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, and should prompt immediate medical evaluation, particularly in postmenopausal women. 1

Key Symptoms

Primary Warning Signs

• Abnormal vaginal bleeding:
  • Postmenopausal bleeding (most significant warning sign) 1, 2
  • Bleeding between periods in premenopausal women 1
  • Unexpected bleeding after sexual intercourse 2
  • Persistent or recurrent undiagnosed bleeding 1

Additional Symptoms

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

Risk Factors That Increase Symptom Significance

Women with the following risk factors should be particularly vigilant about abnormal bleeding symptoms:

• Obesity 1, 2
• Diabetes mellitus 1
• Hypertension 1
• History of unopposed estrogen exposure 1
• Tamoxifen therapy 1
• Lynch syndrome 1
• Nulliparity or infertility 1
• Late menopause 1

Diagnostic Considerations

When abnormal bleeding occurs, diagnostic evaluation typically includes:

1. Transvaginal ultrasound:

   • First-line imaging modality for evaluating abnormal bleeding 1
   • Endometrial thickness ≤4mm has a negative predictive value for endometrial cancer of nearly 100% in postmenopausal women 1

2. Endometrial biopsy:

   • Office endometrial biopsies have a false-negative rate of approximately 10% 1
   • A negative endometrial biopsy in a symptomatic patient must be followed by a fractional dilation and curettage (D&C) under anesthesia 1

Important Caveats

• Despite the generally high survival rate for endometrial cancer, mortality rates have been increasing more rapidly than incidence rates 1
• Uterine cancer incidence and mortality rates are higher among non-Hispanic Black women compared to other racial/ethnic groups 2
• In premenopausal women, even after exclusion of cancer, the original presenting symptoms often require ongoing management, as about 60% report their symptoms are not "much improved" at 10 months 3
• Symptoms may be subtle in early stages, and any unexplained vaginal bleeding should be evaluated promptly 1

Patient Education

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

• Any bleeding after menopause 1, 2
• Persistent or recurrent undiagnosed bleeding 1
• Abnormal bleeding with risk factors for endometrial cancer 1