Part of getting an endometrial cancer diagnosis is finding out which stage of endometrial cancer you have. Stage 4 endometrial cancer means the cancer has spread from the inner lining of the uterus to other parts of the body, often other pelvic organs like your bladder or bowel. The further endometrial cancer progresses, the more likely you are to notice symptoms.

In this article, we’ll go over symptoms of endometrial cancer (also called uterine cancer) at stage 4 and how palliative care can help manage them.

Stages 4A and 4B: What’s the Difference?

Only 10 percent to 30 percent of endometrial cancer cases are diagnosed during stage 4. Early-stage cancers typically have a better outlook and survival rates. There are two subcategories of stage 4 endometrial cancer: stages 4A and 4B. If you have stage 4A endometrial cancer, the cancer has metastasized (spread) into the bladder, bowel, or both.

Stage 4 endometrial cancer may cause pelvic pain or a lump or mass in the pelvic area that you can feel with your hand.

If your endometrial cancer is at stage 4B, it has spread further, beyond the pelvis. It can spread into organs like your lungs or liver. Your doctor might discover cancer cells in lymph nodes far away from your uterus.

What Are the Symptoms of Stage 4 Endometrial Cancer?

The symptoms of stage 4 endometrial cancer depend on how far the cancer has spread and which areas it has spread into.

1. Vaginal Bleeding Outside of Menstrual Periods or Postmenopausal Bleeding

Vaginal bleeding between periods or after menopause is the most common endometrial cancer symptom at any stage. When abnormal vaginal bleeding comes from endometrial cancer, the consistency of the blood is usually watery at first and gets thicker with time. A major change in your menstrual cycle can also be a warning sign of stage 4 endometrial cancer.

Bleeding that’s unrelated to menstruation doesn’t automatically mean you have endometrial cancer. Abnormal uterine bleeding can also be a sign of hormone imbalances, endometriosis, and some sexually transmitted infections (STIs). Always talk to your gynecologist if you experience abnormal bleeding between periods or after menopause.

Members of MyEndometrialCancerTeam have described their experiences with bloody and abnormal vaginal discharge. “I have advanced recurrent endometrial cancer,” reported one. “I have a constant watery, bloody discharge leaking out of me. It recently has developed somewhat of an odor.”

2. Unexplained Weight Loss

Losing weight when you’re not trying to lose weight may be a sign of stage 4 endometrial cancer. No matter how you feel about this weight loss, it’s important to bring it up with your doctor if you don’t have a reasonable explanation like a diet change, lifestyle change, or weight loss medication.

3. Pelvic Pain or Cramping

Do you get cramps in your pelvic area even when your period isn’t coming soon? Pelvic pain, pressure, and cramping can be a sign of stage 4 endometrial cancer. It’s also fairly common to experience pain during sexual intercourse if endometrial cancer has spread through your pelvis.

Along with pelvic pain, you might feel a mass or lump in your pelvis, which may be a source of discomfort. The mass you feel may be an endometrial cancer tumor. Endometrial cancer tumors form when cancerous cells in your uterus grow and multiply rapidly (known as a high mitotic rate) without dying like normal cells.

If endometrial cancer spreads to the bowel, you may notice symptoms like constipation, incontinence, or abdominal pain.

One MyEndometrialCancerTeam member wrote, “The pain in my pelvis has increased over the past month or so — so much that I need to be on pain meds constantly.”

4. Changes in Urination

Painful urination is a common stage 4 endometrial cancer symptom, but the urinary symptoms don’t stop there. As endometrial cancer spreads into the inner lining of your bladder, you might experience:

• Frequent urination (more than 10 times during the day)
• A strong urge to urinate
• Difficulty urinating
• Painful urination

Let your doctor know if it becomes painful or difficult to pee or if you notice more urgency or frequency.

5. Changes in Bowel Habits

Your bowel habits can also change during stage 4 endometrial cancer, which might indicate that the cancer has spread to your intestine. Bowel issues are some of the most common (and sometimes the most troublesome) symptoms of endometrial cancer.

One study found that older women with endometrial cancer were more likely to experience gastrointestinal issues than other women in their same age group. They showed a variety of gastrointestinal symptoms, including:

• Constipation
• Diarrhea
• Fecal incontinence (trouble holding their stool or gas)
• Abdominal pain

Treatments for advanced endometrial cancer, like radiation and some forms of chemotherapy, can cause or worsen bowel symptoms too.

6. Lung Symptoms

Endometrial cancer is one of the most likely cancers to spread to the lungs. If stage 4B endometrial cancer spreads to the lungs, you might experience trouble breathing. Beyond shortness of breath, stage 4 endometrial cancer that has metastasized to the lungs may cause:

• Coughing
• Chest pain
• Coughing up blood

Fatigue is a common symptom of cancer at different stages. If you have stage 4 endometrial cancer, fatigue may worsen if it spreads to the liver.

Other lung problems share similar symptoms, including serious respiratory infections like bronchitis. Whether or not you know you have endometrial cancer, you should bring these symptoms up with your doctor.

7. Fatigue

Fatigue is a common symptom of many cancers, even in their early stages. Extreme tiredness can also be a sign that stage 4 endometrial cancer has spread into your liver. This isn’t the everyday tiredness you feel after a long and stressful workday. Fatigue associated with cancer doesn’t improve with a nap or a good night’s sleep.

Fatigue from liver metastases goes hand in hand with weakness and may come with other liver-related symptoms like jaundice. Jaundice causes your skin and the whites of your eyes to turn yellow. Jaundice is a common sign of liver problems, and it indicates that your liver is having trouble functioning properly. It often appears along with tiredness and feelings of confusion.

Managing Symptoms of Stage 4 Endometrial Cancer

You may already have received surgery or systemic (whole-body) treatment options like immunotherapy, hormone therapy, or chemotherapy to treat your cancer. The main goal of these treatments is to kill, shrink, or remove cancer cells, not to control cancer symptoms. In fact, cancer treatments can cause uncomfortable side effects or worsen symptoms like gastrointestinal issues and fatigue.

That’s where palliative care comes in. The main goal of palliative care is to improve your quality of life at any stage of endometrial cancer, often by reducing or even preventing symptoms. It can also help you cope with side effects of stage 4 endometrial cancer treatment.

Palliative care can be an important part of cancer care at any stage of endometrial cancer.

If you live with serious symptoms of stage 4 endometrial cancer, your oncology team can refer you to a palliative care specialist who will address your physical and psychological needs while you go through treatment.

Talk With Others Who Understand

MyEndometrialCancerTeam is the social support network for people with endometrial cancer and their loved ones. On MyEndometrialCancerTeam, members come together to gain a new understanding of endometrial cancer and connect with others who understand life with endometrial cancer.

Are you living with symptoms of stage 4 endometrial cancer? Share your experience in the comments below or post on your Activities page.

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