Advanced endometrial cancer starts in your endometrium (the innermost part of your uterus) and spreads beyond your uterus to other tissues and organs. When you’re living with this type of cancer, the physical symptoms – such as pain, heavy vaginal bleeding, and digestive issues – can disrupt your daily life and increase emotional stress. On top of that, the diagnosis itself often brings fear, uncertainty, and stress about the future.
“It's really scary to hear that you have an advanced stage or recurrent endometrial cancer,” says Shannon N. Westin, MD, MPH, a gynecologic oncologist at MD Anderson Cancer Center. “You've already gone through treatment and now the disease is worse. What is that going to mean for you and your family? It can cause a huge strain on mental health.”
Caring for your emotional well-being is a vital part of your cancer care. You can be an active participant in that care by knowing what to watch for, how stressors may be affecting you, and where – and how – to ask for help.
Physical Symptoms, Mental and Emotional Impact
Advanced endometrial cancer can come with a wide array of symptoms, depending on where in your body the cancer has spread. Common issues include vaginal bleeding, pelvic pain or pressure, pain when you pee, pain during sex, and anemia. Each has their own impact on your quality of life.
“Bleeding is extremely traumatic on a day-to-day basis,” says Westin. “It affects the clothes you wear and requires you to know how close a bathroom is. You have to work your schedule around it.”
If you have stage IV endometrial cancer, that means there's cancer inside your abdomen and pelvis. In addition to being painful, it can also impact the way your bowels move, affect your ability to eat, and cause nausea and vomiting.
Some of the more difficult symptoms to manage from an emotional standpoint can be the sexual side effects. Radiation, chemotherapy, surgery – all can have an impact on sexual function, desire, and cause pain with intercourse. And for many people, advanced endometrial cancer means having a hysterectomy – surgery to remove your uterus.
“We see across a number of different cultures, races, and ethnicities that (hysterectomies) can impact the feeling of womanhood for some people,” says Westin. “The idea that the uterus is gone can make some people ask, ‘What does this mean for me as a woman?’”
Why Your Mental Health Matters
If you’re having these or any other emotional side effects from your cancer, tell your doctor. It’s not an issue to address in addition to your health — it is your health. And your doctor wants to know. Not only because your whole well-being is their priority, but because when you’re struggling mentally, it can have a negative effect on your medical treatment.
“There's lots of evidence showing that depression, when you combine it with any other medical illness, worsens outcomes for that medical illness,” says Kevin Johns, MD, associate clinical professor of psychiatry and behavioral health at The Ohio State University Comprehensive Cancer Center. “Like I tell all my patients who are surviving cancer, mind and body are very much connected.”
For example, if someone has cancer and they develop depression, says Johns, they can have a harder time finishing treatment, have longer hospital stays, and even have a higher mortality risk and lower quality of life. Bottom line: Overall survival rates go down when anxiety and depression enter the picture. Which is why addressing them should be a vital part of your treatment plan.
“Oftentimes there’s this misunderstanding that people are supposed to be depressed or anxious when they have cancer, but clinical depression is never an appropriate response to an illness,” Johns says. “I actually consider it a dreaded complication of a medical illness.”
Johns says the best approach to mental health care is three-pronged: biological, psychological, and social.
Biologically, your doctor will make sure that there aren’t any underlying conditions contributing to your mental health issues, like sleep apnea or thyroid disease. If you have clinical depression or anxiety disorder, your doctor can prescribe medications to help treat them.
Psychologically, there are mental health professionals who can offer you effective psychotherapies, like cognitive behavioral therapy. You might see a psychologist, licensed social worker, or other licensed counselor.
And your social health is about being connected to the people around you, like family, friends, support groups, or spiritual communities. Your doctor or social worker can point you to local and national groups created exactly for this purpose.
Where to Turn
Start with your doctor. Your medical visits can be busy, but make time to bring up your emotional well-being. Your oncologist is an important starting point — if they can’t address your need medically, they know who to refer you to.
“I'm always open to talking about those things with my patients, but I know I don't always have the bandwidth or the training to support them the way they need,” says Westin. “So I’m very happy to consult and expand the medical team to include mental health professionals to make sure people are getting full support.”
Hospitals and cancer centers usually have survivor-to-survivor programs that can connect you with someone who gets it and can offer a listening ear, advice, or sympathy. Many institutions, like MD Anderson where Westin works, offer cancer support groups. These groups are not only for survivor-to-survivor connection, but also have lectures, educational opportunities, and counselors.
Online resources can offer more specific connections. For example, you can search on social media for groups dedicated to your type and stage of cancer, or search the web for national organizations that meet your needs.
“The Foundation for Women's Cancer is a great organization that has a lot of educational opportunities as well as national and local events,” says Westin. “It's a great opportunity to not only learn about different things in regards to your cancer, but also to meet other people going through the same thing.”
The Endometrial Cancer Action Network for African Americans (ECANA) is an organization dedicated to educating African American and other underrepresented groups who live with endometrial cancer.
“I encourage people to gather as much support as they can around them,” says Westin. “Don’t be afraid to ask for help and share what you can so that people can help you. This is a marathon, not a sprint.”
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Shannon N. Westin, MD, MPH, gynecologic oncologist, MD Anderson Cancer Center.
Kevin Johns, MD, associate clinical professor, psychiatry and behavioral health, The Ohio State University Comprehensive Cancer Center.
Moffitt Cancer Center: “What Are the Most Common Metastatic Uterine Cancer Symptoms?”
International Journal of Radiation Oncology: “Development of Mental Health Disorders in Endometrial Cancer Survivors and the Impact on Overall Survival: A Population-Based Cohort Study.”
