2:08

We are seeing a rise of endometrial cancer, not only in the United States, but globally. And endometrial cancer is the most common G WAN cancer we see. There are about 68,000 new cases in the United States. And we're seeing this rise for several reasons. One, we have an aging population, and one of the risk factors for this cancer is increasing age. But two, and more importantly, is we have an obesity epidemic in the United States. And obesity is one of the leading risk factors for developing endometrial cancer. And we're seeing these trends throughout the world. And in fact, in many third world countries where for many, many years cervical cancer was the most commonly diagnosed GYN cancer due to lack of screening, like papsomeres and lack of HP vaccines, we're now seeing a correlation with their increasing obesity numbers and an increasing in their endometrial cancer cases.

SPEAKER_01 2:57

You mentioned obesity, but what relation is there between obesity and endometrial cancer?

SPEAKER_02 3:02

That's a great question. So obesity can be associated with a lot of cancers, but endometrial cancer in particular. That extra tissue there isn't just fat storage. It actually acts like an endocrine gland and it converts precursor hormones into estrogen. And that estrogen stimulates that endometrial lining. And prolonged exposure of extra estrogen causes that lining to make a mistake. And those endometrial cells can then convert into precancer and ultimately cancerous cells. And so that's that correlation that we see with obesity and the rise in endometrial cancer cases.

SPEAKER_01 3:35

When we talk about endometrial cancer, we treat it as one disease, but really, as I understand, there are several and they're more aggressive forms. Talk to us about that.

SPEAKER_02 3:44

The most common type of endometrial cancer is endometrioid. And this is usually a less aggressive form of this. We tend to catch these early, and patients are often cured with surgery alone. But there are other more aggressive subtypes like cirrus and clear cells. Those oftentimes present in a more advanced stage, and that requires surgery, sometimes radiation, sometimes chemotherapy, immunotherapy, or a combination of those factors for the treatment of these diseases. And those are kind of accounting for the increased deaths that we're seeing from endometrial cancer. Ovarian cancer used to be the leading cause of death in GUN cancers, but now because the increased numbers, the leading cause of death is now endometrial cancer.

SPEAKER_01 4:23

Well, let's talk about warning signs so people know what to look out for. Abnormal bleeding might be one, but explain to us how that presents.

SPEAKER_02 4:31

Yeah. So I think we need to define abnormal bleeding, right? Any postmenopausal bleeding is abnormal. That doesn't mean that it's cancer, but any woman that has bleeding after the intermenopause, even just spotting, they need to report that to their gynecologist. And that needs to be worked up to see. But even young women who are having abnormal bleeding, which is abnormal for them. So if you normally have regular periods, but now you're bleeding between your periods, you need to tell your gynecologist. Or if your periods have become heavier or you're bleeding after intercourse, that needs to be reported to your gynecologist. And one of the challenges is, you know, as women go through that perimenopause phase, their periods are going to change. And most of the time, thankfully, this abnormal bleeding is not an imetrial cancer, but you can't assume that. And so any change in bleeding for you should be considered abnormal. Any change should report to your gynecologist, your primary care doctor, and that needs to be worked up further.

SPEAKER_01 5:20

So besides bleeding, what other um warning signs should women look out for?

SPEAKER_02 5:25

Bleeding is the most common, again, abnormal bleeding. But there are other signs that could be shown: pelvic pain, bloating, abnormal discharge. This is where women really need to be their own advocates. If you notice something is different about your body, you need to report that. And if you're not getting the answers from the doctor when you tell them this, then you need to find a physician that's going to listen to you because it's these subtle changes that give us the opportunity to catch the disease early. When the metal cancer is caught early, patients have excellent outcomes. The problem becomes when women ignore these symptoms or they don't get worked up. And now we miss that opportunity for an early diagnosis, and then it can become harder to treat.

SPEAKER_01 6:01

So we're talking about women in menopause having abnormal bleeding. We're talking about women during their women in the age of that that they can that they're having their period that are bleeding. So who's most at risk? Is it women in post-menopause, pre-menopause?

SPEAKER_02 6:17

Most endometrial cancers are diagnosed in women who are in menopause. And again, it's the risk factors we talked about, an aging population, being overweight, other comorbidities like diabetes and other things that put you at risk. But we are seeing this in young women. And that becomes sometimes a little bit more difficult for women to discern is this my normal period? Is this something different? And that's why I say if there's a change for you and what you know your normal menstrual cycle is, you need to report that to your gynecologist and get that worked up.

SPEAKER_01 6:45

So I hear that we've covered this, but I want to make sure that I bust this myth, if you will, because a lot of people think that know enough about endometrial cancer. They believe that this happens only after menopause. But what I'm hearing in this conversation is that that's not necessarily the case.

SPEAKER_02 7:00

No, and in fact, overall cancer numbers are down, and that's great. But we're seeing a rise in younger patients. And so if you're a young woman and you've had a change in your menses, don't just assume this is normal and could be part of aging. It very well could be. We need to make sure, because again, if we can catch this early, this is treatable and curable. If we catch this at a later stage and things can be a little bit more difficult to manage.

SPEAKER_01 7:24

Walk us through the process of diagnosis. How do you diagnose endometrial cancer?

SPEAKER_02 7:28

Yeah. So again, most women will present to their gynecologist with postmenopausal bleeding. And we start by having a discussion to really understand what this bleeding pattern is. And then a pelvic exam. Oftentimes we'll order an ultrasound to look at what's called the endometrial stripe or the endometrial lining of the uterus. But the only way to really diagnose it is with tissue biopsy and doing an endometrial sampling or taking a small piece of tissue from that endometrium to look at it under the microscope and then confirm whether this is abnormal bleeding due to something non-cancerous or if there's an endometrial cancer that's causing this abnormal bleeding.

SPEAKER_01 8:02

Is there a screening like we have screening for breast cancer or other types of pap smear?

SPEAKER_02 8:07

That's a great question. Unfortunately, there is no screening for endometrial cancer, not for the average whisk women. And that's why reporting your symptoms is so important. Because if you report these symptoms and we can catch this early, this is a very treatable and curable disease. It's those women who ignore these symptoms or don't have access to health care when we run into trouble. So any kind of abnormal bleeding, be that post-menopausal bleeding or a change from your menstrual cycle, you should report that to your provider.

SPEAKER_01 8:34

And let's talk about why catching this early is so important. What different talk to us about the difference of catching it early as opposed to catching it late stage.

SPEAKER_02 8:42

Yeah. So if we catch these early, oftentimes all we need to do is what's called the hysterectomy, which is to remove that uterus or endometrial lining. Depending on your age, you can talk to your provider by removing the fallopine tubes and the ovaries as well. And that makes a big difference. If we can catch it early, oftentimes surgery is all that's needed. If we catch this at a more advanced stage, then after surgery, you may require radiation therapy, sometimes chemotherapy, or sometimes immunotherapy, or a combination of these approaches.

SPEAKER_01 9:09

Let's talk about women that have had endometriosis or adenomiosis, which is the thickening. Of course, you know, doctor. But if you can explain for the audience, adenomiosis, endometriosis, is there a higher risk of that population developing endometrial cancer?

SPEAKER_02 9:26

So endometriosis is when you have those cells that line the endometrial cavity outside of the uterus. And this is a very common diagnosis and can be associated with pelvic pain, sometimes infertility. Adenomiosis, when you have those cells inside the muscle of the uterus. And again, that can present with pelvic pain or heavy menses. So these don't necessarily increase your risk for endometrial cancer, but endometriosis has been associated with a slight increased risk for ovarian cancer.

SPEAKER_01 9:53

And is that the case even postmenopause?

SPEAKER_02 9:56

Even postmenopause, that risk still persists. Now it's a small increase, right? So a woman's risk of developing ovarian cancer is only about 1.7% if they don't have a genetic predisposition or a family history. With a prior history of endometriosis, it increases slightly to about 3 to 5%. So still very low, but more than the general population.

SPEAKER_01 10:14

And so what is the outlook for a woman that has been diagnosed and has treated endometriosis? I'm sorry, endometrial cancer early on. What is the prospect?

SPEAKER_02 10:27

So actually, women with endometrial cancer who are diagnosed early on, many are cured. And in fact, most women with an early stage endometrial cancer don't die from endometrial cancer. They usually succumb to something that caused that endometrial cancer, again, being overweight. So cardiac disease, diabetes. And that's why obesity, it's so important that we get a handle on this. It's not just for your overall health, but obesity associated with other cancers. Okay. And so if we can do something about the obesity epidemic, we're going to see a drop in not only endometrial cancer, but other cancers, and patients are going to live longer. Then the important part with endometrial cancer is we've had a really exciting time the last five to 10 years. For a long time, we had limited options for our patients with advanced endometrial cancer if the endometrial cancer came back. We had chemotherapy and it worked, but it wasn't great. And now we've discovered immunotherapy for the treatment of endometrial cancer. And this has really revolutionized the way we treat advanced endometrial cancer. And by adding immunotherapy to chemotherapy, we've seen a lot of women in the past, we would worry that maybe that cancer would come back. We're actually curing a lot of these women. And in fact, just last week, there was a new study that was released, preliminary results showing that in many of these cancers, we might be able to treat them with just immunotherapy, and we may not even need chemotherapy. So it's been an exciting time in G1 oncology, particularly for the management of immunityal cancer. We've come a long way by adding immunotherapy and new biomarker drinking therapies to endometrial cancer. So while we're seeing more cases, hopefully with programs like this, we can identify women early where surgery is all that they need. And those that do have advanced cases, with adding these new medications like immunotherapy, like antibody drug conjugates, we're getting great results for our patients.

SPEAKER_01 12:07

And what is the impact for women of childbearing age on their fertility? A woman is diagnosed, treated for endometrial cancer. Can she possibly have a baby afterwards?

SPEAKER_02 12:16

So she can, and it depends again on the type. So again, the most common type is that endometroid that we talked about. And so women who are diagnosed with this in certain early stages, we could potentially treat them with fertility-sparing treatments, either just resecting the cancer and leaving the uterus behind, or using hormone therapy like high-dose progesterones, or even the progesterone circreating entry in the vice to treat the cancer, they can preserve their uterus. And once we eliminate the risk of the endometrial cancer, they can go on to get pregnant in the future. We've had several patients who have delivered healthy babies after being treated for their endometrial cancer.

SPEAKER_01 12:50

And that is great news for those patients, of course, if they want it to be mothers. As we wrap up, cases are climbing. What is the number one thing you want the audience to walk away with knowing after our conversation?

SPEAKER_02 13:01

I think the number one thing is to report any abnormal symptoms, particularly any abnormal bleeding. Don't ignore this. Report that to your gynecologist, your provider, and let them work it up to see. Again, most likely this abnormal bleeding is not cancer. We can never assume that. And the other important thing is to learn your family history. So a numetrial cancer can be associated with a syndrome called Lynch syndrome. And so if in your family you have other family members that had colon cancer or ovarian cancer or uterine cancer, you should talk to your provider should you get tested. Because if you carry a gene that puts you at increased risk, then we can do something preventative before you ever develop any of these cancers.

SPEAKER_01 13:39

And that gene you test for specifically with your doctor, or is are those tests available, say, with the with the genetic testing?

SPEAKER_02 13:46

So those tests are available over-the-counter testing, but those are limited mutations they look for. And this is covered by health insurance. So as you get that family history over Thanksgiving or Christmas and you find out that actually you had an uncle that was diagnosed with colon cancer, or the cancer that we never talked about that Aguilita had turned out to be an endometrial cancer. You should talk to your provider about that family history and then get tested because they'll do a full panel testing. And so we can hopefully identify these families and prevent endometrial cancers, colon cancers, ovarian cancers that are associated with this syndrome.

SPEAKER_01 14:19

Well, thank you so much for the work that you do because this is really very powerful, very powerful and very powerful message today that we've learned. Most important thing is be in touch with our bodies and make sure we take care of our health. That's always the message that we walk away with here on this podcast. Thank you so much, Dr. Diaz, for being with us. It's been a great conversation. Um, thank you for sharing your insight. And for you viewers, thank you so much for being with us. And be sure to hit that subscribe button on our channel here to keep up with the latest health and wellness information and tips from our experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts. So you can tune in anytime, anywhere.

SPEAKER_00 14:56

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