Endometriosis and Its Link to Gynecological Cancers

Endometriosis is a condition where the lining of a woman’s uterus, the endometrium, grows outside of the uterus. Endometriosis affects roughly 10% of reproductive age women and girls globally and awareness and understanding of the condition and its associated symptoms are rising.

Alongside awareness and diagnosis of endometriosis there has been an increase in discussion over how the condition can negatively affect a woman’s health. Patient questions often fall into two main categories:

• what may be the effects of my endometriosis treatment and
• are endometriosis and endometrial cancer linked?

While there is no cure for endometriosis, there are many treatment options including pain medication, hormone therapy and surgery. Hormone therapy can be as simple as taking common forms of birth control to better regulate hormone cycles so the endometrial tissue grows and sheds each month. Surgery is common treatment for women hoping to improve their fertility. In most cases these interventions help manage pain and address the issues.

Siteman Cancer Center’s Gynecological Oncology Division Chief, Dr. Matthew A Powell, MD, addresses the concerns related to cancer to better educate women.

Does Endometriosis Increase a Women’s Cancer Risk?

Short answer, no. There is no clear correlation between a woman’s diagnosis of endometriosis and endometrial cancer. In fact, having endometriosis doesn’t clearly increase the risk of any gynecological cancers like cervical cancer. There is a very small association with ovarian cancer but this is rare. While some symptoms of endometriosis and a normal menstrual cycle can mimic signs and symptoms of cancer, it’s important to understand that these conditions are different.

What are Symptoms of Endometrial Cancer?

Endometrial cancer occurs when endometrial tissue grows abnormally and in excess. But this growth differs from endometriosis because it eventually forms tumors within the uterus. Endometrial cancer cells can also spread to and create tumors in other areas of the body.

Endometrial cancer is the most common gynecological cancer, but it’s important to note it most often happens after a woman has gone through menopause. While endometriosis and endometrial cancer aren’t linked, having obesity or polycystic ovarian syndrome (PCOS) can increase cancer risk. Both conditions can elevate levels of estrogen in the body and can keep those levels elevated for prolonged periods of time, which creates an environment where endometrial cancer can develop.

Though obesity and PCOS are risk factors, they are only single factors in a complex picture. “[T]his is not a one-to-one, if you’re thin you’re fine, if you’re heavy you’re at risk,” states Dr. Powel. The exact cause of endometrial cancer is not clear. Women should consider symptoms they’re experiencing and report those to their provider rather than focus on risk factors in isolation. Combined with exams, family history, and other essential information, a provider will be able to apply their expertise to what you’re reporting to them.

Are Endometrial Cancer Symptoms Similar to Endometriosis Symptoms?

Yes. Unfortunately, endometrial cancer and endometriosis symptoms share similarities. Even a normal menstrual cycle with its discomfort, pain and bleeding can mirror and sometimes even mask symptoms that need to be shared with your provider. Making a distinction between typical and normal monthly symptoms and symptoms that should be cause for concern can be challenging. Both endometriosis and endometrial cancer can cause pain in the lower belly and back, irregular bleeding or heavy bleeding. In addition, a woman might notice her bladder function or bowel movements change.

What if I Have Irregular Bleeding?

Notice changes in your cycle and in your body. That can help determine what is normal and what is not. Bleeding at times when you haven’t before needs special attention. Unusual bleeding or bleeding between periods is correlated with endometrial cancer and occurs in nearly 90% of diagnosed patients. In addition, unusual belly pain or swelling of the abdomen may occur and can suggest later stages of the disease.

In general, if something seems different or has been different for two to four weeks, women should mention the change to their healthcare provider. Checking in or getting a complete checkup is a proactive next step. Dr. Powell explains, “Especially as we age, people need to lower their threshold for when it’s appropriate to speak with a physician.”

How Can You Advocate for Your Gynecological Health?

A woman’s hormonal, sexual, and reproductive health should all be prioritized during a visit with a provider.

It may feel uncomfortable but open and frequent communication with your provider is needed. The signs and symptoms of both endometriosis and all gynecological cancers might be ones you consider to be normal or expected. But it is also helpful information your provider needs to know. Consider that you are advocating for yourself. Sharing specific information may help indicate if other conditions like gynecologic cancers should be suspected.

“I think that’s the trickiest part, [knowing] when to make that call and when to go in to be seen,” shares Dr. Powell. Especially if you have new changes that have persisted over weeks or months, it is time to make a new appointment with your provider instead of waiting to bring it up at your scheduled checkup. Taking that step is crucial for your long-term health. Identifying issues like cancer early helps improve possible outcomes and often allows for many treatment options.

Why is Early Diagnosis for Endometrial Cancer Helpful?

Across cancer types early diagnosis is always preferred and initial testing can be as simple as a blood test or an ultrasound. Screenings like regular Pap tests are effective in catching cervical cancer early, and testing can help indicate if other gynecological cancers are suspected. “[T]he good news is, we’ve made a lot of progress for treating these cancers including therapies that address cancers that have spread. These cancers are very curable, and it’s absolutely worth being evaluated,” states Dr. Powell.

If you’re having a gynecological problem, like painful sex, bleeding after menopause, or bleeding between periods, it is important to see a provider. If you’re seeing a primary care physician, they may refer you to a gynecologist if you haven’t seen one already. A gynecologist can use their specialized expertise with you and help you navigate your symptoms.

Sharing your symptoms with your provider can bring you peace of mind. It may also be the first step toward getting a cancer diagnosis, which, while unknown and scary, can lead to better outcomes for your well-being over your lifetime.

If you have questions about your gynecological cancer risk or have a gynecological cancer diagnosis, you can request an appointment and even seek a second opinion. Siteman Cancer Center is here for you.