History

Postmenopausal period

Because approximately 75% of women with endometrial cancer are postmenopausal, the most common symptom is postmenopausal bleeding.

Investigate all bleeding during menopause unless the patient is on cyclic replacement therapy with normally anticipated withdrawal bleeding. The duration or amount (staining vs gross) of bleeding does not make any difference.

The fact that only approximately 20% of postmenopausal bleeding is due to cancer is appreciated, but obviously, the diagnosis must be eliminated in these patients.

Perimenopausal/premenopausal period

Because 25% of endometrial cancers are in patients who are perimenopausal or premenopausal, symptoms suggestive of cancer may be more subtle. The idea that any type of bleeding during the perimenopausal period is probably due to menopause is a common misconception. This irregular bleeding is often ignored by the patient and even health care providers. Remember that the normal bleeding pattern during this time should become lighter and lighter and further and further apart. Heavy frequent menstrual periods or intermenstrual bleeding must be evaluated.

Physical Examination

Because bleeding usually occurs from the endometrium, pelvic examination findings may be entirely normal, with no gross evidence of disease on the cervix and with a normal-sized uterus. Note the following:

Bleeding leads to an evaluation of the endometrium. In the vast majority of cases, no gross evidence of disease is noted.
The uterus may be of normal size upon pelvic examination.
Cancer can be present upon cervical evaluation and, less frequently, in the upper vagina or periurethrally. In current practice, occult cervical involvement is very unusual, as is clinically evident metastasis, such as in the vagina.

Differential Diagnoses

de Haydu C, Black JD, Schwab CL, English DP, Santin AD. An update on the current pharmacotherapy for endometrial cancer. Expert Opin Pharmacother. 2015 Dec 2. [QxMD MEDLINE Link].
National Cancer Institute. SEER stat fact sheets: endometrial cancer. Surveillance, Epidemiology, and End Results (SEER) Program. Available at http://seer.cancer.gov/statfacts/html/corp.html. Accessed: June 13, 2018.
Bernstein L, Deapen D, Cerhan JR, et al. Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Cancer Inst. 1999 Oct 6. 91(19):1654-62. [QxMD MEDLINE Link].
Creasman WT. Endometrial cancer: incidence, prognostic factors, diagnosis, and treatment. Semin Oncol. 1997 Feb. 24(1 Suppl 1):S1-140-S1-50. [QxMD MEDLINE Link].
Bjorge T, Stocks T, Lukanova A, et al. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol. 2010 Apr 15. 171(8):892-902. [QxMD MEDLINE Link].
Kernochan LE, Garcia RL. Carcinosarcomas (malignant mixed Müllerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. J Natl Compr Canc Netw. 2009 May. 7(5):550-6; quiz 557. [QxMD MEDLINE Link].
Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute. Available at https://seer.cancer.gov/faststats. Accessed: June 29, 2018.
Saunders R. Biomarker predicts recurrence of endometrial cancer. Medscape Medical News from WebMD. July 11, 2013. Available at http://www.medscape.com/viewarticle/807678. Accessed: July 23, 2013.
Zeimet AG, Reimer D, Huszar M, et al. L1CAM in early-stage type I endometrial cancer: results of a large multicenter evaluation. J Natl Cancer Inst. 2013 Aug 7. 105(15):1142-50. [QxMD MEDLINE Link].
Kilgore LC, Partridge EE, Alvarez RD. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995 Jan. 56(1):29-33. [QxMD MEDLINE Link].
Chan JK, Cheung MK, Huh WK, et al. Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer. Oct 15 2006. 107(8):1823-30. [QxMD MEDLINE Link].
Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009 May. 105(2):103-4. [QxMD MEDLINE Link].
Papadia A, Bellati F, Ditto A, et al. Surgical treatment of recurrent endometrial cancer: time for a paradigm shift. Ann Surg Oncol. 2015 Dec. 22 (13):4204-10. [QxMD MEDLINE Link].
Bendifallah S, Canlorbe G, Laas E, et al. A predictive model using histopathologic characteristics of early-stage type 1 endometrial cancer to identify patients at high risk for lymph node metastasis. Ann Surg Oncol. 2015 Dec. 22 (13):4224-32. [QxMD MEDLINE Link].
Fotopoulou C, El-Balat A, du Bois A, et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer. Arch Gynecol Obstet. 2015 Dec. 292 (6):1321-7. [QxMD MEDLINE Link].
Seagle BL, Kocherginsky M, Shahabi S. Association of Pelvic and Para-Aortic Lymphadenectomy With Survival in Stage I Endometrioid Endometrial Cancer: Matched Cohort Analyses From the National Cancer Database. JCO Clinical Cancer Informatics. 2017. 1:1-14.
Seagle BL, Gilchrist-Scott D, Graves S, et al. Association of Lymph Node Count and Overall Survival in Node-Negative Endometrial Cancers. JCO Clinical Cancer Informatics. 2017. 1:1-15.
Sharma C, Deutsch I, Lewin SN, et al. Lymphadenectomy influences the utilization of adjuvant radiation treatment for endometrial cancer. Am J Obstet Gynecol. 2011 Dec. 205(6):562.e1-9. [QxMD MEDLINE Link].
Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD006655. [QxMD MEDLINE Link].
[Guideline] National Comprehensive Care Network. Uterine Neoplasms. Version 4.2019. NCCN. Available at http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed: September 16, 2019.
M. Alexander Otto, PA, MMS. FDA OKs Dostarlimab Plus Chemo for Endometrial Cancer. Medscape Medical News. Available at https://www.medscape.com/viewarticle/995014. July 31, 2023; Accessed: August 4, 2023.
[Guideline] National Cancer Institute. Endometrial Cancer Screening–for health professionals (PDQ®). National Cancer Institute. Available at http://www.cancer.gov/cancertopics/pdq/screening/endometrial/HealthProfessional/page1. March 4, 2016; Accessed: September 5, 2016.
[Guideline] Smith RA, Andrews K, Brooks D, DeSantis CE, Fedewa SA, Lortet-Tieulent J, et al. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2016 Mar-Apr. 66 (2):96-114. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Barretina-Ginesta MP, Quindós M, Alarcón JD, Esteban C, et al. SEOM-GEICO clinical guidelines on endometrial cancer (2021). Clin Transl Oncol. 2022 Mar 21. [QxMD MEDLINE Link]. [Full Text].
[Guideline] National Comprehensive Cancer Network. Genetic/Familial High-Risk Assessment: Colorectal, V1.2016. NCCN. Available at https://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. June 23, 2016; Accessed: September 5, 2016.
[Guideline] Committee on Practice Bulletins-Gynecology, Society of Gynecologic Oncology. ACOG Practice Bulletin No. 147: Lynch syndrome. Obstet Gynecol. 2014 Nov. 124 (5):1042-54. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016 Jan. 27 (1):16-41. [QxMD MEDLINE Link]. [Full Text].
[Guideline] SGO Clinical Practice Endometrial Cancer Working Group, Burke WM, Orr J, Leitao M, Salom E, Gehrig P, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014 Aug. 134 (2):385-92. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Oaknin A, Bosse TJ, Creutzberg CL, et al. Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Sep. 33 (9):860-77. [QxMD MEDLINE Link]. [Full Text].
Corpus Uteri. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 7th Ed. New York: Springer-Verlag; 2010. 403-18.
[Guideline] Practice Bulletin No. 149: Endometrial cancer. Practice Bulletin No. 149: Endometrial cancer. Obstet Gynecol. 2015 Apr. 125 (4):1006-26. [QxMD MEDLINE Link].
[Guideline] SGO Clinical Practice Endometrial Cancer Working Group, Burke WM, Orr J, Leitao M, Salom E, Gehrig P, et al. Endometrial cancer: a review and current management strategies: part II. Gynecol Oncol. 2014 Aug. 134 (2):393-402. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, Erickson B, et al. The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014 May-Jun. 4 (3):137-44. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011 Jun. 204 (6):466-78. [QxMD MEDLINE Link]. [Full Text].
Creasman WT, Kohler MF, Odicino F, Maisonneuve P, Boyle P. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol. 2004 Dec. 95(3):593-6. [QxMD MEDLINE Link].
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987 Oct 15. 60(8 Suppl):2035-41. [QxMD MEDLINE Link].

Media Gallery

Diagnostic hysteroscopy for endometrial cancer. Video courtesy of Tarek Bardawil, MD.

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Table. Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

Table. Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

Primary tumor (T)
TNM	FIGO stages	Surgical-pathologic findings
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
T1	I	Tumor confined to uterus
T1a	IA	Tumor ≤5 cm
T1b	IB	Tumor >5 cm
T2a	IIA	Tumor extends to the pelvis, adnexal involvement
T2b	IIB	Tumor extends to extra-uterine pelvic tissue
T3a	IIIA	Tumor invades abdominal tissues, one site
T3b	IIIB	Tumor invades more than one site
T4	IVA	Tumor invades bladder and/or rectum
Regional lymph nodes (N)
TNM	FIGO stages	Surgical-pathologic findings
NX		Regional lymph nodes cannot be assessed
N0		No regional lymph node metastasis
N1	IIIC	Metastasis to pelvic and/or para-aortic lymph nodes
Distant metastasis (M)
TNM	FIGO stages	Surgical-pathologic findings
M0		No distant metastasis
M1	IVB	Distant metastasis

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Author

William T Creasman, MD J Marion Sims Distinguished University Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina College of Medicine

William T Creasman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, North Carolina Medical Society, Society of Gynecologic Oncology, South Carolina Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Laurel K Berry, MD Clinical Instructor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jori S Carter, MD, MS Gynecologic Oncologist, Women's Cancer and Wellness Institute

Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Society of Clinical Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, Society of Gynecologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Leslie M Randall, MD, MAS, FACS Professor and Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Diane Harris Wright Professor of Gynecologic Oncology Research, Massey Cancer Center, Virginia Commonwealth University School of Medicine

Leslie M Randall, MD, MAS, FACS is a member of the following medical societies: Academy for Innovation in Medical Education, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, International Gynecologic Cancer Society, Society of Gynecologic Oncology

Disclosure: Nothing to disclose.

Additional Contributors

John J Kavanagh, Jr, MD Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas Medical School at Houston

John J Kavanagh, Jr, MD is a member of the following medical societies: American Association for the Advancement of Science, Society of Gynecologic Oncology, American Association for Cancer Research, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Medscape Drugs & Diseases thanks Tarek Bardawil, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, for assistance with the video contribution to this article.