What are the common symptoms and treatment options for cervical and endometrial/uterine cancer?

Common Symptoms of Cervical and Endometrial/Uterine Cancer

The earliest symptoms of cervical cancer include watery vaginal discharge, postcoital bleeding, and intermittent spotting, while endometrial cancer most commonly presents with postmenopausal bleeding. 1

Cervical Cancer Symptoms

Early Symptoms

• Watery vaginal discharge
• Postcoital bleeding (bleeding after intercourse)
• Intermittent spotting between periods 1
• Often asymptomatic in very early stages 1

Advanced Symptoms

• Persistent vaginal bleeding
• Pelvic pain
• Pain during intercourse
• Unexplained weight loss
• Fatigue
• Leg pain or swelling
• Difficulty urinating or defecating

Endometrial/Uterine Cancer Symptoms

Primary Symptom

• Postmenopausal bleeding (present in most cases) 1, 2
• Abnormal uterine bleeding in premenopausal women

Additional Symptoms

• Pelvic pain or pressure
• Abnormal vaginal discharge
• Difficulty or pain with urination
• Pain during intercourse
• Weight loss
• Abdominal distension (in advanced cases)

Key Differences in Presentation

Cervical Cancer

• More likely to be asymptomatic in early stages
• Postcoital bleeding is highly characteristic
• Symptoms often appear later in disease progression
• May be detected through routine screening (Pap smear) before symptoms develop 1

Endometrial Cancer

• Postmenopausal bleeding is the cardinal symptom (present in ~90% of cases)
• Often presents earlier due to bleeding symptoms
• No effective screening test for asymptomatic women 2
• Risk factors include obesity, diabetes, hypertension, and unopposed estrogen exposure 2

Diagnostic Approach

Cervical Cancer

1. Pap smear and HPV testing
2. Colposcopy with directed biopsies
3. Cone biopsy (conization) if microinvasion suspected 1
4. Imaging studies (CT, MRI, PET/CT) for staging in confirmed cases

Endometrial Cancer

1. Transvaginal ultrasound to measure endometrial thickness
2. Endometrial biopsy or dilation and curettage (D&C)
3. Hysteroscopy for direct visualization
4. MRI for local staging and CT/PET for distant metastasis evaluation 3

Warning Signs Requiring Immediate Evaluation

• Any vaginal bleeding in postmenopausal women
• Persistent vaginal discharge with blood
• Bleeding after intercourse
• Pelvic pain unrelated to menstruation
• Unexplained weight loss with any of the above symptoms

Common Pitfalls in Diagnosis

1. Attributing postmenopausal bleeding to atrophy or hormone therapy without proper evaluation
2. Failing to investigate persistent vaginal discharge in reproductive-age women
3. Mistaking cervical cancer spread to the endometrium for primary endometrial cancer 4
4. Delaying evaluation of abnormal bleeding in premenopausal women due to attribution to benign causes

Remember that early detection significantly improves outcomes in both cancers. Any woman with postmenopausal bleeding or persistent abnormal vaginal discharge/bleeding should undergo prompt evaluation to rule out malignancy.