Endometrial cancer is a common malignancy, usually an adenocarcinoma.
Overweight and obesity 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.
The most important prognostic information relates to stage, histological subtype, tumour grade, patient age, presence of lymphovascular space invasion, and extent of cervical and myometrial invasion.
Adjuvant vaginal brachytherapy or pelvic external beam radiotherapy can reduce local recurrence and improve progression-free survival, but does not improve survival in stages I and II disease.
Chemotherapy and chemoradiotherapy are options for patients with stages III and IV disease. The optimal role of chemotherapy in patients with recurrent disease or non-endometrioid carcinomas (e.g., serous, clear-cell, undifferentiated carcinoma, carcinosarcoma) is unclear and controversial.
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 hereditary non-polyposis colorectal cancer (Lynch syndrome)
- family history of PTEN syndromes
- nulliparity and infertility
- polycystic ovary syndrome
- white ethnicity
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
Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology, and Reproductive Sciences
Magee-Womens Hospital of UPMC
University of Pittsburgh School of Medicine
ABO declares that he has no competing interests.
Richard T. Penson, MD, MRCP
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
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
Department of Radiation Oncology
Brigham and Women’s Hospital/Dana-Farber Cancer Institute
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.
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.
NSH and AHR declare that they have no competing interests.
Susan A. Davidson, MD
S/M Obstetrics & Gynecology (UCD)
University of Colorado Health Sciences Center
SAD declares that she has no competing interests.
Svetlana Mironov, MD
Assistant Professor of Radiology
Memorial Sloan-Kettering Cancer Center
SM declares that she has no competing interests.
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