From the Guidelines
The most common early presenting sign in endometrial cancer is abnormal uterine bleeding, particularly postmenopausal bleeding, with approximately 90% of women reporting this symptom as their initial presentation, as noted in the most recent guidelines 1. This symptom occurs early because endometrial cancer typically begins in the lining of the uterus, causing disruption to the endometrial tissue that results in bleeding. The presence of abnormal bleeding allows for relatively early detection of endometrial cancer compared to many other cancers, contributing to its generally favorable prognosis when caught early. Any woman experiencing unexplained vaginal bleeding, especially after menopause, should seek prompt medical attention for evaluation, which typically includes a pelvic examination, transvaginal ultrasound, and possibly an endometrial biopsy to rule out cancer. Key points to consider in the evaluation and management of endometrial cancer include:
- The importance of prompt evaluation of postmenopausal bleeding, as it is a common presenting symptom of endometrial cancer 1
- The use of endometrial biopsy as a diagnostic tool, with a high sensitivity for detecting endometrial carcinoma 1
- The role of imaging studies, such as transvaginal ultrasound, in the evaluation of endometrial cancer 1
- The importance of involving gynecologic oncologists in the primary management of patients with endometrial cancer, as recommended by the NCCN guidelines 1
From the Research
Early Presenting Signs in Endometrial Cancer
The most common early presenting sign in endometrial cancer is postmenopausal bleeding. This symptom is reported in several studies as the primary indicator of endometrial cancer in women, particularly those in the postmenopausal stage [(2,3,4,5,6)].
Characteristics of Postmenopausal Bleeding
- Postmenopausal bleeding is the most frequent symptom of endometrial cancer, occurring in approximately 91% of women with the disease 5.
- The risk of endometrial cancer in women with postmenopausal bleeding is around 9% 5.
- Postmenopausal bleeding can be caused by benign conditions, but its presence warrants further evaluation to rule out endometrial cancer [(4,5)].
Diagnostic Approaches
- Ultrasound is a useful diagnostic tool in evaluating postmenopausal bleeding, with an endometrial thickness of 4 mm or less indicating a low likelihood of endometrial cancer 4.
- Endometrial biopsy, saline infusion sonography, and hysteroscopy are also used in the diagnosis of endometrial cancer [(2,4)].