Causes of Endometrial Cancer and How to Prevent It

Endometrial cancer is cancer that attacks the inner lining of the uterus. This condition generally occurs in women who have entered menopause, which is around 60-70 years old.

The endometrial layer acts as a place to attach a fertilized egg. Therefore, the endometrial wall will thicken before menstruation. If the egg is not fertilized, the endometrium will decay so that menstruation occurs.

Endometrial cancer is one type of cancer in the female reproductive organs that often occurs. Based on WHO data in 2020, there were more than 7,000 cases of endometrial cancer in Indonesia, with 2,000 of them experiencing death.

Endometrial cancer can be detected early, characterized by abnormal bleeding in the vagina. If detected early, doctors can perform a hysterectomy or surgical removal of the uterus to treat this condition.

Types of Endometrial Cancer

Endometrial cancer is divided into two main types, namely:

  • Type 1 endometrial cancer
  • This type is the most common. The development of cancer cells in type 1 occurs slowly (non-aggressive) and can be detected early.
  • Forms of endometrial cancer type 1 are endometrioid adenocarcinomas.
  • Type 2 endometrial cancer
  • This type has a more aggressive nature. Cancer cells in this type develop and spread faster, and recur more often.
  • The forms of type 2 endometrial cancer are uterine serous carcinomas and clear cell carcinomas.

Causes of Endometrial Cancer

Endometrial cancer occurs when cells in the endometrium undergo changes (mutations). These changes cause the cells to grow rapidly and uncontrollably and develop into cancer cells.

It is not yet known exactly why these cells grow uncontrollably. However, there are several factors that are thought to increase a person’s risk of endometrial cancer, namely:

  • Imbalance of progesterone and estrogen hormones in the body
  • Excess weight or obesity
  • Age 60-70 years
  • Menopause
  • Menstruation at an early age (<12 years old)
  • Menopause at a later age than usual (>50 years)
  • Never been pregnant
  • Tamoxifen hormone therapy, for breast cancer patients
  • Colon cancer
  • Polycystic ovary syndrome (PCOS)
  • Family history of endometrial cancer
  • Other types of cancer, such as breast cancer or uterine cancer

Endometrial Cancer Symptoms

The most common symptom of endometrial cancer is vaginal bleeding. This symptom usually appears since the early stages of cancer. However, the nature of this bleeding may vary depending on whether the patient is menopausal or not.

If the patient is not yet menopausal, vaginal bleeding is characterized by:

More blood during menstruation with a longer menstrual period (more than 7 days).
Blood spots appear outside the menstrual period
The menstrual cycle occurs every 21 days or sooner
Bleeding occurs before or after sexual intercourse

In patients who have menopause, any bleeding or spotting from the vagina that appears at least a year after menopause should be seen by a doctor immediately.

Apart from bleeding, other early symptoms of endometrial cancer are vaginal discharge that is watery or mixed with blood, and pain during sexual intercourse.

If it has developed and entered an advanced stage, endometrial cancer will cause additional symptoms, such as:

  • Pelvic pain
  • Decreased body weight
  • Loss of appetite
  • Lumps appearing in the lower abdomen
  • Fatigue
  • Flatulence
  • Changes in urination and bowel movement patterns
  • Pain in the lower abdomen, back, or legs

When to see a doctor

See a doctor immediately if you experience any of the symptoms below:

  • Bleeding that occurs after menopause, after sexual intercourse, or outside the menstrual cycle
  • Vaginal bleeding that lasts more than 7 days
  • Menstruation that occurs more than once a month
  • Vaginal discharge that occurs after menopause
  • Pelvic pain or cramps that do not improve

Although the above conditions are not always associated with endometrial cancer, early examination is necessary so that the cause can be identified and treated immediately.

Diagnosis of Endometrial Cancer

To diagnose endometrial cancer, the doctor will ask questions about the symptoms experienced and the patient’s medical history, followed by a physical examination.

Furthermore, the doctor will conduct further examinations to determine the diagnosis, including:

Pelvic examination

A pelvic examination is performed by examining the outside of the vagina, then inserting two fingers into the vagina while pressing the patient’s abdomen using the other hand. The aim is to detect abnormalities in the uterus and ovaries.

The doctor may also use a speculum to detect abnormalities in the vagina and cervix.

Transvaginal ultrasound

This examination involves inserting a special device called a transducer into the vagina. It emits high-frequency sound waves into the uterus to be converted into images on a monitor. This allows the doctor to see the texture and thickness of the endometrium.


Hysteroscopy involves inserting a special instrument with a small camera and light (hysteroscope) into the uterus through the vagina. This tool helps the doctor to see the endometrium and the condition inside the uterus.

Endometrial biopsy

This examination involves taking a tissue sample from the lining of the uterus, which is then analyzed in the laboratory. The aim is to detect the presence of cancer cells.

Dilation and curettage

This examination is also called curettage, which is the scraping or scraping of tissue in the uterus using a special tool. This procedure is performed if the sample from the biopsy is not sufficient to detect cancer cells and the results of the analysis cannot be confirmed.

If endometrial cancer is suspected to be at an advanced stage, the doctor will perform X-rays, CT scans, PET scans, and MRIs, to detect whether the cancer has spread to other organs.

The doctor may also perform a cystoscopy or colonoscopy, to detect if the cancer has spread to the bladder or digestive tract.

Endometrial Cancer Stages

Once endometrial cancer is diagnosed, the doctor will determine the stage of endometrial cancer. There are four stages of endometrial cancer, namely:

  • Stage 1: cancer is still in the uterus
  • Stage 2: the cancer has spread to the cervix (cervix)
  • Stage 3: the cancer has spread outside the uterus, such as to the lymph nodes in the pelvis, but has not yet reached the colon or bladder
  • Stage 4: the cancer has spread to the bladder, colon, and even to other organs or parts of the body

Endometrial Cancer Treatment

Endometrial cancer treatment can be done with several methods that are determined based on several factors, namely:

  • Stage or degree of spread of cancer cells in the uterus
  • Overall health condition of the patient
  • Endometrial cancer type and tumor size
  • Location of endometrial cancer

The following are some actions that can be taken to treat endometrial cancer:


Surgery is one of the most effective treatments for endometrial cancer. Surgery can be performed at an early stage of endometrial cancer.

The surgery performed is uterine removal surgery (hysterectomy). Based on the condition of endometrial cancer, hysterectomy may also be accompanied by procedures to remove the tubes and ovaries.

In a hysterectomy, the doctor may also remove the seed lymph nodes in the uterine area, to detect the spread of cancer cells. Please note that this surgery may prevent the patient from having children in the future.


Chemotherapy is the administration of drugs to kill cancer cells and prevent their spread. This therapy is performed on endometrial cancer that has spread to other parts of the body or has recurred.

The types of chemotherapy drugs used are cisplatin, carboplatin, doxorubicin, or paclitaxel.


Radiotherapy is a therapy using high radiation beams to destroy cancer cells. This may be done after a hysterectomy or in combination with chemotherapy.

Radiotherapy can also be used to inhibit the spread of cancer cells when surgery cannot be performed. There are two types of radiotherapy, namely:

External radiotherapy, by directing energy beams to the part of the body affected by the cancer
Internal radiotherapy (brachytherapy), by placing radioactive material inside the vagina

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