A 42-year-old female patient presented with abnormal bleeding, self-reporting a minimum of "10 episodes in 3 days." The examination results, however, revealed the distressing diagnosis of advanced-stage endometrial cancer.

The early warning signs repeatedly emphasized by doctors were ignored, leading to regret only after the situation became severe.

In summary, abnormal uterine bleeding is a crucial warning sign for endometrial cancer. Timely recognition and seeking medical attention can significantly improve the prognosis.

Abnormal bleeding is the most important signal

Many women dismiss bleeding outside of their menstrual cycle, attributing it simply to hormonal imbalance. This patient initially held the same belief, until the frequency of bleeding increased to an unavoidable level.

The bleeding caused by endometrial cancer stems from cancerous tissue eroding the blood vessels within the endometrium. Simultaneously, the tumor itself releases angiogenic factors, leading to the formation of abnormal blood vessels.

These newly formed blood vessels are fragile and prone to rupture, resulting in irregular bleeding. As the tumor continues to grow, the bleeding becomes increasingly frequent and gradually increases in volume.

What often starts as occasional spotting eventually progresses to a point where sanitary pads need to be changed several times almost daily. This process can last for months or even longer. Unfortunately, many individuals only realize the severity of the problem when symptoms of anemia begin to appear.

High-risk factors cannot be ignored

This patient presents multiple high-risk factors for endometrial cancer, including obesity, hypertension, and polycystic ovary syndrome (PCOS). In obese women, fat cells convert androgens into estrogen, leading to persistently high levels of estrogen in the body.

This long-term estrogen stimulation of the endometrium without progesterone antagonism promotes endometrial hyperplasia, which may eventually progress to atypical hyperplasia or even malignancy. In patients with hypertension, impaired vascular endothelial function and local tissue hypoxia further accelerate this process.

Patients with polycystic ovary syndrome experience anovulation and lack the protective effect of progesterone on the endometrium, resulting in continuous endometrial proliferation under unopposed estrogen stimulation. These factors collectively and significantly increase the risk of developing cancer.

Delayed diagnosis is heartbreaking

From the onset of symptoms to diagnosis, this patient experienced a delay of nearly one year. During this period, she tried various traditional Chinese medicine remedies and health supplements, but did not undergo standardized gynecological examinations.

Endometrial cancer typically progresses slowly, with the process from endometrial hyperplasia to atypical hyperplasia, and then to early-stage cancerous changes possibly taking several years.

Because of this, many patients think, "No rush," or "Let's wait and see a bit longer." In reality, once endometrial cancer breaks through the basal membrane, its progression accelerates significantly, and lymphatic metastasis may occur.

When diagnosed at an advanced stage, treatment becomes significantly more challenging, and the prognosis is markedly worse. Standardized gynecological examinations, including ultrasound assessment of endometrial thickness and diagnostic dilation and curettage or hysteroscopy when necessary, can all aid in the early detection of issues.

Treatment Difficulty and Prognosis

Advanced endometrial cancer is far more complex to treat than early-stage disease, requiring a combination of multiple modalities such as surgery, radiotherapy, and chemotherapy. Cancer cells may have invaded the deep myometrium or cervix, or even metastasized to pelvic lymph nodes.

At this stage, the surgical scope needs to be expanded, potentially including procedures such as radical hysterectomy and pelvic lymph node dissection. Postoperative adjuvant radiotherapy and chemotherapy are also required. These treatments are not only costly but also associated with a significant increase in side effects.

More critically, the five-year survival rate for patients with advanced-stage disease is significantly lower than that for early-stage patients. Even after aggressive treatment, the risk of recurrence remains high, necessitating long-term follow-up for patients.

This stands in stark contrast to early-stage endometrial cancer, where a simple surgery can lead to a favorable prognosis.

Prevention and Early Detection

Endometrial cancer is, to a large extent, a preventable and early detectable disease. Regular gynecological examinations are key to identifying early-stage lesions, particularly for women with high-risk factors.

Obese patients can significantly reduce their risk of disease by losing 5%–10% of their body weight. Patients with polycystic ovary syndrome should adjust their menstrual cycles under the guidance of a doctor and regularly supplement progesterone to protect the endometrium.

Long-term users of tamoxifen require regular monitoring of their endometrial status. For women who have already experienced abnormal bleeding, hysteroscopy allows direct observation of the endometrium and enables biopsy, serving as the gold standard for diagnosis.

Lifestyle Recommendations and Reminders

It is recommended that women undergo annual gynecological check-ups, particularly those with obesity, hypertension, diabetes, or polycystic ovary syndrome.

In cases of abnormal uterine bleeding, especially postmenopausal bleeding or menstrual irregularities, timely medical consultation is essential.

Maintain a healthy weight with a BMI below 24; adopt a balanced diet rich in dietary fiber while limiting high-fat foods; engage in moderate exercise, aiming for at least 150 minutes of moderate-intensity activity per week. Avoid the indiscriminate use of estrogen-based supplements and use them under medical guidance when necessary.