What are the symptoms of uterine cancer?

Symptoms of Uterine Cancer

Abnormal vaginal bleeding is the most common symptom of uterine cancer, occurring in approximately 90% of patients with endometrial carcinoma, particularly in postmenopausal women. 1

Common Presenting Symptoms

Primary Symptoms

• Abnormal vaginal bleeding:

  • Postmenopausal bleeding (most significant warning sign) 1
  • Irregular, heavy, or prolonged menstrual bleeding in premenopausal women 2
  • Bleeding between periods (intermenstrual bleeding) 3
  • Bleeding after sexual intercourse 3
  • Any unexpected vaginal bleeding after menopause 3

• Abnormal vaginal discharge:

  • Excessive or offensive vaginal discharge 4
  • Blood-stained discharge 4

Secondary Symptoms (More common in advanced disease)

• Abdominal distention or bloating 1
• Pelvic pain or pressure 1
• Early satiety (feeling full quickly when eating) 1
• Abdominal discomfort or vague pain 1
• Changes in bowel habits (constipation) 1
• Urinary frequency (if mass compresses bladder) 1
• Dyspareunia (painful intercourse) 1
• Shortness of breath (in stage IV disease with pleural effusion) 1

Symptoms by Disease Stage

Early Stage Disease

• Predominantly abnormal vaginal bleeding 1
• Irregular menses in premenopausal women 1
• Urinary frequency or constipation if mass compresses adjacent organs 1

Advanced Stage Disease

• Symptoms related to ascites and abdominal distension 1
• Abdominal bloating and discomfort 1
• Nausea, anorexia, or early satiety 1
• Shortness of breath (with pleural effusion in stage IV) 1
• Palpable enlarged lymph nodes (inguinal, supraclavicular, axillary) if nodal metastases present 1

Risk Factors and Symptom Significance

The presence of abnormal vaginal bleeding is particularly concerning in women with:

• Obesity 1
• Diabetes mellitus 1
• Hypertension 1
• History of unopposed estrogen exposure 1
• Tamoxifen therapy 1
• Lynch syndrome (60% lifetime risk of endometrial cancer) 1
• Nulliparity or infertility 1
• Late menopause 1

Important Clinical Considerations

• Timing is critical: Early symptoms often prompt patients to seek care when the disease is at an early, treatable stage 1
• Diagnostic pitfall: Office endometrial biopsies have a false-negative rate of approximately 10% 1
• Critical follow-up: A negative endometrial biopsy in a symptomatic patient must be followed by a fractional dilation and curettage (D&C) under anesthesia 1, 5
• Imaging considerations: Transvaginal ultrasound is the first-line imaging modality for evaluating abnormal bleeding, with endometrial thickness ≤4mm having a negative predictive value for endometrial cancer of nearly 100% in postmenopausal women 5
• Warning sign: Despite the generally high survival rate for endometrial cancer, mortality rates have been increasing more rapidly than incidence rates, possibly due to increased rates of advanced-stage cancers and high-risk histologies 1

When to Seek Immediate Medical Attention

Women should be strongly encouraged to report any vaginal bleeding, discharge, or spotting to their doctor immediately, especially:

• Any bleeding after menopause 1
• Persistent or recurrent undiagnosed bleeding 1
• Abnormal bleeding with risk factors for endometrial cancer 1

Early recognition of these symptoms and prompt medical evaluation are essential for early detection and improved outcomes in uterine cancer.