endometrial cancer cases are rising, but public awareness lags behind other gynecologic cancers
lorraine nelson didn’t think much about her postmenopausal bleeding until her sisters told her she should see her gynecologist
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“i’d heard of cancer of the uterus, but i was a lot more familiar with cervical and ovarian cancer,” says nelson.
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this story was created by content works, postmedia’s commercial content division, on behalf of a client.
in late 2019, lorraine nelson was supposed to be getting a chance to focus on her personal goals after raising five children and finishing up four challenging years as a foster parent. but lorraine’s plans to return to work and do more traveling were about to be put on hold. while visiting her two older sisters in quebec, they asked her how menopause was going. “i said, ‘you’re not going to believe it, but after a whole year without periods, i got one last month,’” recalls nelson. “they looked at me and said, ‘you should have that checked out.’”
nelson dutifully followed her sisters’ advice, ultimately seeing her gynaecologist for an in-office procedure to sample the tissue lining the uterus, looking for any abnormalities that might explain the bleeding. at a follow-up appointment that nelson attended alone because her husband was away for work, she was given the news she had endometrial cancer.
“i didn’t know my gynecologist well, but she was very straightforward and compassionate, and gave me the hug i needed,” nelson says. a few hours later, while picking her daughter up from a store, nelson realized she’d been staring sightlessly at the book display as a tear trickled down her face. “i was dazed, thinking about how i was going to handle this.”
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sometimes referred to as uterine cancer, “endometrial cancer starts in the lining of the uterus,” explains dr. neesha dhani, a medical oncologist at toronto’s princess margaret cancer centre. in 2024, it’s expected that 8,600 canadian women will be diagnosed with endometrial cancer, making it the most common cancer arising in the female reproductive organs. “that’s more than twice the number of patients that will be diagnosed with ovarian cancer,” says dr. dhani.
dr. neesha dhani
and the incidence of endometrial cancer is growing worldwide, likely due to multiple factors. “one is an aging population, as age is a significant risk factor for this disease,” dr. dhani explains. other contributors include increasing rates of other major risk factors, namely obesity and metabolic syndromes, including diabetes.
yet public awareness of endometrial cancer is arguably lower than it is for other gynecologic cancers. “i’d heard of cancer of the uterus, but i was a lot more familiar with cervical and ovarian cancer,” nelson says.
consequently, nelson didn’t recognize the potential implications of what she mistook for a normal period. “the most common symptom of endometrial cancer is postmenopausal bleeding,” explains dr. dhani. “but it’s very unusual for it to be heavy, dramatic bleeding. it could be a little bit of spotting on and off.”
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and since this symptom is often so subtle, it can be overlooked by both patients and their doctors. “it’s easy for a healthcare provider to say, maybe this is related to a bit of irritation after intercourse or other activities.”
women may similarly dismiss periodic spotting, particularly during the years leading up to menopause, when periods are often erratic. “we see many people who’ve had postmenopausal bleeding for years before they have a diagnosis of endometrial cancer,” dr. dhani notes. other less common symptoms include difficult or painful urination, and pain during sexual intercourse. two procedures that can help determine whether abnormal bleeding is due to endometrial cancer are vaginal ultrasound and an endometrial biopsy.
thankfully, in the past decade, advances in the understanding and treatment of endometrial cancer, “have been quite phenomenal,” says dr. dhani.
prior to that, endometrial cancers were simply divided into two categories — type i (most common) and type ii (more aggressive) — based on how tissue samples looked under the microscope. today, “the use of next-generation molecular sequencing has revolutionized things,” dr. dhani says.
endometrial cancers are now categorized according to whether they carry specific genetic or molecular signatures. this means, “we can better identify which patients should have which treatments,” dr. dhani explains.
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five years after she received treatment, nelson is now eagerly planning a trip with her sisters to explore her family’s roots in northern ireland. with the risk of recurrence behind her, nelson cherishes her cancer care team with gratitude. “i don’t think about cancer every day,” she says. “but i do look back with loads of appreciation for my cancer care team.”
nelson’s journey through cancer has transformed her perspective. reflecting on her journey, she acknowledges the importance in being proactive in addressing postmenopausal bleeding, “i don’t think i heard the message enough. i look back and think, my goodness, i could have sat on this for years, because it was not fazing me.”
this story was created by content works, postmedia’s commercial content division, on behalf of gsk.
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