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For decades, cervical and breast cancer have dominated conversations around women's health. Yet another gynaecological cancer is steadily gaining ground: endometrial cancer. India is witnessing a gradual rise in endometrial cancer cases, driven by changing lifestyles, increasing obesity, metabolic disorders and shifting reproductive patterns. The incidence of endometrial cancer is on the rise in India, with about 17,240 new cases reported in 2022.
As an oncologist, I am concerned that while women are aware of the symptoms of other cancers such as breast and cervical cancer, very few understand the risks of endometrial cancer or recognise when seemingly routine changes call for immediate medical attention.
Why are we seeing more cases of endometrial cancer?
Endometrial cancer, which develops in the inner lining of the uterus, is among the most common gynaecological cancers worldwide. While age remains an important risk factor, prolonged exposure to estrogen, without adequate hormonal balance (specifically when estrogen is left unopposed by progesterone), makes women more susceptible to the condition. Over time, this continuous stimulation can cause the cells lining the uterus to grow abnormally, increasing the risk of endometrial cancer.
This helps explain why obesity has emerged as one of the strongest risk factors for endometrial cancer. Fat tissue is not merely a storage site for excess weight; it actively converts other hormones into estrogen, creating a state of prolonged hormonal exposure. As obesity rates continue to rise across India, so does the number of women who may unknowingly be at increased risk.
Women who begin menstruating early or reach menopause later experience more years of estrogen exposure during their lifetime. Conditions such as polycystic ovary syndrome (PCOS), infertility and certain metabolic disorders can also disrupt hormonal regulation and increase risk.
The symptom that should never be ignored
Risk factors apart, one of the most important realities about endometrial cancer is that it often provides an early warning sign: abnormal post-menopausal vaginal bleeding.
For postmenopausal women, even a small amount of spotting, staining, or brown discharge should prompt medical evaluation. For women approaching menopause, warning signs may include heavier-than-usual periods, bleeding between cycles or menstrual changes that persist over time.
Not every episode of post-menopausal abnormal bleeding is cancer. However, every episode deserves attention because it may be the first indication that something requires further investigation.
Why early intervention changes everything
When detected early, endometrial cancer is one of the more treatable cancers, with favourable outcomes. However, as the disease progresses, treatment becomes significantly more complex.
Today, there is genuine progress in how we approach this cancer. With advances in diagnostics, we can better understand the biological characteristics of a tumour and tailor treatment accordingly. In selected cases, newer and more targeted therapies are being explored, offering additional options beyond traditional approaches.
But these advances are most effective when patients reach the right specialist early. The timing of intervention continues to shape not just survival, but also the intensity of treatment and quality of life. This becomes particularly important during perimenopause and menopause, a phase when symptoms can be easily overlooked, and yet the underlying risk is higher.
The takeaway
Endometrial cancer rarely begins without warning. In most cases, it starts with a signal, which is visible, identifiable, and actionable. If a woman is post-menopausal and notices any bleeding, she must seek medical advice promptly. Women in their late 40s or early 50s who notice their menstrual patterns changing significantly must not ignore it. And if symptoms persist, women must ensure that further evaluation is carried out. Recognising symptoms is important. But ensuring timely referral and specialist care is what truly changes outcomes.
(Dr. Nitesh Rohatgi, Senior Director, Medical Oncology, Fortis Gurgaon)
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