Understanding Endometriosis & Cancer Risk
- Stand-up comedian Amy Schumer, 42, had both a hysterectomy and an appendectomy to treat endometriosis. She hopes to spread awareness for endometriosis, something 10 percent of women have, which she describes as “really painful and debilitating.”
- Endometriosis occurs when tissue similar to the tissue that normally lines the inside of the uterus, known as the endometrium, grows on the outside of the uterus. It often brings debilitating pain and can often be difficult to diagnose.
- Endometrial cancer begins when cancerous cells form in the tissues of the endometrium or lining of the uterus. Symptoms typically associated with this type of cancer include vaginal bleeding and pelvic pain – like endometriosis.
- Although endometriosis and endometrial cancer cause similar symptoms, research published in E Cancer Medical Science in a 2018 study noted that the “overall risk of endometriosis-associated cancer remains low.”
- Advocating for your own health can lead to better patient outcomes. Sometimes, this includes going back to your doctor multiple times or seeking a second and third opinion from different doctors.
The New York-native and “I Feel Pretty” star previously opened up to her fans on social media to spread awareness for endometriosis, something 10 percent of women have, which she describes as “really painful and debilitating.”
Read MoreBack in 2021, Schumer took to Instagram to announce she had the surgeries done, saying in a video clip of herself in the hospital, “I’m feeling really hopeful and I am really glad that I did it, and I think it’s going to change my life.”View this post on Instagram
Schumer, who was 40 at the time and filmed by her loving husband Chris Fischer on the morning after her surgery, revealed that her doctor had discovered “30 spots of endometriosis that he removed.”
The mom of one explained, “It’s the morning after my surgery for endometriosis and my uterus is out. The doctor found 30 spots of endometriosis he removed.
“He removed my appendix because the endometriosis had attacked it. There was a lot of blood in my uterus and I’m, you know, sore and I have some, like, gas pains. But, other than that, I already feel that my energy is [returning].”
In a followup clip shared to Instagram, she aded, “I’m gonna try to share this story at some point to raise awareness because so many people don’t even know the word endometriosis.
“It’s like 1 in 10 women has it. It’s really painful and debilitating, and you don’t have to live with it. When I get a helpful female tidbit I like to pass it on to my sisters. I have a catheter in, so I’ll be seeing you later.”
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View this post on Instagram
She captioned one of the video posts of herself speaking from her hospital bed, “Women are made to feel like they are just supposed to ‘tough it out’ but that is bullshit.
“We have a right to live pain free. Have you ever heard of endo?”
Schumer also shared a photo of herself standing with a hospital gown on with the caption, “If you have really painful periods you may have #endometriosis.”
According to the Independent, Schumer opened up about her endometriosis diagnosis back in August 2020 on the “What to Expect” podcast, about 15 months after her son Gene was born.
Schumer, who underwent IVF and also admitted that her and her husband were considering “the surrogacy route,” said she had experienced “really bad endometriosis and adenomyosis.”
View this post on Instagram
Is Endometriosis Linked to Endometrial Cancer?
Research published in E Cancer Medical Science in 2018 studied the two conditions for a cancer link and found no evidence of a significant link.
Endometriosis is often found on the “ovarian, fallopian tubes, tissues that hold the uterus in place and the outer surface of the uterus.”
According to the National Cancer Institute, endometrial cancer (also called uterine cancer) begins when cancerous cells form in the tissues of the endometrium or lining of the uterus. Symptoms typically associated with this type of cancer include vaginal bleeding and pelvic pain.
After a woman has been diagnosed with endometrial cancer, her doctor will stage the cancer based on its spread within the body. A pelvic exam and imaging tests help your doctor learn if the cancer has spread or metastasized.
Researchers involved in the 2018 study noted that the “overall risk of endometriosis-associated cancer remains low.” They add, “In a large epidemiological study, the overall frequency of ovarian cancer arising in a patient with a diagnosis of endometriosis was 0.3 to 0.8%.”
For doctors to confirm symptoms are indeed benign endometriosis growths and nothing malignant, they must perform surgery.
Dr. Lindsey Ford, a Gynecologic oncologist at Thomas Jefferson Health University Hospital, adds further context between the two conditions.
“While endometrial cancer can sometimes present with this kind of pain, the most common warning signs for those who are pre-menopausal are spotting between periods; heavy periods; or any other changes to the menstrual cycle…For those who are post-menopausal, any vaginal bleeding is a ‘red flag,'” Dr. Ford explained to Jefferson Health.
Endometrial Cancer Risk Factors and Treatment
Some common risk factors for endometrial cancer include:
- Obesity
- Taking estrogen-only hormone replacement therapy after menopause
- Having never given birth or started menstruation at an early age
- Having a family history of endometrial cancer
WATCH: Advanced or Recurrent Endometrial Cancer Treatment Option.
Treatment for endometrial cancer includes surgery, radiation, chemotherapy, hormone therapy, and targeted therapy. Surgery is the most common treatment method.
During radiation therapy, high-energy beams such as X-rays are aimed at cancer cells to kill them. Chemotherapy kills cancer cells by using drugs designed to stop the cancer cells from growing. Chemo drugs are usually taken orally or intravenously.
RELATED: Are Diet and Lifestyle Factors Responsible for Increasing Cancer Rates in People Under 50?
Treating endometrial cancer with hormone therapy involves removing hormones or blocking their ability to help cancer cells grow. Targeted therapy treatment uses drugs designed to target specific cancer cells.
Each of these treatment methods can come with side effects. Depending on the treatment type, the impact on the body may differ. If you are moving toward treating endometrial cancer, talking with your doctor about potential side effects and how to minimize their impact is important.
Symptoms of Endometriosis
According to the WHO, “Endometriosis often causes severe pain in the pelvis, especially during menstrual periods. Some people also have pain during sex or when using the bathroom. Some people have trouble getting pregnant.
“Some people with endometriosis don’t have any symptoms. For those who do, a common symptom is pain in the lower part of the belly (pelvis). Pain may be most noticeable during a period, during or after sex, when urinating or defecating.”
Some may also experience:
- chronic pelvic pain
- heavy bleeding during periods or between periods
- trouble getting pregnant
- bloating or, nausea
- fatigue
- depression or anxiety.
Recovering From a Hysterectomy
A hysterectomy is the surgical removal of part or all of the uterus, and can include the cervix. “The uterus is a hollow muscular organ that nourishes the developing baby during pregnancy,” Medline Plus explains.
Schumer did not say what specific type of hysterectomy she had, but the various types of hysterectomies include:
- Total hysterectomy: Removal of the uterus and cervix, but keeping the ovaries.
- Supracervical hysterectomy: Removal of just the upper part of the uterus, but keeping the cervix.
- Total hysterectomy with bilateral salpingo-oophorectomy: Removing the uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy).
- Radical hysterectomy with bilateral salpingo-oophorectomy: Removing the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and some surrounding tissue and lymph nodes. This hysterectomy is done when cancer is involved.
As for why a woman may need a hysterectomy, reasons, as per MedlinePlus could be:
- A condition that causes heavy, painful periods called Adenomyosis
- Endometrial cancer
- Cancer of the cervix or changes in the cervix called cervical dysplasia that could lead to cancer
- Ovarian cancer
- Long-term (chronic) pelvic pain
- Severe endometriosis
- Long-term vaginal bleeding that’s unable to be controlled
- Uterine prolapse
- Uterine tumors/fibroids
- Uncontrolled bleeding during childbirth
If you’ve never had surgery before, and are set to undergo a hysterectomy, you may be nervous about what to expect after the operation is over. How much pain will you be in? When can you get up and walk? When will you start to feel better? When will your recovery be complete?
So, you may be surprised to learn that recovery from this surgery can happen much more quickly than you think. It generally takes between six and eight weeks to fully recover from a hysterectomy. But not all of that time will be spent in the hospital.
“With modern medicine, with programs that we call ERAS, which are enhanced recovery programs, a lot of our patients even when they’ve had radical operations are home and out of the hospital within five to seven days,” Dr. Elizabeth Jewell, a gynecologic surgeon at Memorial Sloan-Kettering Cancer Center, previously told SurvivorNet.
“During that time (the first week in the hospital), we try to get patients up and moving very quickly,” Dr. Kimberly Levinson, director of Johns Hopkins Gynecologic Oncology at Greater Baltimore Medical Center, told us.
“We know that getting patients out of bed, getting them moving, helps them recover more quickly. And depending on how extensive the surgery was, that may be as early as the day after surgery,” she added.
Recovery From Ovarian Cancer Surgery: A General Timeline
The rest of the timeline, according to Dr. Levinson:
- By weeks three and four, most patients are beginning to feel better.
- By the fifth and sixth weeks, there may still be some fatigue. And at this point, doctors are thinking about how well the patients are rebounding.
- After six to eight weeks, recovery is usually complete.
What is an Appendectomy?
Schumer also had an appendectomy, which is surgery to remove the appendix, to treat her endometriosis.
According to MedlinePlus, “The appendix is a small, finger-shaped organ that branches off from the first part of the large intestine. When it becomes swollen (inflamed) or infected, the condition is called appendicitis.
“When you have appendicitis, your appendix may need to be removed. An appendix that has a hole in it can leak and infect the entire abdomen area. This can be life threatening.”
According to a study published in the National Library of Medicine, “Endometriosis is a well known cause of infertility. Endometriosis of the appendix is a very rare condition. To highlight this rare entity, we are reporting a case of a young lady who was admitted with recurrent attacks of lower abdominal pain associated with primary infertility.
“Preoperative diagnosis was acute appendicitis. Histopathological examination of the appendix revealed endometriosis. Endometriosis should be considered in the differential diagnosis of recurrent lower abdominal pain in young females especially with history of infertility.”
It adds, “Endometriosis of the appendix is rare. The prevalence of appendiceal endometriosis in patients with endometriosis is 2.8%.
“Involvement of the appendix may present as appendicitis, mucocele of appendix, or appendicular mass that may mimic a neoplasm. Perforation of the appendix may occur especially during the first two trimesters of pregnancy.”
The Importance of Advocating for Yourself
Standing up for yourself is important. If you feel that you’re being dismissed or mistreated by a doctor. Getting a second opinion is crucial if something doesn’t feel right. Experts tell SurvivorNet that no one knows your body better than you, so if you feel like something is wrong, keep pushing for answers.
Dr. Zuri Murrell, a colorectal surgeon at Cedars-Sinai Medical Center, previously told SurvivorNet that sometimes, patients need to be pushy.
Be Pushy, Be Your Own Advocate… Don’t Settle
“From a doctor’s perspective, every problem should have a diagnosis, a treatment, a plan for follow-up, and a plan for what happens next if the treatment doesn’t work,” Dr. Murrell said.
And as a patient, “if you don’t feel like each of these four things has been accomplished, just ask! Even if it requires multiple visits or seeing additional providers for a second opinion, always be your own advocate.”
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
