Endometrial cancer
Summary
Definition
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
Risk factors
- overweight and obesity
- inactivity
- smoking
- 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 hereditary non-polyposis colorectal cancer (Lynch syndrome)
- family history of PTEN syndromes
- nulliparity and infertility
- polycystic ovary syndrome
- radiotherapy
- white ethnicity
Diagnostic investigations
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
- FBC
Investigations to consider
- serum CA-125 level
- saline infusion sonohysterogram
- urea and creatinine (renal function testing)
- LFTs
- chest x-ray
- CT scan of chest, abdomen, and pelvis
- MRI of uterus, pelvis, and abdomen
- PET/CT scan
Treatment algorithm
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
Contributors
Authors
Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
Associate Professor
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology, and Reproductive Sciences
Magee-Womens Hospital of UPMC
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
ABO declares that he has no competing interests.
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
RTP declares that he is on the scientific advisory boards of: Genentech, Inc., AstraZeneca, Endocyte, Inc., Eisai Inc., Vascular Biogenics Ltd, Baxalta Oncology, AbbVie, Clovis Oncology, Roche, and Merck. RTP receives research funding from: Genentech, Inc., ImClone Systems, Inc., Endocyte, Inc., AstraZeneca., Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. RTP was an expert witness for Aventis Pharma S.A. Vs. Apotex Inc in 2009. RTP has received royalties from: BMJ, Blackwell Publishing Medicine at a glance, and UpToDate Advance Medical: Second Medical Opinion.
Larissa J. Lee, MD
Assistant Professor
Department of Radiation Oncology
Brigham and Women’s Hospital/Dana-Farber Cancer Institute
Boston
MA
Disclosures
LJL receives institutional funding for investigator-initiated immunotherapy trial from AstraZeneca; Grant funding from the Koch Institute at MIT and DFCI; sponsored travel from AstraZeneca for immunotherapy symposium; and has an international patent filing for quantitative tumour oxygen measurements in cervical cancer.
Acknowledgements
Dr Alexander B. Olawaiye, Dr Richard T. Penson, and Dr Larissa J. Lee would like to gratefully acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
Disclosures
NSH and AHR declare that they have no competing interests.
Peer reviewers
Susan A. Davidson, MD
Associate Professor/Chief
Gynecologic Oncology
S/M Obstetrics & Gynecology (UCD)
University of Colorado Health Sciences Center
Aurora
CO
Disclosures
SAD declares that she has no competing interests.
Svetlana Mironov, MD
Attending Radiologist
Assistant Professor of Radiology
Memorial Sloan-Kettering Cancer Center
New York
NY
Disclosures
SM declares that she has no competing interests.
Differentials
- Endometrial hyperplasia
- Endometrial polyp
- Endometriosis
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- ACR appropriateness criteria: pretreatment evaluation and follow-up of endometrial cancer
More GuidelinesPatient leaflets
Hysterectomy
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