Endometrial Adenocarcinoma: Symptoms, Diagnosis, Tests, and Treatment (Personal Experience)

(From early symptoms of endometrial cancer to diagnosis, MRI findings, and treatment options)

What Is Endometrial Adenocarcinoma?

Endometrial adenocarcinoma is one of the three major gynecologic cancers, along with cervical cancer and ovarian cancer.
Because it is often considered a very personal and sensitive condition, I felt that there is less practical, patient-centred information available compared to other cancers. That is why I decided to share my own experience.

Unlike many other cancers, endometrial cancer often shows symptoms even in its early stages, which means the chance of early diagnosis is relatively high.
The most common early symptom is abnormal uterine bleeding.

In particular, if a person has endometrial hyperplasia and the biopsy shows atypical cells, the risk of progression to endometrial cancer is higher. In such cases, regular and careful follow-up is extremely important.

Image by u_7jr9kuzf77 from Pixabay

My Experience With Endometrial Cancer Diagnosis (Diagnostic Process)

The process that led to my diagnosis of endometrial cancer was as follows:

• Before starting IVF (in vitro fertilisation), I felt something was not right with my uterus and asked my doctor for further checks

• First transvaginal ultrasound: no major issues were seen

• Second transvaginal ultrasound during menstruation: after reviewing the results, the doctor decided to proceed with surgery immediately

• On the day of surgery, a large amount of thickened endometrial tissue was removed and sent to the lab for biopsy

• One week later, during a follow-up visit for stitch removal, I was informed that the biopsy confirmed endometrial cancer

Looking back, considering the long history of gynecologic issues I had before surgery, I strongly feel that paying close attention to changes in symptoms and menstrual patterns can play a crucial role in early diagnosis.

Image by Julio César Velásquez Mejía from Pixabay

Early Symptoms of Endometrial Cancer That I Experienced

Long-Term Menstrual Pattern 

• Extremely severe menstrual cramps (Painkillers took a long time to become effective)

• Heavy bleeding with large amounts of blood clots

• Chronically low iron levels

• Average menstrual duration of about 10 days (lingering and not clearly ending)

• In addition to typical cramps on days 2–3, sudden, random pain occurs throughout the entire 10-day period

• Frequent bloating of the lower abdomen that felt like a balloon inflating and deflating, depending on the menstrual cycle

❗Before my cancer diagnosis, I already had adenomyosis, which caused the symptoms described above. Because my baseline menstrual pattern was already abnormal, it is difficult to clearly distinguish cancer-related symptoms from those of adenomyosis. However, even for me—someone who had become accustomed to abnormal bleeding—the menstrual pattern prior to my cancer diagnosis was clearly different.

Due to difficult menstrual cycles, I had been taking birth control pills that stop menstruation. I completely stopped taking them around April 2024 in preparation for pregnancy. I had planned to start IVF around June-July 2025, but I noticed sudden changes in my cycle that were very different from usual, so I requested further testing. In November 2025, a biopsy was performed along with a related procedure.

👉 For more details about the procedure and related cost at a private hospital in Australia, please refer to my previous post.

Rapid Changes Over the Last 4 Months

• Menstrual bleeding became abnormally heavy

• Periods lasted more than two weeks

• Blood clots increased dramatically in both size and amount

• Sudden “gushing” bleeding, causing heavy blood loss within less than one minute

• Even using a super-sized tampon and pad together was not enough

• Daily life and work were significantly affected

Previously, my abdomen would swell and then return to normal. Recently, however, the bloating did not go away and remained constant.
Even though my weight did not change much, none of my high-waisted pants or trousers fit anymore.

Systemic Symptoms I Noticed

• Overall loss of motivation

• Persistent fatigue

• Developing a habit of daytime naps, which I rarely did before

• Continued going to the gym and running, but only by forcing myself due to a lack of energy

Risk Factors for Endometrial Cancer and the Importance of Early Detection

Common risk factors for endometrial cancer include:

• Obesity (Fat tissue produces excess estrogen, which continuously stimulates the endometrium)

• Diabetes

• Older age

I did not fall into any of these risk categories, yet cancer was still found.
This made me realise that changes in symptoms are important even without known risk factors.

When You Should See a Doctor Immediately

• Noticeable changes in bleeding patterns

• Any bleeding after menopause

• A history of endometrial hyperplasia, especially with atypical cells

Image by fernando zhiminaicela from Pixabay

What a Biopsy Can Show in Endometrial Cancer

According to my biopsy results, the pathology report showed:

Tumor Evaluation

• FIGO Grade: Determines the tumour grade based on how differentiated the cancer cells are

• Macroscopic findings: Gross appearance, including tumour size, shape, and extent

• Microscopic findings: Cell morphology and tissue architecture under the microscope

Immunohistochemistry (IHC)

• ER (Estrogen Receptor)

• PR (Progesterone Receptor)

→ Used to assess hormone responsiveness and suitability for hormone therapy

Tumor Characteristics

• p53: wild-type status

• p16: positive in some parts of the tissue

• Ki-67: shows how quickly the cancer cells are growing

Genetic and Molecular Testing

• MLH1, PMS2, MSH2, MSH6

→ Used to determine Microsatellite Instability (MSI) status (high or low)

→ Helps assess the possibility of Lynch syndrome

What MRI Can Show in Endometrial Cancer (Staging)

Although I had undergone pelvic MRIs before due to uterine issues, this was the first time I had an MRI with contrast.

My MRI report included information on:

• Depth of myometrial invasion

• Spread to the cervix, ovaries, lymph nodes, blood vessels, or peritoneum

• Possible invasion of nearby organs such as the bladder or rectum

These findings are critical for deciding on surgery, treatment planning, and fertility preservation options.

✔ Difference Between Grade and Stage

The MRI report stated that the staging of the lesion was T1a, and the biopsy report stated, “The sections show endometrioid endometrial adenocarcinoma, FIGO grade 1.” After receiving the results, I looked up what “grade” and “stage” mean and learned that they describe different things about the cancer.

❗Grade

→ Reflects how aggressive the cancer cells look

→ Determined by microscopic examination of biopsy tissue

❗Stage

→ Indicates how far the cancer has spread

→ Based on MRI/CT imaging or postoperative pathology

Image by Michal Jarmoluk from Pixabay

Treatment Options for Endometrial Cancer

Low-Grade Endometrial Cancer

• Fertility-sparing hormone therapy may be an option

• Requires thorough discussion with a specialist

High-Grade Cancer or Hormone-Resistant Cases

• Hysterectomy

• Additional treatment such as chemotherapy or radiation therapy, depending on postoperative findings

Key Takeaways 

• Changes in menstrual patterns, heavy bleeding, and blood clots are important warning signs

• Patients with endometrial hyperplasia need regular follow-up

• Biopsy determines Grade, MRI determines Stage

• Fertility-sparing treatment may be possible in low-grade cases

My Case (Actual Diagnosis)

• FIGO Grade 1

• Stage T1A

• Minimal myometrial invasion

• No spread to other organs

• Cancer limited to the surface of the endometrium

Hormone receptor testing showed that my cancer was responsive to progesterone therapy, so we decided to try fertility-preserving treatment first in preparation for IVF.

Thoughts After Being Diagnosed With Cancer

Before my diagnosis, I often heard people say, “I became a cancer patient overnight.”

Now I understand exactly what that means.
Fortunately, my condition was not severe, and I did not feel mentally overwhelmed. Still, it made me realise how suddenly cancer can enter anyone's life.

I hope fewer people will ever have to experience cancer.

*This review is based on my personal experience, and results may vary for others. Please take it as a friendly reference.

This is not medical advice. Always consult a qualified healthcare professional for medical concerns.