Endometrial cancer
Summary
Definition
História e exame físico
Principais fatores diagnósticos
- postmenopausal vaginal bleeding (PVB)
Outros fatores diagnósticos
- uterine mass, fixed uterus, or adnexal mass indicating extrauterine disease
- abnormal menstruation or vaginal bleeding in a premenopausal woman
- pain (abdominal or pelvic) and weight loss
- symptoms of metastatic disease
- signs of metastatic disease
Fatores de risco
- overweight and obesity
- age >50 years
- endometrial hyperplasia
- unopposed endogenous estrogen
- unopposed exogenous estrogen
- tamoxifen use (postmenopausal women)
- insulin resistance
- family history of endometrial or colorectal cancer
- family history of breast cancer or ovarian cancer
- family history of Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- family history of PTEN syndromes
- polycystic ovary syndrome
- radiation therapy
- inactivity
- diet
- nulliparity and infertility
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- pelvic (transvaginal) ultrasound
- office-based endometrial biopsy (with or without office-based hysteroscopy) and histopathology
- hysteroscopy, dilation and curettage (D&C), and histopathology
- cervical cytology (liquid-based cytology or Pap smear)
- CBC
Investigações a serem consideradas
- tumor molecular analysis
- genetic evaluation
- serum CA-125 level
- saline infusion sonohysterogram
- BUN 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
Algoritmo de tratamento
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 nonendometrioid carcinomas (high risk)
recurrent or incurable disease
Colaboradores
Autores
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
Declarações
ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Corcept, Merck, Eisai, Daiichi Sankyo, and Eli Lilly.
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Declarações
RTP declares personal fees for advisory boards from Aadi Bioscience, AstraZeneca, GSK Inc., ImmunoGen Inc., Merck & Co., Roche Pharma, Sutro Biopharma, and Tubulis GmbH. RTP serves on data and safety monitoring boards for AstraZeneca, EQRx, and Roche Pharma. RTP has received institutional research funding as Principal Investigator for 858 Therapeutics. RTP has received royalties from BMJ Publishing, UptoDate, Elsevier Ltd., Wolters Kluwer Health, and Wiley Blackwell. RTP has received payment for educational events: Research to Practice, ExpertConnect, ReachMD, and CMEO Outfitters.
Agradecimentos
Dr Alexander B. Olawaiye and Dr Richard T. Penson would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who has sadly died, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
Declarações
NSH and AHR declare that they have no competing interests.
Revisores
Susan A. Davidson, MD
Associate Professor/Chief
Gynecologic Oncology
S/M Obstetrics & Gynecology (UCD)
University of Colorado Health Sciences Center
Aurora
CO
Declarações
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
Declarações
SM declares that she has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: uterine neoplasms [internet publication].Texto completo
Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021 Jan;31(1):12-39.Texto completo Resumo
Oaknin A, Bosse TJ, Creutzberg CL, et al. Endometrial cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Sep;33(9):860-77.Texto completo Resumo
Amant F, Mirza MR, Koskas M, et al. Cancer of the corpus uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:37-50.Texto completo Resumo
American College of Obstetricians and Gynecologists; Society of Gynecologic Oncology. Practice bulletin no. 149: endometrial cancer. Apr 2015 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Endometrial hyperplasia
- Endometrial polyp
- Endometriosis
Mais Diagnósticos diferenciaisDiretrizes
- Pain management for in-office uterine and cervical procedures
- Fertility preservation in people with cancer: ASCO guideline update
Mais DiretrizesFolhetos informativos para os pacientes
Hysterectomy
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