Endometrial Carcinoma Clinical Presentation

Updated: Aug 22, 2023
  • Author: William T Creasman, MD; Chief Editor: Leslie M Randall, MD, MAS, FACS  more...
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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.