What are the key symptoms and risk factors for endometrial cancer that I should be aware of in my patients?

Key symptoms of endometrial cancer primarily include abnormal uterine bleeding, especially postmenopausal bleeding, which is the most common presenting symptom in affected patients. Premenopausal women may present with heavy or irregular menstrual bleeding or intermenstrual bleeding. Other symptoms can include pelvic pain or a palpable pelvic mass, but these are less common and usually indicate more advanced disease NICE NG12,NICE CKS SGO Clinical Practice Endometrial Cancer Working Group et al. 2014Morice et al. 2016.

Major risk factors for endometrial cancer include prolonged exposure to unopposed oestrogen, which can occur in obesity, polycystic ovary syndrome (PCOS), oestrogen-only hormone replacement therapy, and tamoxifen use. Additional risk factors are increasing age (most cases occur in postmenopausal women), nulliparity, early menarche, late menopause, diabetes mellitus, hypertension, and Lynch syndrome (hereditary nonpolyposis colorectal cancer) NICE CKS,NICE NG12,NICE CKS. Obesity is particularly significant as adipose tissue increases peripheral conversion of androgens to oestrogens, thus increasing endometrial proliferation NICE CKS[SGO Clinical Practice Endometrial Cancer Working Group et al. 2014].

In summary, vigilance for abnormal uterine bleeding, especially postmenopausal bleeding, combined with awareness of these risk factors, should prompt timely investigation and referral according to NICE NG12 guidelines for suspected cancer NICE NG12,NICE CKS.