Do You Know the Warning Signs of Uterine Cancer?

The majority of new cases will be diagnosed in women over 50

Rachel Nania,

AARP

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En español

Published June 25, 2024

Photo Collage: AARP (Source: Getty Images)

When Ursula Matulonis, M.D., started treating women with gynecologic cancers more than 20 years ago, she says it was rare to see a patient who had an aggressive form of uterine cancer.

“Now I see several per week,” says Matulonis, chief of the division of gynecologic oncology at Dana-Farber Cancer Institute in Boston and a professor of medicine at Harvard Medical School.

Uterine cancer — also called endometrial cancer because that is the most common type — is one of the few cancers in the U.S. that’s increasing in incidence, growing by about 1 percent each year in white women and by about 2 to 3 percent in women of all other racial and ethnic groups, according to a 2024 report from the American Cancer Society.

This year, an estimated 67,880 new cases of uterine cancer will be diagnosed in the U.S., up from what Memorial Sloan Kettering Cancer Center in New York City says was roughly 35,000 in 1987. The majority of these cases will be in women over 50. This “steady increase” has been especially noticeable in the past 10 years, says Pamela T. Soliman, M.D., a professor in the department of gynecologic oncology and reproductive medicine at MD Anderson Cancer Center in Houston. “We are definitely well aware of it,” she says.

Equally concerning is the increasing death rate. While survival rates for most cancers have improved in recent decades, the opposite is happening for uterine cancer. Since the mid-2000s, the death rate has risen by about 1.7 percent each year, the American Cancer Society says. And studies have found that Black women are twice as likely to die from uterine cancer than patients from other racial and ethnic groups.

This year, the disease is expected to kill 13,250 U.S. women.

What is uterine cancer?

Uterine cancer occurs when the cells in the uterus grow out of control. There are two types.

Endometrial: The most common type of uterine cancer is also called endometrial cancer because it forms in the lining of the uterus, called the endometrium.
Uterine sarcoma: Rarer is uterine sarcoma, which is often more aggressive and harder to treat. This type typically forms in the muscle layer of the uterus.

Source: CDC/National Cancer Institute

“I would call this a public health emergency, with the rising cases and the poor survival,” Matulonis says. “We all should be worried about this.”

Obesity may be contributing to climb in cases

There are likely “a number of different factors” contributing to the troublesome trends, Soliman says. A big one, doctors and scientists say, is the growing prevalence of obesity, which affects nearly 43 percent of U.S. women age 60 and older, according to the Centers for Disease Control and Prevention.

Fat cells are not dormant, Soliman explains. They secrete chemicals and can change other hormones in the body into estrogen, the American Cancer Society says. And higher than usual estrogen levels can lead to some types of cancer, including uterine. (This is why women taking estrogen as part of hormone replacement therapy for menopause symptoms are often also prescribed progesterone or progestin to balance out estrogen levels and offset any increased risk for endometrial cancer.)

“If you have too much estrogen targeting that organ, it can create these early changes in the cells that can lead to [increased cell production] and eventually cancer,” says Jennifer Mueller, M.D., a gynecologic surgeon who specializes in treating endometrial cancer at Memorial Sloan Kettering Cancer Center.

Excess weight can also trigger insulin resistance, and that can affect hormone levels in the body. “We think maybe inflammation and insulin resistance is another pathway that can drive toward endometrial cancer,” Mueller says.

The American Cancer Society estimates that 70 percent of uterine cancers can be attributed to excess body weight and insufficient physical activity. The organization says endometrial cancer is twice as common in overweight women and more than three times as common in women with obesity than it is in women who are at a healthy weight.

But that’s only one part of the explanation, Matulonis says. Other risk factors for the cancer include a family history, having had breast or ovarian cancer, and having used the breast cancer treatment tamoxifen. Women with polycystic ovarian syndrome are also at a higher risk for uterine cancer. More recently, scientists have linked chemical hair straighteners to a higher risk for uterine cancer.

When it comes to the increasing death rate, research shows that more women are being diagnosed with aggressive forms of uterine cancer than in the past, which could explain the shift. A study out of the National Cancer Institute found that between 2000 and 2015, incidence rates for dangerous subtypes of the cancer rose rapidly among women — especially Black women — between age 30 and 79, though it’s unclear why.

“There’s a gap right now in knowledge about exactly why we are seeing an increase in cases” and mortality, Matulonis says. She adds that more research is needed to better understand what’s driving the trends and contributing to the alarming racial and ethnic divides.

Bleeding after menopause is the No. 1 warning sign

There aren’t routine screenings for women at average risk for uterine cancer, like there are for breast cancer, colon cancer and cervical cancer. That’s why it’s crucial to pay attention to any early warning signs of the disease, doctors say.

The most common symptom of uterine cancer is abnormal bleeding after menopause. (The average age of uterine cancer diagnosis is 60.) The American Cancer Society says about 90 percent of women with uterine cancer have abnormal bleeding.

“And when we say bleeding, I’ve started adding other words like ‘spotting,’ ‘discharge’ or ‘staining,’ ” Mueller says. It doesn’t need to be a lot of blood, she says — the smallest amount, a spot even, should prompt you to check in with your doctor. “Any kind of discharge that’s abnormal is a huge red flag,” Mueller says.

What’s more, if you have uterine fibroids, or noncancerous growths, and experience bleeding, don’t assume it’s from the fibroids, Mueller says. According to the Cleveland Clinic, it’s rare for fibroids to create any symptoms after menopause.

For women who are not in menopause, talk to your doctor if you notice bleeding between periods or a change in your periods, Soliman says. If you experience pain when you urinate or pain during intercourse, that could be another warning sign of uterine cancer. And if your routine Pap smear shows endometrial cells, “that’s another kind of a red flag that that individual needs to be further worked up,” Matulonis says.

Video: Uterine Cancer Deaths Are Rising; 3 Warning Signs

Treatments continue to advance

Despite the concerning statistics, there is some good news in the field: Treatment options for uterine cancer are advancing. Surgery (a hysterectomy) is the primary treatment, and Soliman says for the most common type of uterine cancer, this method is pretty successful. For more advanced forms of the disease, “there’s been a lot going on in the last four or five years” that has helped improve patient survival, she says.

For example, some people with the inherited genetic condition known as Lynch syndrome, which increases the risk for certain types of cancer, “have very good response rates” to immunotherapy treatments, or drugs that help a person’s own immune system better spot and kill cancer cells, Soliman says.

Researchers have found that others may benefit from immunotherapy plus targeted therapy, a form of treatment that targets certain changes in the cancer cells. And a study published in 2023 found that immunotherapy plus chemotherapy dramatically improved how long certain patients with advanced disease might live without the cancer getting worse. “That’s been one of the biggest changes over the past year,” Matulonis says. “There’s a lot going on in this setting with regard to different [treatments].”

Many of the new and promising treatments are being used in clinical trials, which is why the American Cancer Society says participation should be considered if you are diagnosed with uterine cancer. Mueller says it’s also important that trial populations become more diverse to better reflect “all of the patients who are diagnosed with endometrial cancer.” Doing so can help to identify the factors contributing to its disparities.

“We really need to put more focus on endometrial cancer,” Matulonis says. “It’s really affecting women in the United States.”

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