What are the key components of taking a specific history for a postmenopausal woman suspected of having endometrial cancer, considering her symptoms, medical history, family history, and demographic information?

Endometrial Cancer-Specific History Taking

When evaluating a patient for suspected endometrial cancer, obtain a detailed history focusing on abnormal bleeding patterns, risk factors for unopposed estrogen exposure, family history of Lynch syndrome-associated cancers, and comorbidities that influence surgical candidacy. 1

Primary Presenting Symptom

• Abnormal uterine bleeding is present in 90% of endometrial cancer cases, particularly postmenopausal bleeding, which mandates immediate evaluation. 1, 2
• Document the precise bleeding pattern: timing, duration, volume, and relationship to menopause. 3
• Ask specifically about vaginal discharge, as this can be an alternative presenting symptom. 4
• Inquire about pain, which may indicate hematometra or pyometra in advanced cases. 4

Risk Factors for Unopposed Estrogen Exposure

Document all sources of endogenous and exogenous estrogen exposure, as these are the primary modifiable risk factors for endometrial cancer. 1

Hormonal and Reproductive History

• Age at menarche and menopause: Early menarche and late menopause increase cumulative estrogen exposure. 3, 5, 6
• Parity status: Nulliparity and infertility significantly increase risk. 1, 3, 6
• History of anovulation or polycystic ovary syndrome (PCOS): These conditions result in chronic unopposed estrogen. 1, 3, 5
• Current or past hormone replacement therapy: Specifically ask about unopposed estrogen therapy (without progestin). 1, 3, 5
• Tamoxifen use: This selective estrogen receptor modulator increases endometrial cancer risk (2.20 per 1000 women-years versus 0.71 for placebo). 2

Metabolic Risk Factors

• Obesity: Document body mass index, as obesity is a critical independent risk factor. 1, 3, 5
• Diabetes mellitus: Associated with increased endometrial cancer risk. 1, 3, 5
• Hypertension: Document presence and control status. 1, 3, 5

Family History Assessment

Systematically screen for Lynch syndrome (hereditary nonpolyposis colorectal cancer), as these patients have a 30-60% lifetime risk of endometrial cancer. 1, 2

Lynch Syndrome Red Flags

• Family history of endometrial cancer, particularly in first-degree relatives diagnosed before age 50. 1
• Family history of colorectal cancer, especially if diagnosed before age 50 or if multiple family members are affected. 1
• Other Lynch spectrum cancers: Ovarian, gastric, small bowel, hepatobiliary, urinary tract, brain, or sebaceous skin tumors. 1
• Document the age at diagnosis and relationship of all affected family members. 1

Comorbidity Assessment

Perform a comprehensive assessment of comorbidities, as endometrial cancer frequently coexists with conditions that may limit surgical options. 1

• Cardiovascular disease: Assess functional status and prior cardiac events. 1
• Pulmonary disease: Document baseline respiratory function. 1
• Obesity-related limitations: Evaluate mobility and anesthetic risk. 1
• Consider geriatric assessment in elderly patients to determine if standard surgical staging is feasible or if a limited procedure is more appropriate. 1

Demographic and Social History

• Age: Endometrial cancer is most common in the sixth and seventh decades of life. 4, 6
• Race/ethnicity: Caucasians have higher incidence than African or Asian women. 5
• Smoking history: Paradoxically, smoking may have a protective effect due to anti-estrogenic properties, though this should never be encouraged. 5

Prior Diagnostic Workup

• Previous endometrial biopsies: Document results, including any history of hyperplasia (simple, complex, with or without atypia). 1
• Prior imaging studies: Review any transvaginal ultrasound findings, particularly endometrial thickness measurements. 1
• Previous gynecologic surgeries: Document any prior procedures that may affect surgical planning. 1

Symptoms Suggesting Advanced Disease

• Pelvic, abdominal, hip, or back pain: May indicate extrauterine spread. 1
• Decreased appetite or unintentional weight loss: Concerning for metastatic disease. 1
• Cough or shortness of breath: May suggest pulmonary metastases. 1
• Abdominal distension or leg swelling: Could indicate peritoneal or nodal involvement. 1
• Bladder or rectal bleeding: Suggests local invasion. 1

Critical Pitfalls to Avoid

• Never dismiss postmenopausal bleeding as benign without tissue diagnosis, even in patients with presumed atrophic vaginitis. 2
• Do not accept a negative office endometrial biopsy as definitive in a symptomatic patient, as the false-negative rate is approximately 10%. 2
• Never delay evaluation in tamoxifen users with bleeding—these patients require immediate endometrial assessment. 2
• Do not overlook Lynch syndrome screening—failure to identify high-risk patients denies them appropriate surveillance and genetic counseling. 1