What are the symptoms of endometrial cancer?

Symptoms of Endometrial Cancer

The most common symptom of endometrial cancer is abnormal vaginal bleeding, which occurs in approximately 90% of cases. 1, 2 This is particularly significant when it occurs in postmenopausal women, as any postmenopausal bleeding should be considered a warning sign for endometrial cancer until proven otherwise.

Primary Symptoms

• Abnormal vaginal bleeding:

  • Postmenopausal bleeding (most significant warning sign)
  • Irregular or heavy menstrual bleeding in premenopausal women
  • Persistent or recurrent undiagnosed bleeding

• Abnormal vaginal discharge - present in approximately 55% of endometrial cancer cases 3

Secondary Symptoms (Less Common)

These symptoms typically occur in more advanced disease:

• Pelvic or abdominal pain/pressure
• Abdominal distention or bloating
• Early satiety
• Changes in bowel habits
• Urinary frequency
• Dyspareunia (painful intercourse) 2
• Shortness of breath (in stage IV disease with pleural effusion) 2

Risk Factors That Should Heighten Suspicion

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

• Obesity
• Diabetes mellitus
• Hypertension
• History of unopposed estrogen exposure
• Tamoxifen therapy
• Lynch syndrome (hereditary non-polyposis colorectal carcinoma)
• Nulliparity or infertility
• Late menopause 1, 2

Diagnostic Pathway When Symptoms Occur

When abnormal vaginal bleeding occurs, especially in postmenopausal women, the following diagnostic pathway is recommended:

1. Transvaginal ultrasound - First-line imaging modality

   • Endometrial thickness ≤4mm has a negative predictive value for endometrial cancer of nearly 100% in postmenopausal women 2

2. Endometrial sampling/biopsy - If endometrial thickening is detected

   • Office endometrial biopsies have a false-negative rate of approximately 10% 2
   • A negative endometrial biopsy in a symptomatic patient must be followed by a fractional dilation and curettage (D&C) under anesthesia 2

3. Hysteroscopy - Should be used as the final step in the diagnostic pathway of women with postmenopausal bleeding 1

Important Considerations

• Despite the generally high survival rate for early-stage endometrial cancer (90% 5-year survival for stage I), mortality rates have been increasing, possibly due to increased rates of advanced-stage cancers 2

• There is no evidence supporting endometrial cancer screening in asymptomatic women in the general population 1

• Most cases of endometrial cancer are diagnosed at an early stage because abnormal uterine bleeding prompts medical evaluation 1

• Any woman experiencing abnormal vaginal bleeding, especially after menopause, should seek immediate medical attention as early detection significantly improves outcomes

The presence of abnormal vaginal bleeding combined with abnormal discharge should raise particular concern for malignant disease and prompt immediate gynecological evaluation 3.

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