Uterine Corpus

Abstract

Most cancers of the endometrial lining of the uterus occur after menopause. Indeed, postmenopausal vaginal bleeding is the most common presenting symptom, and enlargement of the uterus is the most common sign at physical examination in this disease. As Fig. 9.1 shows, the peak age of incidence is the late fifties and early sixties. There is a substantial, though declining, incidence into the eighties, however. During the past 10 years or so the incidence has markedly increased, to the greatest degree in the 50–70-year age part of the curve, creating a strange biomodal distribution. In cancer incidence this usually indicates two separate inciting factors, perhaps in this instance reflecting disease from increased use of estrogens immediately after menopause. Because this cancer is eminently treatable with excellent survival prospects in early stages, it is to the great benefit of the patient to detect it early. The only screening mechanism is periodic pelvic examination. The most efficient diagnostic strategy is careful investigation of any patient with postmenopausal bleeding.