Uterine bleeding can be a sign of cancer in some cases. The most common cancers that cause uterine bleeding are endometrial cancer, cervical cancer, and uterine sarcomas. Let’s take a quick look at each of these cancers and their relationship to abnormal uterine bleeding:
Quick Facts on Cancers that Cause Uterine Bleeding
– Endometrial cancer is the most common gynecologic cancer and the leading cause of uterine bleeding after menopause. Nearly 95% of endometrial cancers occur in women over the age of 40.
– Cervical cancer can cause abnormal vaginal bleeding, including bleeding after sex. Cervical cancer screening through Pap tests aims to detect precancerous changes before cancer develops.
– Uterine sarcomas are very rare, accounting for just 3-7% of all uterine cancers. Abnormal bleeding can be a symptom.
Now let’s go into more detail on each type of cancer.
Endometrial Cancer and Uterine Bleeding
Endometrial cancer starts in the lining of the uterus, called the endometrium. It is the most common gynecologic cancer, with over 65,000 cases estimated in the United States for 2022.
The most common symptom of endometrial cancer is abnormal uterine bleeding, especially in postmenopausal women. Over 90% of women diagnosed with endometrial cancer report abnormal vaginal bleeding.
Key facts about endometrial cancer:
– It primarily affects postmenopausal women, with the average age at diagnosis being 60.
– Increased estrogen exposure without progesterone raises endometrial cancer risk. Obesity, polycystic ovary syndrome (PCOS), and estrogen replacement therapy without progesterone can increase risk.
– Most endometrial cancers are detected at an early stage when the cancer is still confined to the uterus. The 5-year relative survival rate for localized endometrial cancer is over 95%.
– Treatment usually involves hysterectomy along with other approaches like radiation, hormone therapy, or chemotherapy.
Abnormal bleeding patterns that may indicate endometrial cancer include:
– Bleeding after menopause
– Heavy, prolonged menstrual periods
– Bleeding between periods
– Vaginal bleeding after intercourse
Women experiencing these symptoms, especially after age 40, should see a doctor. Prompt evaluation of abnormal bleeding can detect cancer early when it is most treatable.
Diagnosing Endometrial Cancer
If endometrial cancer is suspected, diagnosis will begin with a pelvic exam and imaging tests. A biopsy of the uterine lining is then taken to confirm cancer.
The doctor may perform an endometrial biopsy in the office by inserting a thin tube through the cervix to sample the uterine lining. Alternatively, a dilatation & curettage (D&C) can be done as an outpatient procedure to scrape tissue from inside the uterus for examination.
Once a diagnosis is made, doctors will determine the stage of cancer based on how far it has spread. Endometrial cancer staging helps guide treatment.
Cervical Cancer and Vaginal Bleeding
Cervical cancer originates in the cervix, the lower part of the uterus. It is estimated that there will be over 14,000 new cases of invasive cervical cancer diagnosed in the U.S. in 2022.
One of the classic symptom of cervical cancer is abnormal vaginal bleeding, such as:
– Bleeding after intercourse
– Bleeding between periods
– Heavier, longer menstrual periods than usual
– Vaginal bleeding after menopause
Bleeding is typically light. Heavy, severe vaginal bleeding is less common with cervical cancer.
Key facts on cervical cancer:
– It is most frequently diagnosed in women between the ages of 35 and 44.
– HPV (human papillomavirus) infection is a major risk factor. Most cervical cancer cases are linked to just two strains of HPV.
– Regular Pap tests allow precancerous changes to be found so they can be monitored or treated before becoming cancer.
– When diagnosed at an early stage, cervical cancer is highly treatable with a 5-year survival rate of over 90%.
– Hysterectomy, chemotherapy, and radiation are common treatments.
In addition to abnormal bleeding, other cervical cancer symptoms can include pain during intercourse and vaginal discharge with a foul odor. Pelvic pain may also occur in advanced stages.
Diagnosing Cervical Cancer
Cervical cancer screening begins with a Pap test to look for abnormal cells. If results are concerning, the doctor will perform a colposcopy exam of the cervix. A biopsy of any suspicious areas is then taken to confirm a cancer diagnosis if cancer cells are detected.
Determining the stage of cervical cancer is critical for appropriate treatment planning. Imaging tests like CT, MRI, and PET scans may be used to assess the extent of disease spread.
Uterine Sarcoma and Vaginal Bleeding
Uterine sarcomas are cancers arising from the muscle or supporting tissues of the uterus. They are far less common than endometrial or cervical cancers, representing just 3-7% of uterine cancers. An estimated 6550 women will be diagnosed with uterine sarcoma in 2022.
The most common symptoms of uterine sarcoma are:
– Abnormal vaginal bleeding
– Pelvic pain and pressure
– Abdominal mass
Vaginal bleeding is typically heavy and prolonged but may also occur after menopause. Pain can indicate advanced disease.
Key facts about uterine sarcomas:
– They can occur at any age but are more common after menopause.
– There are several subtypes, including leiomyosarcoma, endometrial stromal sarcoma, and undifferentiated sarcoma.
– These cancers tend to be aggressive and challenging to treat compared to more common uterine cancers.
– Hysterectomy is the main treatment and may be paired with radiation, chemotherapy, or hormone therapy.
Diagnosing Uterine Sarcoma
Uterine sarcomas are not always detected on a Pap test. Ultrasound or MRI may raise suspicion for a uterine mass.
To confirm diagnosis, surgery is typically needed to remove tissue for biopsy. Staging helps determine if the sarcoma has spread and guides treatment recommendations.
When to See a Doctor
Any abnormal vaginal bleeding should prompt medical attention, especially after age 40 or after menopause. While it does not always indicate cancer, prompt evaluation is key.
See a doctor right away if you experience:
– Bleeding between periods
– Heavy periods or bleeding lasting over a week
– Vaginal bleeding after age 55
– Bleeding after intercourse
– Increased menstrual cramps or pelvic pain
Keep a record of your symptoms to share with your doctor. Cancer is just one possible cause, so try not to panic. Your doctor will perform tests to determine the underlying reason for bleeding.
If cancer is found early, it is more likely to be cured. So don’t delay in reporting abnormal bleeding patterns or other symptoms that concern you.
Risk Factors for Endometrial, Cervical, and Uterine Cancer
Certain risk factors increase the odds of developing a gynecologic cancer like endometrial, cervical, or uterine sarcoma. Some of the main factors that raise risk include:
Age: Endometrial and uterine cancers predominantly affect older women around menopause or after. Cervical cancer risks peak earlier.
Obesity: Being overweight is linked to increased endometrial cancer risk. This is due to increased estrogen production in fatty tissue.
Hormone imbalances: Too much estrogen without progesterone prepares the lining of the uterus for cancer growth. Conditions like PCOS that cause high estrogen are a concern.
HPV infection: The strains HPV 16 and 18 cause most cervical cancers. HPV is sexually transmitted.
Genetics: A strong family history raises risks for certain uterine and cervical cancers.
Radiation exposure: Prior pelvic radiation for another cancer can sometimes lead to endometrial cancer.
Knowing your personal risk factors allows you to be proactive about cancer screening and prevention.
| Risk Factor | Endometrial Cancer | Cervical Cancer | Uterine Sarcoma |
|---|---|---|---|
| Age over 55 | High risk | Moderate risk | Moderate risk |
| Obesity/overweight | High risk | Possible risk | No known link |
| HPV infection | No link | High risk | No known link |
| Family history | Moderate risk | Moderate risk | Low risk |
Diagnostic Tests for Uterine Cancers
If uterine cancer is suspected based on symptoms, your doctor will use various tests to make a diagnosis:
Pelvic exam: Feeling for changes in the size and shape of reproductive organs.
Pap test: Screening for cervical cell changes. Colposcopy may follow if abnormal.
Endometrial biopsy: Sampling of the uterine lining tissue to check for cancer.
Dilatation and curettage (D&C): Scrapes tissue from inside the uterus to test.
Imaging: CT, MRI, PET scans determine stage of cancers.
HPV test: Checks for high-risk HPV strains linked to cervical cancer.
These tests allow doctors to confirm if cancer is present, what type it is, and how advanced it is. This guides treatment recommendations.
| Test | Purpose |
|---|---|
| Pelvic exam | Evaluate cervix and uterus for changes or growths |
| Pap test | Screen for precancerous or cancerous cervical cells |
| Endometrial biopsy | Sample uterine lining to test for cancerous cells |
| D&C | Obtain uterine tissue to examine under a microscope |
| Imaging tests | Determine size and spread of uterine cancers |
| HPV test | Check for high-risk strains of HPV that cause cervical cancer |
Reducing Your Risk of Uterine and Cervical Cancers
While some cancer risk factors are out of your control, certain lifestyle changes may help lower your chances of developing uterine or cervical cancer:
Maintain a healthy weight: Obesity raises risks for endometrial cancer, so aim for a BMI in the normal range.
Exercise regularly: Being active is beneficial for cancer prevention and improves health overall.
Don’t smoke: Smoking is linked with higher cervical cancer risk. Quitting reduces risks.
Limit alcohol: Heavy, long-term alcohol use is tied to increased endometrial cancer risk.
Know HPV status: Get screened for HPV and have abnormal cell changes monitored or treated promptly.
Use contraception: Having multiple pregnancies raises exposure to excess estrogen. Consider birth control options.
Consider progesterone therapy: After menopause, estrogen plus progesterone helps prevent overgrowth of uterine lining.
Together with your doctor, determine if any preventive steps are recommended for your individual health profile and cancer risks.
Conclusion
Abnormal uterine bleeding can occasionally be the first presentation of an underlying gynecologic cancer. The most common cancers linked to uterine bleeding are endometrial cancer, cervical cancer, and uterine sarcoma.
Any irregular bleeding warrants medical evaluation, especially in women over age 40. Often it reflects benign conditions like hormonal changes, uterine fibroids, or polyps. But prompt assessment is key to detect the possibility of cancer early.
Cancers found at an early stage are often highly treatable. So be vigilant about bleeding changes and don’t delay reporting symptoms to your doctor for evaluation. Awareness of personal risk factors allows earlier cancer detection and prevention.