Endometrial cancer is a common malignancy, usually an adenocarcinoma.
Obesity and being overweight are associated with an increased incidence and poorer outcome.
Patients typically present with post-menopausal vaginal bleeding and often have surgically curable disease.
Diagnosis is confirmed by biopsy, or dilation and curettage; staging and histology is confirmed at surgery.
Determining Lynch syndrome status (microsatellite instability-high [MSI-H]/mismatch repair [MMR] protein expression) in women with a significant relevant family history can enable surgical prevention of a subset of endometrial cancers. Patients with these tumours are candidates for immunotherapy.
Adjuvant vaginal brachytherapy and pelvic external beam radiotherapy can reduce local recurrence and improve progression-free survival, but do not improve survival in stages I and II disease.
Chemotherapy and chemoradiotherapy are options for patients with stages III and IV disease at presentation. Hormonal treatment and chemotherapy offers palliation in patients with recurrent disease and non-endometrioid carcinomas (e.g., serous, clear-cell, undifferentiated carcinoma, carcinosarcoma).
An epithelial malignancy of the uterine corpus mucosa, usually an adenocarcinoma.
History and exam
Key diagnostic factors
- post-menopausal vaginal bleeding (PVB)
Other diagnostic factors
- uterine mass, fixed uterus, or adnexal mass indicating extra-uterine disease
- abnormal menstruation or vaginal bleeding in a pre-menopausal woman
- pain (abdominal or pelvic) and weight loss
- symptoms of metastatic disease
- signs of metastatic disease
- overweight and obesity
- age >50 years
- endometrial hyperplasia
- unopposed endogenous oestrogen
- unopposed exogenous oestrogen
- tamoxifen use (post-menopausal women)
- insulin resistance
- family history of endometrial cancer
- family history of breast cancer or ovarian cancer
- family history of Lynch syndrome (hereditary non-polyposis colorectal cancer)
- family history of PTEN syndromes
- polycystic ovary syndrome
- nulliparity and infertility
1st investigations to order
- pelvic (transvaginal) ultrasound
- outpatient endometrial biopsy (with or without outpatient hysteroscopy) and histopathology
- hysteroscopy, dilation and curettage (D&C), and histopathology
- Pap smear
Investigations to consider
- serum CA-125 level
- saline infusion sonohysterogram
- urea and creatinine (renal function testing)
- chest x-ray
- CT scan of chest, abdomen, and pelvis
- MRI of uterus, pelvis, and abdomen
- PET/CT scan
stage IA endometrioid carcinoma not considering fertility preservation
stage IA endometrioid carcinoma considering fertility preservation
stage IB or II endometrioid carcinoma
stages III to IV endometrioid carcinoma; all non-endometrioid carcinomas (high risk)
recurrent or incurable disease
- Endometrial hyperplasia
- Endometrial polyp
- NCCN clinical practice guidelines in oncology: uterine neoplasms
- Radiation therapy for endometrial cancer
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