Don't Ignore These Early Warning Signs of Endometrial Cancer

“My husband and I are avid travelers. If there’s something to see and explore, we’re packed and ready to go,” says Isabel “Mimi” Stein of Palmetto Bay, whose next adventure will be a three-week cruise next month visiting nine Mediterranean islands in Italy and Greece. It’s a trip that would not have been possible two years ago, when the 72-year-old was diagnosed with and underwent treatment for endometrial cancer, also known as uterine cancer.

In early 2022, Ms. Stein started experiencing vaginal bleeding. “It was nothing unusual and there was no pain,” she recalls. “I didn’t think it was anything that required a doctor. I just figured it was something women usually get.”

Ms. Stein would be leaving soon to visit her daughter and her family in Mexico, however. Not wanting to be bothered with her condition while traveling, she decided to see her gynecologist just before leaving.

“My gynecologist did an endometrial biopsy in her office and remarked that it was very unusual – my uterus was full of liquid,” says Ms. Stein. Her doctor suspected it was endometrial cancer and told her the pathology report would provide confirmation. “She recommended I see a specialist and said I should consider having a hysterectomy.”

Ms. Stein was boarding her flight to Mexico when she got the call with the results of her pathology report. “I was so surprised to hear the word ‘cancer’ because I’ve always been very healthy,” she says. She was referred to John Diaz, M.D., chief of gynecologic oncology at Baptist Health Miami Cancer Institute and director of robotic surgery at Baptist Health.

John Diaz, M.D., chief of gynecologic oncology at Baptist Health Miami Cancer Institute and director of robotic surgery at Baptist Health

Dr. Diaz notes that endometrial cancer patients such as Ms. Stein “typically present with abnormal vaginal bleeding or post-menopausal bleeding” and that if caught early enough, it can be treated surgically with a hysterectomy. “Later-stage disease is more difficult to treat and usually entails both radiation therapy and chemotherapy,” he adds.

Knowing the risk factors for endometrial cancer

Endometrial cancer is the most common gynecologic cancer in the United States. According to the National Cancer Institute (NCI), there are nearly 900,000 women living with uterine cancer in the U.S. This year alone, the NCI estimates 67,800 new cases of uterine cancer will be diagnosed and 13,250 women will die from the disease.

Age and obesity are the most common risk factors for endometrial cancer. Unfortunately, says Dr. Diaz, the U.S. population is growing increasingly older and heavier. “As a result, we’re seeing more and more of this type of cancer.” Minority women – Blacks, African-Americans and Hispanics, in particular – have a higher risk for developing the disease and need to be especially vigilant, he says.

There is also a hereditary factor to endometrial cancer, Dr. Diaz says. “All individual cancer patients at Miami Cancer Institute undergo pathological evaluation to see if their disease could be associated with a hereditary syndrome known as Lynch Syndrome.” Although Ms. Stein was screened for Lynch Syndrome and does not carry the gene, Dr. Diaz says that knowing you have it would be important for both you and your family.

“Hopefully, family members would recognize the need for genetic testing to see if they, too, carry the gene,” he says. “If so, they should be screened regularly for endometrial cancer and colon cancer, both of which are associated with Lynch Syndrome.”

Treating endometrial cancer

Ms. Stein’s surgery was scheduled for early April 2022. “Once I met with Dr. Diaz, I trusted him completely,” Ms. Stein says, noting that she had done her homework and was certain he was the one who she should entrust with her surgery. “Not only is he a wonderful human being but he also treats you with the utmost professionalism. He provided me with such comfort and security while I was dealing with my cancer.”

According to Dr. Diaz, treatment of endometrial cancer involves removing the uterus, the cervix, the bilateral fallopian tubes and the ovaries. At the same time, he also performs a sentinel lymph node evaluation, using a technique he helped develop 15 years ago.

“In the past, a sentinel lymph node evaluation required a full lymph node dissection in which all of the anatomical lymph nodes are removed,” Dr. Diaz explains. This can be associated with an increased risk of postoperative bleeding, nerve injury and lymphedema, he says.

“Now, we inject a dye into the cervix and the uterus and follow it out to the first draining lymph node,” Dr. Diaz continues. “We then remove just that node, which we call the sentinel node, and send it to pathology for ‘ultra-staging’ to determine if cancer is present and if so, to what degree.”

Dr. Diaz says this approach has actually led to a higher cancer detection rate for endometrial cancer – so much so that it has now become the standard of care for women with endometrial cancer.

Benefits of minimally invasive surgery

Thanks to technological advances in robotic surgery, Dr. Diaz is able to perform the surgery and sentinel lymph node evaluation using a minimally invasive approach. “We make a small incision in the abdomen and the entire surgery is done robotically, with me at the controls,” he says. “It gives me far greater vision and precision and allows me to get into places I might not be able to otherwise.”

The benefits of minimally invasive surgery are just as compelling for patients, who experience much less discomfort and are able to go home the very same day. “Surprisingly, I came home and was walking the same day as my surgery,” says Ms. Stein. “I took a bath, had dinner and went to sleep. I didn’t even need to take any painkillers. It was like going to the dentist.”

Dr. Diaz says that with the Enhanced Recovery After Surgery (ERAS) protocol employed at Miami Cancer Institute, many patients are able to recover from their surgery without having to rely on painkillers. “Most of our patients require no narcotics following surgery and are able to return to their normal activities within seven to 14 days,” he says.

Adding proton therapy to prevent recurrence

Based on her age and other risk factors, Dr. Diaz recommended Ms. Stein also undergo proton therapy to prevent recurrence. Proton therapy is a highly specialized form of radiation therapy that directs powerful, precise beams of radiation to the cancer, sparing healthy surrounding tissue. “Although Ms. Stein had early-stage disease, after discussing the risks and benefits, she was agreeable with our recommendation that she undergo radiation therapy for local control of her cancer.”

Ms. Stein trusted her surgeon completely and says that whatever Dr. Diaz recommended, she would go with it. “The procedure room was a little scary,” she admits. “The machine itself is a world of its own, but the proton therapy team at Miami Cancer Institute was excellent. I don’t know that I could have picked better people to help me through the process.”

Recovering from minimally invasive surgery

Ms. Stein says recovering from her surgery was easy, thanks to her husband and children and her medical team at Miami Cancer Institute. “My stamina was lower for a while after surgery, and I had to be careful not to overdo it or lift anything heavy,” she says.

Still, she considers herself lucky. “It was a blessing that I could have my uterus removed along with the cancer,” Ms. Stein remarks. “It’s not like cancer of the bladder or liver or lungs. Your uterus can be removed without major consequences, so if you’re diagnosed with endometrial cancer, a hysterectomy is probably the way to go.”

Two years after her surgery, Ms. Stein is “doing great,” says Dr. Diaz. “I follow up with her every three to four months and as of her last evaluation, she continues to be free of disease. The important thing to note here is that she noticed something was wrong, she went to her gynecologist and she was able to catch this at an early stage.”

Knowing your body and trusting your team

Dr. Diaz says that any bleeding in post-menopausal women – even what they call spotting or pequenas manchas – needs to be reported and evaluated by a physician. “It may be the first sign of endometrial cancer.

Ms. Stein says it feels great to be disease-free and Miami Cancer Institute has become a special place of healing for her. It’s a unique and wonderful space, she says, adding that she always stays longer when she goes back for her follow-up appointments. “It’s a place that’s very familiar to me and has such a special ambiance. I love to look at the art and listen to live music there.”

Having gone through endometrial cancer herself, Ms. Stein offers some advice for all women. "If you have any unusual symptoms, don’t wait to see a doctor,” she urges. “Know your body and trust your medical team. Follow directions and be disciplined. Have faith and maintain a positive outlook.”