What are the symptoms of uterine cancer?

Uterine Cancer Symptoms

Approximately 90% of patients with uterine cancer present with abnormal vaginal bleeding, most commonly painless postmenopausal bleeding, which is the cardinal symptom that warrants immediate evaluation. 1, 2, 3

Primary Presenting Symptom

• Abnormal vaginal bleeding is the hallmark symptom, occurring in 85-90% of cases, and is characteristically painless in the postmenopausal population 1, 2, 4, 5
• The painless nature of this bleeding often prompts early medical attention, resulting in approximately 75-83% of patients being diagnosed at stage I when disease is still localized and curable 1, 2
• Any postmenopausal bleeding, regardless of amount or associated pain, requires immediate evaluation with transvaginal ultrasound and endometrial biopsy 2, 3, 6

Additional Common Symptoms

Beyond vaginal bleeding, patients may present with:

• Pelvic or abdominal mass - palpable in 32-45% of cases, particularly in more advanced disease 1, 5
• Abdominal discomfort or pain - reported in 28-38% of patients, including pelvic pressure or lower abdominal pain 1, 5
• Vaginal discharge - occurs in approximately 27% of cases 7
• Abdominal distension or bloating - particularly when ascites is present in advanced disease 1
• Early satiety, decreased appetite, or weight loss - associated with advanced disease or recurrence 1

Symptoms by Disease Stage

Early-stage disease (Stage I-II):

• Irregular menses in premenopausal women 1
• Urinary frequency or constipation from mass effect on bladder or rectum 1
• Dyspareunia from pelvic mass compression 1

Advanced-stage disease (Stage III-IV):

• Ascites causing abdominal distension 1
• Shortness of breath from pleural effusion 1
• Bowel obstruction from intra-abdominal masses 1
• Palpable enlarged lymph nodes (inguinal, supraclavicular, or axillary) 1

Critical Clinical Context

• The early symptom of painless bleeding triggers patients to seek care when disease is at an early, treatable stage, with 5-year survival rates exceeding 90-95% for stage I disease 1, 2
• Even with intensive surveillance protocols, 50-70% of recurrences are detected based on symptoms rather than routine testing 1
• Patients must be counseled to report immediately: vaginal bleeding (including bladder or rectal bleeding), decreased appetite, weight loss, pain in pelvis/abdomen/hip/back, cough, shortness of breath, or swelling in abdomen or legs 1

High-Risk Histologic Variants

Aggressive variants (serous carcinoma, clear cell carcinoma, carcinosarcoma) may present with:

• Pelvic masses 1
• Abnormal cervical cytology 1
• Ascites in addition to postmenopausal bleeding 1
• Higher incidence of extrauterine disease at presentation, even in apparent early-stage disease 1